Socio-economic differences in healthcare access from a welfare system perspective, Italy: 2007-2010

Icelandic physiotherapists' perceptions of contextual factors as triggers of nocebo effects: a mixed methods survey

INTRODUCTION

Contextual factors surrounding physiotherapy treatment can trigger nocebo effects, resulting in negative outcomes despite evidence-based treatment.

PURPOSE

This study explored Icelandic physiotherapists' awareness, perception, and prevention of contextual factors that may trigger nocebo effects.

METHODS

This was a cross-sectional, convergent mixed-methods study utilizing an online survey. Quantitative data was collected by translating and adapting a previously developed survey and analyzed using descriptive and non-parametric statistics. Qualitative data from open-ended questions were transformed and analyzed using a contextual factor framework.

RESULTS

For the quantitative analysis, 206 responses were included. Seventy percent of Icelandic physiotherapists reported "seldom" or "rarely" encountering nocebo effects. The highest-rated perceived causes, based on the percent answering "very much" or "much," were inappropriate touch (89%), lack of trust between physiotherapist and patient (85%), use of negative language by the physiotherapist (83%), patient's prior negative experiences (80%), physiotherapist's negative attitude (78%), patient's negative expectations (77%), and negative non-verbal communication (74%). The most endorsed strategy for preventing nocebo effects was to teach and train patients in coping skills. Eighty-eight percent agreed that nocebo effects should be part of the physiotherapy curriculum. Qualitative descriptions of nocebo effects by 81 physiotherapists showed little self-reflection, with a tendency to attribute nocebo effects primarily to the patient's mind-set.

CONCLUSION

Comparisons to other surveys showed similarities that may be universal among physiotherapists alongside notable differences. Physiotherapists frequently attributed nocebo effects to the patient's mind-set but may need to consider a broader range of contextual factors to reduce nocebo effects more effectively.

Orthopedic workforce planning in Germany - an analysis of orthopedic accessibility

In Germany, orthopedic workforce planning relies on population-to-provider-ratios represented by the 'official degree of care provision'. However, with geographic information systems (GIS), more sophisticated measurements are available. By utilizing GIS-based technologies we analyzed the current state of demand and supply of the orthopedic workforce in Germany (orthopedic accessibility) with the integrated Floating Catchment Area method. The analysis of n = 153,352,220 distances revealed significant geographical variations on national scale: 5,617,595 people (6.9% of total population) lived in an area with significant low orthopedic accessibility (average z-score = -4.0), whereas 31,748,161 people (39.0% of total population) lived in an area with significant high orthopedic accessibility (average z-score = 8.0). Accessibility was positively correlated with the degree of urbanization (r = 0.49; p<0.001) and the official degree of care provision (r = 0.33; p<0.001) and negatively correlated with regional social deprivation (r = -0.47; p<0.001). Despite advantages of simpler measures regarding implementation and acceptance in health policy, more sophisticated measures of accessibility have the potential to reduce costs as well as improve health care. With this study, significant geographical variations were revealed that show the need to reduce oversupply in less deprived urban areas in order to enable adequate care in more deprived rural areas.