Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes

Testa, Marco; Rossettini, Giacomo

doi:10.1016/j.math.2016.04.006

Cited by 185 publications

(226 citation statements)

References 136 publications

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“…These experts worked independently and then agreed upon the final list of items by providing feedback on content accuracy, wording clarity and appropriateness of survey structure. Items regarding beliefs and use of CFs were organised according to the available frameworks (Palese, Rossettini et al, ; Testa & Rossettini, ), thus capable of evaluating each specific domains regarding: (a) the nurse; (b) the patient; (c) the nurse–patient relationship; (d) the therapy; and (e) the healthcare setting domain. Adjustments in the questionnaire were progressively included by considering the feedback emerged from the panellist experts.…”

Section: Methodsmentioning

confidence: 99%

“…Several researchers (e.g., Carlino & Benedetti, 2016;Geuter, Koban, & Wager, 2017) have studied to date the rationale mechanisms explaining the occurrence of placebo or nocebo effects in certain circumstances (e.g., pain), and recently, a set of contextual factors (CFs) functioning as triggers of placebo/nocebo effects capable of influencing the clinical outcomes has been documented (Testa & Rossettini, 2016). Specifically, the CFs have been reported to enhance the clinical outcomes of evidence-based interventions by enacting various psychological and neurobiological mechanisms increasing placebo and preventing or reducing nocebo effects (Miller & Miller, 2015).…”

Section: Backg Rou N Dmentioning

confidence: 99%

“…As a consequence, the term CFs has been preferred instead of "placebo" (Rossettini, Carlino, & Testa, 2018), especially while conducting research aiming at preventing response bias (Tilburt, Emanuel, Kaptchuk, Curlin, & Miller, 2008). Moreover, in accordance with the available conceptual frameworks (Palese, Rossettini, Colloca, & Testa, 2018;Testa & Rossettini, 2016), the CFs relevant for placebo and nocebo effects have been recognised in a set of different elements, such as: (a) the healthcare professional features (professional reputation, appearance [e.g., uniform], positive attitudes and optimistic behaviour), (b) the patients' features (expectations, preferences, previous experience, clinical conditions, gender and age), (c) the healthcare professional-patient relationship (verbal and non-verbal communication, the empathetic therapeutic alliance), (d) the specific aspects of the interventions (over therapy, patient-centred approach, professional approach and therapeutic touch) and (e) the healthcare setting (comfortable setting, environment, architecture and internal design). This framework is translated into clinical practice by manifesting an optimistic approach, using appropriate verbal and non-verbal communication, and a patient-centred approach, which can trigger positive or negative outcomes .…”

Section: Backg Rou N Dmentioning

confidence: 99%

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Contextual factors triggering placebo and nocebo effects in nursing practice: Findings from a national cross‐sectional study

Palese

Cadorin

Testa

et al. 2019

Journal of Clinical Nursing

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Aims and objectives To describe contextual factors (CFs) used by nurses to increase placebo and to prevent nocebo effects. Background Placebo effects have been studied in the nursing discipline, but nocebo effects still remain unexplored. Recently, a set of CFs functioning as triggers of placebo/nocebo effects has been described; however, its use in daily care has never been documented to date. Design A national cross‐sectional survey, according to the Checklist for Reporting Results of Internet E‐Surveys guidelines and STrengthening the Reporting of OBservational Studies in Epidemiology (STROBE), was performed in 2016. Methods A wide sample of Italian nurses belonging to four national associations was involved. A questionnaire based on CFs literature was developed and administered through the SurveyMonkey Software® exploring: (a) CFs definition, (b) beliefs, (c) case‐by‐case frequency of use, (d) circumstances of application, (e) clinical conditions where participants perceived their potential beneficial effects, (f) ethical implications and (g) communication issues with the patient. Results Out of 1,411 eligible nurses, 455 answered (32.2%) and 425 questionnaires (30.1%) were valid for the analysis. A total of 211 nurses (49.6%) defined the CFs as an intervention with a possible aspecific effect; participants believed in the CFs (2.91; 95%CI 2.88–2.94), using them >2 times/month, mainly in addition to a nursing intervention to optimise clinical outcomes (n = 79; 18.6%). Psychological and physiological therapeutic effects have been perceived mainly in chronic pain (n = 259; 60.9%) and insomnia (n = 243; 57.2%). According to participants, CFs have been reported as ethically acceptable when exerting beneficial psychological effects (n = 148; 34.8%); however, 103 (24.2%) of nurses did not communicate to the patient when CFs were used. Conclusions Nurses are aware of CFs as elements to increase the placebo and prevent the nocebo effects in concomitance with evidence‐based nursing interventions. Relevance to clinical practice The CFs valued by nurses and experienced as effective are mainly based upon the internal quality of the nurse and the quality of the relationship between the nurse and the patient. These qualities require a large personal investment; therefore, nurses should be supported in developing these qualities since their nursing graduation.

