Reframing patient expectations as therapeutic targets in musculoskeletal care

A complex interplay of biopsychosocial factors influences the management of individuals with persistent musculoskeletal pain. Among these, patient expectations (PEs) are often underappreciated, yet profoundly impactful.

The purpose of this Professional Practice article is to describe the expectations patients bring to the clinical encounter and argue that PEs are not just prognostic; they are modifiable, therapeutic targets that can be leveraged to shape patient outcomes. PEs extend beyond the narrow confines of treatment and recovery to encompass relational, contextual, lifestyle, spiritual, and cultural dimensions that influence therapeutic outcomes. Reconceptualizing PEs as dynamic, multidimensional, and co-created between clinician and patient, physiotherapists can deliver care that is truly person-centered and contextually grounded.

Clinically, PEs should be systematically assessed, revisited, and actively aligned with prognosis through person-centered communication and shared decision-making. PEs can inform key aspects of care, including goal setting, intervention selection, and patient engagement. Integrating these PEs into assessment and treatment planning may enhance the therapeutic alliance and support improved engagement and long-term outcomes.