Rehabilitation Clients' Recovery Expectations and Their Relationship to Functional Outcomes
Vroman, Kerryellen, Arnsberger, Pamela, Stevens, Tasha, Williams, Nicole, Journal of Allied Health
The purpose of this study was to examine the relationship between specifically defined expectations that clients have of rehabilitation and their actual outcomes as measured by the Short Form-36 Health Survey. This study with pretreatment and posttreatment measures was conducted at a medical service center where clients received comprehensive work rehabilitation. Twenty-four participants completed pretreatment and posttreatment instruments. The results indicated that, with one exception (a baseline expectation of strength and outcome of general health), no relationships were found between clients' expectations and rehabilitation outcomes. The researchers concluded that in this study there is little relationship between clients' expectations of recovery and rehabilitation outcomes and that new ways to conceptualize expectations may be needed. J Allied Health 2005; 34:51-55.
MOST HEALTH CARE PROFESSIONALS agree that clients' expectations of recovery from illness or injury affect their rehabilitation outcomes. Recovery expectations express the client's beliefs about the potential curative effect of therapies, fears of failure, and their own capacity (i.e., self-efficacy) to achieve their recovery goals.1 These cognitive factors are so significant to the rehabilitation process that the revised version of the World Health Organization International Classification of Impairment, Disability and Handicap-II identified personal contextual factors (the experience of the person and their expectations, beliefs, goals, and aspirations) as fundamental to both the rehabilitation process and health status.2'3
In the climate of client-centered practice, a mutual understanding of the goals and expectations of treatment and the requirements of both are necessary for clinician and client in the therapeutic process.4^ Although therapists acknowledge the importance of psychosocial dimensions of rehabilitation and invest time and energy in reaching therapeutic goals that they assume are congruent with clients' expectations, there has not been corresponding investment in researching the relationship between recovery expectations and rehabilitation therapy outcomes.6"8 There is only one comprehensive literature review (1966-1998) pertaining to the predictive relationship between patients' recovery expectations and outcomes.9 The 16 studies selected were original research measuring patient recovery expectations and independently measuring subsequent health outcomes. Notably, none of these studies examined rehabilitation therapy expectations and therapy outcomes, although several used functional measures such as ability to perform general activities, ability to return to work, and ambulation as outcome measures. These studies addressed outcomes for medical, psychosocial, and surgical interventions for abdominal hysterectomy, abortion, alcoholism, benign prostatic hyperplasia, cardiac conditions, hip fracture, chronic pain, back pain, obesity, and certain psychiatric conditions.
Background and Significance
The existing research forms an ambiguous body of evidence of the relationship between expectations and recovery outcomes. Studies with a rehabilitation focus often report a positive relationship between higher expectations of recovery and better outcomes.4,10 The outcome measure, depending on the study, can be a measure of client satisfaction or a measure of therapeutic (symptom or functional) improvement. Greater satisfaction with treatment is associated with perceived better treatment outcomes,""" but satisfaction does not always accompany actual improvement and is therefore a discrete construct.14 The research on patient satisfaction is concerned with whether having one's expectation met by providers influences outcome, patient behaviors, and/or satisfaction.15"17 Such patient expectations of service are actually patients' beliefs about the probability of the occurrence of events during the course of medical intervention, which are distinctly different from patients' expectations of the outcome related to recovery. …