Do patients' expectations influence conservative treatment in Chronic Low Back Pain? A Narrative Review

Introduction: The clinical management of Chronic Low Back Pain (CLBP) substantially varying among general practitioners, specialists and physical therapists belonging to the same country, resulting in a wide spectrum of approaches. Objective: To determine how outcome expectations influence conservative treatment of working-age patients with CLBP. Methods: This is a narrative review of studies investigating or reporting an association between patients' expectation and conservative treatment in patients with CLBP in working-age. Narrative review's guidelines were followed during the design, research, and reporting. Results: The articles were screened by reading the titles and abstracts or full articles. This process resulted in a total of 5 studies that met the selection criteria and were therefore included in the review and considered eligible for quality assessment through the Critical Appraisal Skills Programme (CASP) tool and PEDro (Physiotherapy Evidence Database) scale. What emerges from the studies included in the review essentially concerned three main topics: (a) the expectations of results, highly influenced by patients' previous experiences; (b) the expectation concerning the clinical professional which includes the desire to receive information and education about the disorder and (c) those about environment or context. Conclusions: The results of the studies analyzed show that certain patients' expectations, such as the expectation of tailored training with frequent follow-ups, the hope for the best possible outcomes, realism or resignation regarding pain relief, activity levels, good dialogue and communication, the need to be seen and confirmed as an individual and the desire to receive an explanation for the pain could be related to a better recovery outcomes.