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Liang H, Huang J. Case report: Spontaneous regression of extruded lumbar disc herniation with acupuncture therapy. Front Neurol 2024; 15:1381292. [PMID: 38895697 PMCID: PMC11184950 DOI: 10.3389/fneur.2024.1381292] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2024] [Accepted: 05/20/2024] [Indexed: 06/21/2024] Open
Abstract
Most patients with lumbar disc herniation (LDH) derive benefit from conservative treatment, prompting growing global interest in non-surgical approaches. Despite being recognized as one of the effective conservative therapies, there is currently limited evidence to support the sole efficacy of acupuncture in treating patients with acute extruded LDH. Here we report the case of a 52-year-old male who presented with low back pain and persistent radiating lower limb pain and numbness. Physical examination and magnetic resonance imaging (MRI) revealed an extruded LDH at the L5/S1 level, compressing the nerve root and causing severe radiculopathy symptoms. After 23 days of continuous inpatient acupuncture treatment, followed by 5 intermittent outpatient acupuncture treatment over 2 months, patient's pain and numbness was significantly alleviated and a followed-up MRI showed a remarkable regression of the extruded disc fragment. In this case, acupuncture as a monotherapy is safe and effective, but more conclusive evidence is needed.
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Affiliation(s)
- Haiwen Liang
- The Second Clinical Medical School of Guangzhou University of Chinese Medicine, Guangzhou, Guangdong, China
| | - Jianhao Huang
- Shenzhen Hospital of Guangzhou University of Chinese Medicine (Futian), Shenzhen, Guangdong, China
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2
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Moretti A, Snichelotto F, Liguori S, Paoletta M, Toro G, Gimigliano F, Iolascon G. The challenge of pharmacotherapy for musculoskeletal pain: an overview of unmet needs. Ther Adv Musculoskelet Dis 2024; 16:1759720X241253656. [PMID: 38799611 PMCID: PMC11119417 DOI: 10.1177/1759720x241253656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 04/10/2024] [Indexed: 05/29/2024] Open
Abstract
Musculoskeletal disorders are characterized by several impairments, including pain, affecting muscles, bones, joints and adjacent connective tissue, resulting in temporary or permanent functional limitations and disability. Musculoskeletal pain is particularly prevalent worldwide and greatly impacts the quality of life, social participation and economic burden. To date, several issues persist about the classification of musculoskeletal pain and its management strategies and resources. The treatment of musculoskeletal pain conditions is complex and often requires a multimodal approach, including pharmacological and non-pharmacological therapy that might be ineffective in many cases, resulting in poor patient satisfaction and controversial expectations about the potential benefits of available interventions. This manuscript provides an overview of unmet needs in managing musculoskeletal pain, particularly focusing on pharmacotherapeutic pitfalls in this context.
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Affiliation(s)
- Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples 80138, Italy
| | - Francesco Snichelotto
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Sara Liguori
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Marco Paoletta
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giuseppe Toro
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Francesca Gimigliano
- Department of Physical and Mental Health and Preventive Medicine, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
| | - Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania ‘Luigi Vanvitelli’, Naples, Italy
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3
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Schienle A, Seibel A. Would You Take an Open-Label Placebo Pill or Give One to Your Child? Findings from a Cross-Sectional Survey. Psychol Res Behav Manag 2024; 17:393-400. [PMID: 38333629 PMCID: PMC10850762 DOI: 10.2147/prbm.s439783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 12/22/2023] [Indexed: 02/10/2024] Open
Abstract
Background Open-label placebos (OLPs), honestly prescribed regarding their inert nature, have been associated with positive health-related effects in both children and adults. However, OLPs are not always perceived by laypeople as a viable treatment option. Methods A brief online survey with 806 adult participants (age range: 18-75 years; 29% parents) was conducted to identify predictor variables that are associated with the willingness to take an OLP pill (criterion 1) or to give an OLP to one's child (criterion 2). The survey covered aspects including the perceived plausibility of the treatment concept for both OLPs and deceptive placebos (DPs), self-reported knowledge about placebos, the expected effectiveness of OLPs in treating emotional/ somatic problems, and attitudes concerning taking pills in general. Multiple hierarchical regressions were carried out. Results The expected effectiveness of OLPs in alleviating both emotional and physical ailments and the plausibility of the treatment concepts for both OLPs and DPs significantly predicted the willingness to use OLPs (R2 = 0.485). A similar finding was observed when predicting the willingness to administer an OLP to one's child (R2 = 0.443). Conclusion Favorable expectations regarding the reduction of emotional and somatic symptoms with OLPs, along with a strong belief in the credibility of placebo mechanisms, play a vital role in influencing the willingness to accept this kind of treatment. These factors can be incorporated into psychoeducational programs.
