A survey on beliefs and attitudes of trainee surgeons towards placebo

Baldwin, Mathew; Wartolowska, Karolina; Carr, Andrew

doi:10.1186/s12893-016-0142-5

Cited by 17 publications

(37 citation statements)

References 24 publications

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“…Although previous studies have not been conducted in the field of orthopaedic physical therapy, some considerations can be made when comparing our results with a similar survey performed among other healthcare professions[19–39]. Similarly to previous surveys among physicians[25,28,29,32], almost 70.0% of OMTs defined CFs as an intervention without a specific effect, but with a possible non-specific effect. These findings reveal that physical therapists conceptualize the context around the treatment as an incidental element that can occur during treatment[61] instead of a powerful therapeutic tool capable of influencing patients’ outcome[56].…”

Section: Discussionsupporting

confidence: 56%

Physical therapists’ perspectives on using contextual factors in clinical practice: Findings from an Italian national survey

Rossettini¹,

Palese

Geri³

et al. 2018

PLoS ONE

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BackgroundContextual factors (CFs) represent a potential therapeutic tool to boost physiotherapy outcomes, triggering placebo effects. Nevertheless, no evidence about the use of CFs among physical therapists is currently available.ObjectiveTo investigate the use of CFs and the opinion of Italian physical therapists specialized in Orthopaedic Manual Therapy (OMTs) on their therapeutic benefits.DesignAn exploratory cross-sectional online survey.MethodsA 17-item questionnaire and 2 clinical vignettes assessed the perspective of OMTs on the adoption of CFs in daily clinical practice. The target population was composed of 906 OMTs. An online survey was performed in 2016 using SurveyMonkey Software. Data were analyzed by descriptive and inferential statistics.ResultsA total of 558 volunteers (61.6% of the target OMT population) participated in the study. Half of the participants (52.0%) claimed to use CFs frequently in their practice. More of 50% of OMTs valued the therapeutic significance of CFs for different health problems as determined by a combined psychological and physiological effect. OMTs considered the use of CFs ethically acceptable when they exert beneficial therapeutic effects and their effectiveness has emerged in previous clinical experiences (30.6%). They disagreed on the adoption of CFs when they are deceptive (14.1%). Moreover, OMTs did not communicate the adoption of CFs to patients (38.2%), and CFs were usually used in addition to other interventions to optimize clinical responses (19.9%). Psychological mechanisms, patient’s expectation and conditioning were believed to be the main components behind CFs (7.9%).LimitationsConsidering that the data collected were self-reported and retrospective, recall and response biases may limit the internal and external validity of the findings.ConclusionsOMTs used CFs in their clinical practice and believed in their therapeutic effect. The knowledge of CFs, placebo and nocebo mechanisms and their clinical effects should be included in physical therapists’ university studies.

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Section: Discussionsupporting

confidence: 56%

Physical therapists’ perspectives on using contextual factors in clinical practice: Findings from an Italian national survey

Rossettini¹,

Palese

Geri³

et al. 2018

PLoS ONE

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“…The adoption of placebo strategies seems to be common practice in clinical routine among healthcare providers [ 193 ]. In musculoskeletal field, orthopedics surgeon, rheumatology physicians and nurses thought that placebo effects are real, have therapeutic benefits, and are permissible within the ethical borders [ 194 – 196 ]. Patients with chronic musculoskeletal pain and rheumatologic complaints know what placebo effects are, consider placebo treatments acceptable when adopted as complementary/adjunct treatments and when no other established treatments are available.…”

