Module 3 Patient Expectations and Therapeutic Alliance

What influences outcomes in PT?

Is it the condition itself?
Is it the interventions we choose?
Are there other factors that affect the outcomes of treatment?

What are 5 Categories of Contextual Factors?

Physiotherapist’s Features
Patient’s Features
Patient-Physiotherapist Relationship
Treatment Features
Healthcare Setting Features

What are Physiotherapist Features?

Professionalism
Mindset
Appearance

What are Patient’s Features?

Mindset
Baseline

What are Patient-Physiotherapist Relationship?

Verbal communication
Non-verbal communication

What are Treatment Features?

Therapeutic touch
Modality
Posology
Marketing

What are Healthcare Setting Features?

Positive distractors
Supportive indications
Comfort elements
Decorations and ornaments

What are placebo effects?

Created by (+) healthcare context

What are nocebo effects?

Created by (-) healthcare context

How does placebo work?

Activation of endogenous opioid pathways

How does Nocebo work?

Condition worsens in response to potential bioactively inert intervention

What are some patient expectations?

Anticipation of a future event
Can be powerful modulator of cognitive, emotional, and physical experiences
Are continuously shaped and updated by inputs from the environment

Whats the simplest and most direct way to shape expectations?

Verbal suggestions + empathy

Conditioned expectations are influenced by:

Patient’s personal experience
Information sources
Observed response of others

What are some patient preferences?

Role in patient-provider interaction
Type of treatment
Characteristics of the provider

What is clinical equipose?

Lack of a preference or uncertainty for treatment

What is therapeutic alliance?

The quality of the relationship between patient and clinician

What are key components of therapeutic alliance

Therapist-patient agreement on goals
Therapist-patient agreement on interventions
Affective bond between patient and therapist

What are some considerations for patient-centered care?

Words we use
How words are communicated (voice, tone)
Nonverbal communication skills

What are key interview goals?

Use active and reflective listening skills
Be mindful of verbal and nonverbal behaviors

What are the 4 Habits Model for Patient Interviewing?

Invest in the Beginning
Elicit the Patient’s Perspective
Demonstrate Empathy
Invest in the End

What is the goal of Motivational Interviewing?

Determine and facilitate intrinsic motivation and commitment to change

What are the 3 essential elements for Motivational Interviewing?

Conversation about change
Collaborative partnership
Evocative (calling forth patient’s own motivations as related to values)

What are the 5 Principles of Motivational Interviewing?

Express Empathy
Avoid Argumentation
Roll with Resistance
Develop Discrepancy
Support Self-Efficacy

What is the Transtheoretical Model of Behavior Change (TTM)?

Idea that motivation for change is on a continuum and each stage has barrier and facilitators

Why is language during the patient interview so important?

Provides reassurance, increases confidence and increases psychosocial contributors of pain

The average US resident reads at or below an ___

8th grade level

What are some impacts of low health literacy?

Decreased self efficacy
Decreased treatment participation
Decreased engagement with resources
Decreased health outcomes