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Affiliation(s)
- Anne Schienle
- Department of Clinical Psychology, University of Graz, Graz, Austria
| | - Arved Seibel
- Department of Clinical Psychology, University of Graz, Graz, Austria
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4
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Fatehi A, Brown LE, Versluijs Y, Van Maren K, Ring D, Gonzalez A, Ramtin S. The relationship of perceived empathy with levels of pain intensity and incapability among patients visiting a musculoskeletal specialist. PATIENT EDUCATION AND COUNSELING 2023; 115:107900. [PMID: 37467592 DOI: 10.1016/j.pec.2023.107900] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Revised: 06/26/2023] [Accepted: 07/11/2023] [Indexed: 07/21/2023]
Abstract
BACKGROUND People that have more intense symptoms and greater incapability might have less rapport with the clinicians that care for them. OBJECTIVE This study tested the hypothesis that perceived clinician empathy is related to pain intensity and magnitude of incapability among people seeing a musculoskeletal specialist. PATIENT INVOLVEMENT After a consult with a musculoskeletal specialist, 211 adult patients completed a survey recording demographics, and measures of pain intensity, incapability, and perceived clinician empathy. RESULTS Higher perceived empathy was associated with being in a committed relationship and, to a modest degree (r = -0.16) lower pain intensity in bivariate and multivariable analyses. DISCUSSION People experiencing greater pain may be slightly less likely to perceive the clinician as empathetic. PRACTICAL VALUE Study of the relationship between the patient's experience of care and patient and clinician personal factors can inform efforts to improve patient experience. Advances may depend on experience measures with more normal distributions and less ceiling effect.
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Affiliation(s)
- Amirreza Fatehi
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Laura E Brown
- Center for Health Communication, Moody College of Communication, University of Texas at Austin, 300 W. Dean Keaton, Austin, TX 78712-1069, USA.
| | - Yvonne Versluijs
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Koen Van Maren
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Amanda Gonzalez
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
| | - Sina Ramtin
- Department of Surgery and Perioperative Care, Dell Medical School, University of Texas at Austin, Health Discovery Building, MC Z0800, 1701 Trinity St., Austin, TX 78712, USA.
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Faria V, Talbert C, Goturi N, Borsook D, Lebel A, Kaptchuk TJ, Kirsch I, Kelley JM, Moulton EA. Placebos in pediatrics: A cross-sectional survey investigating physicians' perspectives. J Psychosom Res 2023; 172:111421. [PMID: 37354748 DOI: 10.1016/j.jpsychores.2023.111421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 06/07/2023] [Accepted: 06/18/2023] [Indexed: 06/26/2023]
Abstract
OBJECTIVE Placebo responses are significantly higher in children than in adults, suggesting a potential underused treatment option in pediatric care. To facilitate the clinical translation of these beneficial effects, we explored physicians' current practice, opinions, knowledge, and likelihood of recommending placebos in the future. METHODS A cross-sectional web-based survey administered by REDCap was conducted at Boston Children's Hospital between October 2021 and March 2022. Physicians (n = 1157) were invited to participate through an email containing a link to a 23-item survey designed to assess physicians' attitudes and perceptions towards the clinical use of placebo in pediatrics. RESULTS From 207 (18%) returned surveys, 109 (9%) were fully completed. Most respondents (79%) believed that enhancing the therapeutic components that contribute to the placebo response may be a way of improving pediatric care. However, whereas most (62%) found placebo treatments permissible, only one-third reported recommending them. In pediatrics, placebos are typically introduced as a medicine that "might help" (43%). The most common treatments recommended to enhance placebo effects are physical therapy, vitamins, and over-the-counter analgesics. Physicians most frequently recommend placebos for occasional pain, headaches, and anxiety disorders. Finally, the great majority of physicians (87%) stated they would be more likely to recommend placebo treatments if there were safety and ethical guidelines for open-label placebos. CONCLUSIONS Placebo treatments seem permissible to physicians in pediatric care, but the development of safety and ethical guidelines may be necessary before physicians systematically incorporate the benefits of the placebo effect in pediatrics.