Section: Clinical Applications and Translational Researchmentioning

confidence: 99%

Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain

Rossettini

Carlino

Testa

2018

BMC Musculoskelet Disord

203

172

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Placebo and nocebo effects are embodied psycho-neurobiological responses capable of modulating pain and producing changes at different neurobiological, body at perceptual and cognitive levels. These modifications are triggered by different contextual factors (CFs) presented in the therapeutic encounter between patient and healthcare providers, such as healing rituals and signs. The CFs directly impact on the quality of the therapeutic outcome: a positive context, that is a context characterized by the presence of positive CFs, can reduce pain by producing placebo effects, while a negative context, characterized by the presence of negative CFs, can aggravate pain by creating nocebo effects. Despite the increasing interest about this topic; the detailed study of CFs as triggers of placebo and nocebo effects is still lacked in the management of musculoskeletal pain.Increasing evidence suggest a relevant role of CFs in musculoskeletal pain management. CFs are a complex sets of internal, external or relational elements encompassing: patient’s expectation, history, baseline characteristics; clinician’s behavior, belief, verbal suggestions and therapeutic touch; positive therapeutic encounter, patient-centered approach and social learning; overt therapy, posology of intervention, modality of treatment administration; marketing features of treatment and health care setting. Different explanatory models such as classical conditioning and expectancy can explain how CFs trigger placebo and nocebo effects. CFs act through specific neural networks and neurotransmitters that were described as mediators of placebo and nocebo effects.Available findings suggest a relevant clinical role and impact of CFs. They should be integrated in the clinical reasoning to increase the number of treatment solutions, boosts their efficacy and improve the quality of the decision-making. From a clinical perspective, the mindful manipulation of CFs represents a useful opportunity to enrich a well-established therapy in therapeutic setting within the ethical border. From a translational perspective, there is a strong need of research studies on CFs close to routine and real-world clinical practice in order to underline the uncertainty of therapy action and help clinicians to implement knowledge in daily practice.

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“…Survey responses from 189 members of the British Orthopaedic Trainees Association revealed that of those who preferred a sham-control design over an active-control, 30% stated they would 'definitely' recruit patients for a sham surgery trial, and 56% stated they would 'probably'. 41 Surgeon willingness to participate in a clinical trial may also depend, at least in part, on remuneration. A pragmatic obstacle for sham surgical trials in orthopaedics is whether payers will reimburse for it.…”

Section: Discussionmentioning

confidence: 99%

Sham surgery: justified but practical? A systematic review of sham surgery trials in orthopaedics

2018

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Background: An increasing trend for sham surgery trials in minor orthopaedic procedures has been observed. Trial outcomes have changed the practice landscape of these procedures. However, there has been no sham surgery trial in a major orthopaedic procedure. The aims of this systematic review were to consider the ethics of sham surgery trials; to describe orthopaedic sham surgery trials conducted to date; and to consider the challenges that will need to be overcome in order to conduct sham surgery trials for major orthopaedic procedures in the future. Methods: A systematic review of the literature and clinical trial registries was undertaken. Trials with a published main findings paper underwent a risk of bias assessment using the Cochrane Collaboration risk of bias tool, in addition to an ethical assessment based on the work of Horng and Miller. Results: We identified 22 sham surgery trials for minor orthopaedic procedures that have been completed, terminated, or are currently in process. Among the ten trials with a published main findings paper, only one was free from risk of bias; all others were at risk of bias. According to the ethical assessment, the benefits of a sham control were outweighed by the risks in all but two of the ten trials. Across the 22 trials with published and unpublished main findings, participant recruitment within reasonable timeframes, as well as the low threshold for crossover from the sham were recurring challenges. Conclusions: Researchers are obliged to carefully consider the feasibility of conducting a sham surgery trial in a major orthopaedic procedure, before drawing on limited research funds. Exploring the conditions under which patients and surgeons would find participation in a sham surgery trial acceptable, and simulating trial costs based on patient and surgeon preferences may assist funders, assessors and ethics boards to determine whether to support the conducting of future sham surgery trials in major orthopaedic procedures. Level of evidence:Level 1 3 9231 3955 Citation: Bunzli S, Dowsey MM, Choong PF. Sham surgery: justified but practical? A systematic review of sham surgery trials in orthopaedics. SA Orthop J 2018;17(3):15-24. http://dx.

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A survey on beliefs and attitudes of trainee surgeons towards placebo

Cited by 17 publications

References 24 publications

Physical therapists’ perspectives on using contextual factors in clinical practice: Findings from an Italian national survey

Physical therapists’ perspectives on using contextual factors in clinical practice: Findings from an Italian national survey

Clinical relevance of contextual factors as triggers of placebo and nocebo effects in musculoskeletal pain

Sham surgery: justified but practical? A systematic review of sham surgery trials in orthopaedics

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