title: Outcome expectancies, functional outcomes, and expectancy fulfillment for patients with shoulder problems.
abstract: OBJECTIVE
  This study was conducted to evaluate the relationship among patient outcome expectancies, perceived shoulder function changes, and perceptions of expectancy fulfillment.
  
  
  METHODS
  Patients (n = 199) treated for shoulder problems at one orthopedic surgeon's office completed a baseline survey comprised of measures of outcome expectancies, shoulder function, health status, and demographics. At 1 month, 2 months, and 3 months, patients completed a mailed follow-up survey comprised of all baseline measures except demographic variables. At 3 months, a measure of expectancy fulfillment was added. A general linear modeling approach was used to assess the significance and effect size of 1) outcome expectancies on changes in shoulder function; and (2) outcome expectancies, shoulder function changes, and their interaction on perceptions of expectancy fulfillment.
  
  
  RESULTS
  Outcome expectancies significantly predicted changes in shoulder function and accounted for 10% of the variance in functional improvement. The improvement difference between patients with high expectancies compared with those with low expectancies was clinically relevant (4.57 points), as it was greater than the minimal clinically important difference (3.02 points). Outcome expectancies and shoulder function changes significantly predicted patients' perceptions of fulfilled expectancies, but their interaction was not statistically significant.
  
  
  CONCLUSIONS
  Results highlight the importance of patient expectancy in medical encounters. The findings suggest the need for interventions targeting patient expectancies such as including discussions about expectancy in patient-physician negotiations of therapeutic plans. Results also underscore the need for the development of better measures of outcome expectancies and expectancy fulfillment.
authors.affiliation: Houston Center for Quality of Care and Utilization Studies, Houston VA Medical Center, Baylor College of Medicine, Department of Medicine, Section of Health Services Research, VA Medical Center (152), Houston, Texas 78753, USA. kimberly.omalley@pearson.com
authors.forename: Kimberly J
authors.initials: KJ
authors.lastname: O'Malley
authors.forename: Toni S
authors.initials: TS
authors.lastname: Roddey
authors.forename: Gary M
authors.initials: GM
authors.lastname: Gartsman
authors.forename: Karon F
authors.initials: KF
authors.lastname: Cook
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001134:Arm Injuries / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D017060:Patient Satisfaction / Q000706:statistics & numerical data*; D020127:Recovery of Function; D012782:Shoulder / Q000601:surgery; D000070599:Shoulder Injuries; D013781:Texas