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Affiliation(s)
- Vanda Faria
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Psychology, Uppsala University, Uppsala, Sweden; Department of Otorhinolaryngology, Smell & Taste Clinic, TU Dresden, Dresden, Germany; Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA.
| | - Cameron Talbert
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - Nathan Goturi
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
| | - David Borsook
- Departments of Psychiatry and Radiology, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
| | - Alyssa Lebel
- Division of Pain Medicine, Department of Anesthesiology, Boston Children's Hospital, Boston, MA, USA
| | - Ted J Kaptchuk
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - Irving Kirsch
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA
| | - John M Kelley
- Program in Placebo Studies, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA; Department of Psychology, Endicott College, Beverly, MA, USA
| | - Eric A Moulton
- Brain and Eye Pain Imaging Lab, Pain and Affective Neuroscience Center, Department of Anesthesiology, Critical Care and Pain Medicine, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA; Department of Ophthalmology, Boston Children's Hospital, Harvard Medical School, Boston, MA, USA
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6
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Rossettini G, Colombi A, Carlino E, Manoni M, Mirandola M, Polli A, Camerone EM, Testa M. Unraveling Negative Expectations and Nocebo-Related Effects in Musculoskeletal Pain. Front Psychol 2022; 13:789377. [PMID: 35369173 PMCID: PMC8966654 DOI: 10.3389/fpsyg.2022.789377] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 02/24/2022] [Indexed: 12/16/2022] Open
Abstract
This Perspective adapts the ViolEx Model, a framework validated in several clinical conditions, to better understand the role of expectations in the recovery and/or maintenance of musculoskeletal (MSK) pain. Here, particular attention is given to the condition in which dysfunctional expectations are maintained despite no longer being supported by confirmatory evidence (i.e., belief-lifting the arm leads to permanent tendon damage; evidence-after the patient lifts the arm no tendon damage occurs). While the ViolEx Model suggests that cognitive immunization strategies are responsible for the maintenance of dysfunctional expectations, we suggest that such phenomenon can also be understood from a Bayesian Brain perspective, according to which the level of precision of the priors (i.e., expectations) is the determinant factor accounting for the extent of priors' updating (i.e., we merge the two frameworks, suggesting that highly precise prior can lead to cognitive immunization responses). Importantly, this Perspective translates the theory behind these two frameworks into clinical suggestions. Precisely, it is argued that different strategies should be implemented when treating MSK pain patients, depending on the nature of their expectations (i.e., positive or negative and the level of their precision).
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,School of Physiotherapy, University of Verona, Verona, Italy
| | - Andrea Colombi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | - Elisa Carlino
- Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Mattia Manoni
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
| | | | - Andrea Polli
- Pain in Motion (PAIN) Department, Vrije Universiteit Brussel, Brussels, Belgium.,Department of Public Health and Primary Care, KU Leuven, Leuven, Belgium.,Research Foundation, Flanders (FWO) Postdoctoral Fellow, Brussels, Belgium
| | - Eleonora Maria Camerone
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy.,Department of Psychology, University of Milan-Bicocca, Milano, Italy
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Genova, Italy
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Rodrigues BA, Silva LMCP, Lucena HÍDS, Morais EPGD, Rocha AC, Alves GADS, Benevides SD. Nocebo effect in health communication: how to minimize it? REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222443022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
ABSTRACT Purpose: to describe the strategies used to minimize the nocebo effect in health communication. Methods: an integrative review of the literature. The keywords “nocebo effect” and “health communication” and their combinations were used in English, Portuguese, and Spanish to search publications from 2011 to 2021 in MEDLINE, Latin American and Caribbean Health Sciences Literature (LILACS), Cochrane Library, EMBASE, and Web of Science/ISI. The following research question was used: “Which strategies have been used to minimize the nocebo effect in health communication?”. Literature Review: altogether, 77 articles were found, although only six met the inclusion criteria and comprised the review sample. Their year of publication ranged from 2015 to 2021. Positive framing, assertive communication, and contextual factors were the strategies used to minimize the nocebo effect. Conclusion: the strategies used to minimize the nocebo effect were contextual factors, motivational talk, positive framing, assertive communication, and empathetic communication. These communication techniques are seemingly effective, though still little known by health professionals. This knowledge is important as it helps develop communicative skills aiming at humanized patient care.