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Section: Methodsmentioning

confidence: 99%

Section: Backg Rou N Dmentioning

confidence: 99%

Section: Backg Rou N Dmentioning

confidence: 99%

See 1 more Smart Citation

Contextual factors triggering placebo and nocebo effects in nursing practice: Findings from a national cross‐sectional study

Palese

Cadorin

Testa

et al. 2019

Journal of Clinical Nursing

Self Cite

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“…Case studies and small trials show benefit from high‐velocity, low‐amplitude joint thrust techniques, muscle energy techniques, and soft‐tissue–based interventions. The specific type of stimulus likely does not matter as much as the patient's expectations, equipoise of the practitioner performing the technique, contextual factors, and therapeutic alliance . Practitioners must be aware of the multifactorial nature of manual therapy effects in order to maximize outcomes of treatment.…”

Section: Utilizationmentioning

confidence: 99%

Use of Manual Therapy for Posterior Pelvic Girdle Pain

Miles

Bishop

2019

PM&R

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Use of manual therapies in the treatment of posterior pelvic pain is a common practice. The rationale for use of manual therapies is often associated with the structural movement of the sacroiliac joint. Increasing evidence has shown this not to be the case, as manual therapy's effect is more neurophysiological in nature. This article seeks to clarify the difference between the two explanations as well as to expand upon outside influences such as expectations, therapeutic alliance, and equipoise that may influence the outcome of treatment. Treatment effects may be maximized with manual therapy if clinicians have an understanding of the role of each of these variables in their treatment approach.

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“…São Paulo, 2016 jul-sep;17(3):157-8 conquests, that is, focusing on functional aspects and not only on pain intensity 8,9 . Placebo and nocebo effects will always be present during the therapeutic process and may positively or negatively impact treatment effects (such as pain, incapacity, satisfaction, etc.)…”

Section: Nocebo and Pain: Adverse Effects Of Excessive Informationmentioning

confidence: 99%

Nocebo and pain: adverse effects of excessive information

2016

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Information to patients about their disease, especially about persistent pain, is important clinical practice approach. Improving (placebo) or worsening (nocebo) expectations may influence patients' evolution during treatment. The interest on this topic has increased the number of studies on behavioral and neurophysiologic bases of placebo and nocebo effects. Placebo effect is related to a change in patients' clinical status attributed to an event, object or behavior in the therapeutic environment 1 . In general, placebo effect is always present in the clinical practice and may be defined as an inert effect within a positive context. If the context is negative, there is the opposite phenomenon, the nocebo effect, which creates negative expectations and worsens health status 2 . Nocebo effect may be defined as a set of events produced by negative expectations during therapeutic process 2,3 . The word nocebo was created to define negative responses observed in placebo-treated groups 4 . Factors as environment (office, clinic, hospital), professional-patient relationship, verbal suggestions and patients' context (expectations, explicit memories, beliefs, emotions) may influence clinical results, thus cannot be ignored 2,5 . Nocebo effect may increase pain intensity (hyperalgesia or induced allodynia), stress, anxiety, catastrophizing, in addition to increasing the search for health services, new therapeutic approaches, higher drug consumption and more surgeries to treat adverse effects produced by nocebo effect itself 5 . For example, excessive imaging exams for information about diagnosis and prognosis in chronic unspecific musculoskeletal conditions (such as low back pain, cervical pain, osteoarthritis) or disclosure of clinical results using medical jargons or specific technical terms, may negatively contribute and produce unnecessary attitudes and beliefs 5 . These approaches favor nocebo effect and may be considered iatrogenic, favoring worsening of pain, limitation of activities, development of negative expectations, anxiety, catastrophizing, avoidance and pain-related fear 4 . Health education process itself may also contribute for the development of nocebo effect in people with persistent pain 6 . Nocebo responses may be manifested by negative verbal suggestions by professionals (such as in communicating diagnosis, therapeutic risks, prognosis and verbal interaction during treatment), by social learning (such as negative media campaigns) or by observation (experiences of others) 3 . Education models based exclusively on biomedical information contribute for nocebo effect development 7 . Maladaptive beliefs developed by patients may be exacerbated by poor professional-patient relationships, low heath services quality, by the media or even by individual experience and primarily include causal relations attributed to pain 7,8 . Pain amplification, as well as amplification of other emotional components present in the nocebo effect, seems to be related to the activation of brain affective-cognitive pathways 8 ....

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Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes

Cited by 185 publications

References 136 publications

Contextual factors triggering placebo and nocebo effects in nursing practice: Findings from a national cross‐sectional study

Contextual factors triggering placebo and nocebo effects in nursing practice: Findings from a national cross‐sectional study

Use of Manual Therapy for Posterior Pelvic Girdle Pain

Nocebo and pain: adverse effects of excessive information

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