Therapeutic contracting and expectations (Therapeutic contracting)

Patients often come to physiotherapy with expectations about diagnosis, treatment, and recovery timelines. Some may expect quick fixes, while others may feel hopeless about long term conditions. Aligning expectations helps set realistic goals and promote shared decision-making.

Example questions to ask about expectations:

• “Do you know/have you been given an explanation of what treatment is available?”
• “Based on what we’ve discussed about your condition and what’s important to you, what do you think would be the most realistic first step for you?”
• “I want to make sure this plan works for you. What do you feel confident about doing, and where do you think you might need some support?”
• “I know you mentioned that getting to the clinic is difficult. Would it be easier if we set up a home-based exercise program or virtual check-ins?”
• “Just to make sure we’re on the same page, let’s summarise your plan. What are the key things you’re going to focus on?”

Tip: If expectations are unrealistic, we can use this opportunity to guide the patient towards more evidence-based information