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8
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Rodrigues BA, Silva LMCP, Lucena HÍDS, Morais EPGD, Rocha AC, Alves GADS, Benevides SD. Efeito nocebo na comunicação em saúde: como minimizá-lo? REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/20222443022s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
RESUMO Objetivo: descrever as estratégias para minimizar o efeito nocebo na comunicação em saúde. Métodos: trata-se de uma revisão integrativa da literatura. Os descritores utilizados foram: “Efeito nocebo” e “comunicação em saúde”, em inglês, português e espanhol e suas combinações, no período de 2011 a 2021, nas bases de dados da Medline, Literatura Latino-Americana e do Caribe em Ciências da Saúde (LILACS), Cochrane Library, Embase e Web of Science/ISI. A pergunta de investigação para esse estudo foi: Quais as estratégias utilizadas para minimizar o efeito nocebo na comunicação em saúde? Revisão da Literatura: foram encontrados 77 artigos. Apenas seis preencheram os critérios de inclusão e compuseram a amostra da revisão. Os anos de publicação dos artigos variaram entre 2015 e 2021. As estratégias definidas para minimizar o efeito nocebo foram: enquadramento positivo, comunicação assertiva e utilização de fatores contextuais. Conclusão: as estratégias encontradas para minimizar o efeito nocebo foram fatores contextuais, conversa motivacional, enquadramento positivo, comunicação assertiva e comunicação empática. Essas técnicas de comunicação parecem ser efetivas, mas ainda são pouco conhecidas pelos profissionais em saúde. Esse conhecimento se faz importante, pois auxilia no desenvolvimento de habilidades comunicativas que visam à humanização do cuidado ao paciente.
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Iolascon G, Moretti A. Myths and Truths about Placebo Effect in Rehabilitation for Musculoskeletal Pain. Adv Ther 2021; 38:4995-5001. [PMID: 34476754 PMCID: PMC8478741 DOI: 10.1007/s12325-021-01894-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2021] [Accepted: 08/12/2021] [Indexed: 02/08/2023]
Abstract
This commentary provides the authors' point of view about the biopsychosocial perspective of placebo effect on musculoskeletal pain in the rehabilitation field.
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Affiliation(s)
- Giovanni Iolascon
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Via de Crecchio, 6, 80138, Naples, Italy.
| | - Antimo Moretti
- Department of Medical and Surgical Specialties and Dentistry, University of Campania Luigi Vanvitelli, Via de Crecchio, 6, 80138, Naples, Italy
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Miller CT, Owen PJ, Than CA, Ball J, Sadler K, Piedimonte A, Benedetti F, Belavy DL. Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-analysis. Sports Med 2021; 52:789-816. [PMID: 34453277 DOI: 10.1007/s40279-021-01526-6] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/20/2021] [Indexed: 12/30/2022]
Abstract
BACKGROUND Pain is the most disabling characteristic of musculoskeletal disorders, and while exercise is promoted as an important treatment modality for chronic musculoskeletal conditions, the relative contribution of the specific effects of exercise training, placebo effects and non-specific effects such as natural history are not clear. The aim of this systematic review and meta-analysis was to determine the relative contribution of these factors to better understand the true effect of exercise training for reducing pain in chronic primary musculoskeletal pain conditions. DESIGN Systematic review with meta-analysis DATA SOURCES: MEDLINE, CINAHL, SPORTDiscus, EMBASE and CENTRAL from inception to February 2021. Reference lists of prior systematic reviews. ELIGIBILITY CRITERIA Randomised controlled trials of interventions that used exercise training compared to placebo, true control or usual care in adults with chronic primary musculoskeletal pain. The review was registered prospectively with PROSPERO (CRD42019141096). RESULTS We identified 79 eligible trials for quantitative analysis. Pairwise meta-analysis showed very low-quality evidence (GRADE criteria) that exercise training was not more effective than placebo (g [95% CI]: 0.94 [- 0.17, 2.06], P = 0.098, I2 = 92.46%, studies: n = 4). Exercise training was more effective than true, no intervention controls (g [95% CI]: 0.99 [0.66, 1.32], P < 0.001, I2 = 92.43%, studies: n = 42), usual care controls (g [95% CI]: 0.64 [0.44, 0.83], P < 0.001, I2 = 76.52%, studies: n = 33), and when all controls combined (g [95% CI]: 0.84 [0.64, 1.04], P < 0.001, I2 = 90.02%, studies: n = 79). CONCLUSIONS There is very low-quality evidence that exercise training is not more effective than non-exercise placebo treatments in chronic pain. Exercise training and the associated clinical encounter are more effective than true control or standard medical care for reductions in pain for adults with chronic musculoskeletal pain, with very low quality of evidence based on GRADE criteria.
