Context matters: the psychoneurobiological determinants of placebo nocebo and context-related effects in physiotherapy

摘要

Contextual factors in clinical practice. The following contextual factors were accepted as effective modifiers of physiotherapy outcomes. For a review of this topic see reviews [ , , ]. Physiotherapist’s features: professionalism (expertise, qualification, reputation, education, trining); mindset (behaviour, beliefs, expectation, previous experience); appearance (attire, uniform, white coat, trustworthiness). Patient’s features: mindset (expectation, previous experience, history of treatment, preference, desire, and emotion); baseline (level of symptoms, comorbidity, health condition, gender, age). Patient-physiotherapist relationship: verbal communication (positive message, tone of voice, active listening, suggestions of support and encouragement, language reciprocity, warmth, attention, care, empathetic interaction); non-verbal communication (eye contact, facial caring expression, smiling, posture, gestures, head nodding, forward leaning, open body orientation). Treatment features: therapeutic touch (emotional, empathetic, affective); modality (level of invasiveness, open/overt application, observational/social learning); posology (personalized treatment, treatment delivered by the same physiotherapist, cleanliness, adequate length of the consultation, punctuality, flexibility with patient’s appointments, timely and efficient treatment, adequate frequency, duration and follow-up of therapy); marketing (brand, prize, novelty, rituality). Healthcare setting features: positive distractors (natural lighting, low noise levels, relaxing and soft music, pleasing aromas, adequate temperature); supportive indications (highly visible and easy to read signs, parking information, accessible entrances, clear and consistent verbal or written directions, information desks and accessible electronic information); comfort element (windows and skylights, private therapeutic settings, good access to services, convenient clinic hours, location, parking, and available and approachable support staff); decorations and ornaments (nature artworks, green vegetation, flowers, water, plants, garden, colour)