Understanding Contextual Factors Effects and Their Implications for Italian Physiotherapists: Findings from a National Cross-Sectional Study

Abstract

An online cross-sectional survey was conducted using Google Docs software. The aim was to understand the management of contextual factors and to identify which are most relevant and which clinicians underestimate. A total of 1250 physiotherapists were chosen from the database of the Manual Therapists group mailing list (GTM-IFOMPT MO) from July to August 2020. A total of 699 responses were received that were considered valid (56%). Participants (40.83%) identified contextual factors (CFs) as “any element, even involuntary, with which the patient interacts during treatment”. Physiotherapists individually chose the representation of CF with the “therapeutic relationship” (82.9%), followed by “therapeutic setting” (75.8%). This choice differed between participants belonging to different age groups. Participants favor communication strategies (76.93%). More than half (57.88%) pay attention to patient involvement during the course of care; and in response to the patients’ doubts about the use of treatments with limited scientific efficacy, they suggest different medical treatments. The patient’s previous clinical experience is not considered significant and does not influence the choice of treatment. Subsequently, however, the participants reported that they stimulate the patients’ positive expectations of the success of the clinical outcome (45.27%). Knowledge of contextual factors in physiotherapy appears limited and very heterogeneous. Future research could increase the focus on professional development.

Unraveling Negative Expectations and Nocebo-Related Effects in Musculoskeletal Pain

“…However, such practice is not routinely implemented in clinical practice ( Rossettini et al, 2019 , 2020c ). As emerged in previous surveys, clinicians involved in MSK care report difficulties in managing patients’ expectations and avoid nocebo-related effects ( Palese et al, 2019a ; Cadorin et al, 2020 ; Rossettini et al, 2020b ; Bisconti et al, 2021 ). This lack highlights the need for clinicians to have a framework that they can apply in everyday practice.…”

Editorial: Harnessing placebo mechanisms

“…Contextual factors (CF) are various elements deriving from a patients' interactions with practitioners and the therapeutic arena that influence disease processes and therapeutic outcomes ( 2 , 3 ). Whilst positive CF may induce placebo effects, negative CF may induce nocebo effects resulting in adverse effects ( 4 , 5 ).…”

“…Whilst positive CF may induce placebo effects, negative CF may induce nocebo effects resulting in adverse effects ( 4 , 5 ). However, studies assessing specific CF have yielded mixed results on their contribution to placebo/nocebo effects ( 2 , 6 , 7 ). This heterogeneity in outcomes have prompted investigating the context of how the CFs are assessed.…”

Auditory Brainstem Response with chirp stimuli in newborns: an integrative review

“…Bisconti and col. conducted a study with physical therapists in 2021 10 to understand the management of contextual factors and identify the most relevant ones and the underestimated ones by professionals. The contextual factors included physical therapists' characteristics, patients' characteristics, patient/ physical therapist relationship, treatment, and therapeutic setting.…”

“…The results highlighted that participants considered any voluntary or involuntary element with which they interacted during the treatment as contextual factors, which made up the therapeutic setting. It then found that physical therapists considered communication strategies -e.g., stimulating positive expectations in patients toward successful therapies, having a therapeutic relationship with patients, and using active clinical listening in the treatment -highly important to achieve better therapeutic results 10 .…”