Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy.
Giacomo Rossettini, Eleonora Maria Camerone, Elisa Carlino and 2 others
PMID 32537245WHAT IT FOUND
Physiotherapy outcomes can be shaped by the treatment context, including therapist words, relationship, setting and touch.
Positive suggestions may enhance benefit; negative or uncertain ones may worsen symptoms.
Key findings
01The review states that physiotherapy outcomes are influenced by contextual factors, including therapist professionalism and appearance, patient beliefs and expectations, the patient-therapist relationship, treatment features and the healthcare setting.
02Positive verbal suggestions during treatment can reduce pain and increase strength, while suggestions of uncertainty or negative information can worsen pain and strength.
03The review describes expectation, classical conditioning, observational learning, operant conditioning, mindset and personality traits as psychological mechanisms behind placebo and nocebo effects.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
This is a narrative review, not a systematic review, so it does not show how the studies were selected or how complete the evidence is. It reports no new patients, outcomes or effect sizes, so it cannot tell you the size of any context effect in your clinic. Much of the evidence comes from other conditions, such as migraine, irritable bowel syndrome, post-surgical pain, Parkinson disease and experimental pain, so it may not transfer directly to routine physiotherapy. The clinical, managerial and educational actions are proposed by the authors, not tested in the paper.
The easy way to misread this
Do not conclude that adding context factors to a specific physiotherapy treatment is proven to improve outcomes. The paper is a narrative review, and it does not report a trial that tested these actions in patients.