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Affiliation(s)
- Clint T Miller
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.
| | - Patrick J Owen
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Christian A Than
- School of Biomedical Sciences, The University of Queensland, St. Lucia, Brisbane, Australia
| | - Jake Ball
- School of Medicine and Public Health, University of Newcastle, Callaghan, Newcastle, Australia
| | - Kate Sadler
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia
| | - Alessandro Piedimonte
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy
| | - Fabrizio Benedetti
- Department of Neuroscience "Rita Levi Montalcini", University of Turin, Turin, Italy.,Medicine and Physiology of Hypoxia, Plateau Rosà, Zermatt, Switzerland
| | - Daniel L Belavy
- Institute for Physical Activity and Nutrition, School of Exercise and Nutrition Sciences, Deakin University, Geelong, VIC, Australia.,Department of Applied Health Sciences, Division of Physiotherapy, Hochschule für Gesundheit (University of Applied Sciences), Bochum, Germany
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11
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Beneciuk JM, Brown-Taylor L, Alodaibi F, Kareha S, Holmes R, Fritz J. Patient- and Physical Therapist-Level Predictors of Patient-Reported Therapeutic Alliance: An Observational, Exploratory Study of Cohorts With Knee and Low Back Pain. Arch Phys Med Rehabil 2021; 102:2335-2342. [PMID: 34283991 DOI: 10.1016/j.apmr.2021.05.018] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2021] [Revised: 05/21/2021] [Accepted: 05/24/2021] [Indexed: 01/11/2023]
Abstract
OBJECTIVE To identify patient- and physical therapist-level predictors for therapeutic alliance at the end of an episode of physical therapy for knee or low back pain (LBP). DESIGN Secondary analysis of observational cohort. SETTING Outpatient physical therapy clinics. PARTICIPANTS Patients receiving physical therapy for knee (n=189) or LBP (n=252) and physical therapists (n=19). Candidate predictor variables included demographics, patient clinical characteristics, and physical therapist attitudes and beliefs (Pain Attitudes and Beliefs Scale for Physical Therapists) and confidence in providing patient-centered care (Self-Efficacy in Patient-Centeredness Questionnaire). INTERVENTIONS Not applicable. MAIN OUTCOME MEASURES Patient-reported therapeutic alliance was measured using the 12-item Work Alliance Inventory-Short Revised (WAI-SR). RESULTS Final linear mixed models indicated different patient- and physical therapist-level factor contributions in predicting final WAI-SR scores across cohorts with knee and LBP. Female sex was a consistent patient-level predictor for both knee (estimated β=1.57, P<.05) and LBP (β=1.42, P<.05), with age (β=-0.07, P<.01) and baseline function (β=0.06, P<.01) contributing to cohorts with knee and LBP, respectively. Physical therapist-level predictors included female sex (β=6.04, P<.05), Pain Attitudes and Beliefs Scale for Physiotherapists behavioral (β=0.65, P<.01), and Self-Efficacy in Patient-Centeredness Questionnaire (SEPCQ) Exploring Patient Perspective (β=-0.75, P<.01) subscale scores for LBP, with SEPCQ Sharing Information and Power subscale scores (β=0.56, P<.05) contributing to both cohorts with knee (β=0.56, P<.05) and LBP (β=0.74, P<.01). Random effects for patients nested within physical therapists were observed for both cohorts. CONCLUSIONS These findings provide preliminary evidence for inconsistent relationships among patient- and physical therapist-level factors and therapeutic alliance across cohorts with knee and LBP.
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Affiliation(s)
- Jason M Beneciuk
- Department of Physical Therapy, University of Florida, Gainesville, FL; Brooks Rehabilitation, Jacksonville, FL.
| | - Lindsey Brown-Taylor
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation VA, Salt Lake City, UT
| | - Faris Alodaibi
- Rehabilitation Science Department, King Saud University, Riyadh, Saudi Arabia
| | - Stephen Kareha
- Physical Therapy at St. Luke's University Health Network, Bethlehem, PA; Department of Physical Therapy, DeSales University, Bethlehem, PA
| | - Rett Holmes
- Physical Therapy at St. Luke's University Health Network, Bethlehem, PA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, Salt Lake City, UT
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12
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Bisconti M, Venturin D, Bianco A, Capurso V, Giovannico G. Understanding Contextual Factors Effects and Their Implications for Italian Physiotherapists: Findings from a National Cross-Sectional Study. Healthcare (Basel) 2021; 9:689. [PMID: 34200302 PMCID: PMC8226546 DOI: 10.3390/healthcare9060689] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Revised: 05/28/2021] [Accepted: 06/01/2021] [Indexed: 11/16/2022] Open
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.
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Affiliation(s)
- Mattia Bisconti
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, c/o Cardarelli Hospital, C/da Tappino, 86100 Campobasso, Italy; (M.B.); (A.B.); (G.G.)
- Physiotherapy and Manual Therapy, Physiotherapy Department UPMC Italy Salvator Mundi International Hospital, Viale delle Mura Gianicolensi 67, 00152 Rome, Italy
| | - Davide Venturin
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, c/o Cardarelli Hospital, C/da Tappino, 86100 Campobasso, Italy; (M.B.); (A.B.); (G.G.)
- Kinè Physiotherapic Center, 31020 San Vendemiano, Italy
| | - Alessandra Bianco
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, c/o Cardarelli Hospital, C/da Tappino, 86100 Campobasso, Italy; (M.B.); (A.B.); (G.G.)
- Reha Medica, Centro Medico di Riabilitazione, 70014 Conversano, Italy
| | | | - Giuseppe Giovannico
- Department of Medicine and Health Science “Vincenzo Tiberio”, University of Molise, c/o Cardarelli Hospital, C/da Tappino, 86100 Campobasso, Italy; (M.B.); (A.B.); (G.G.)
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‘Don't focus on the finger, look at the moon’ - The importance of contextual factors for clinical practice and research. INT J OSTEOPATH MED 2021. [DOI: 10.1016/j.ijosm.2021.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
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Alodaibi F, Beneciuk J, Holmes R, Kareha S, Hayes D, Fritz J. The Relationship of the Therapeutic Alliance to Patient Characteristics and Functional Outcome During an Episode of Physical Therapy Care for Patients With Low Back Pain: An Observational Study. Phys Ther 2021; 101:6123370. [PMID: 33513231 DOI: 10.1093/ptj/pzab026] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 09/22/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE Research supports the relevance of the therapeutic alliance (TA) between patients and physical therapists on outcomes, but the impact of TA during routine physical therapist practice has not been quantified. The primary objective of this study was to examine the relationship between TA assessed during a physical therapy episode of care for patients with low back pain and functional outcome at the conclusion of care. The secondary objective was to examine psychometric properties of the Working Alliance Inventory-Short Revised (WAI-SR) form, a patient-reported TA measure. METHODS This study was a retrospective analysis of prospectively collected data from 676 patients (mean [SD] age = 55.6 [16.1] y; 55.9% female) receiving physical therapy for low back pain in 45 outpatient clinics from 1 health system in the United States. Participating clinics routinely collect patient-reported data at initial, interim, and final visits. The lumbar computer-adapted test (LCAT) was used to evaluate functional outcome. The TA was assessed from the patient's perspective at interim assessments using the WAI-SR, bivariate correlations were examined, and regression models were examined if interim WAI-SR scores explained outcome variance beyond a previously validated multivariate prediction model. Internal consistency and ceiling effects for the WAI-SR were examined. RESULTS Interim WAI-SR scores were not correlated with patient characteristics or initial LCAT, but they were correlated with final LCAT and LCAT change from initial to final assessment. WAI-SR total score (adjusted R2 = 0.36), and Task (adjusted R2 = 0.38) and Goal subscales (adjusted R2 = 0.35) explained additional variance in outcome beyond the base model (adjusted R2 = 0.33). Internal consistency was higher for WAI-SR total score (α = .88) than for subscales (α = .76-.82). Substantial ceiling effects were observed for all WAI-SR scores (27.2%-63.6%). CONCLUSION Findings support the importance of TA in physical therapist practice. Measurement challenges were identified, most notably ceiling effects. IMPACT This study supports the impact of the patient-physical therapist alliance on functional outcome. Results extend similar findings from controlled studies into a typical physical therapist practice setting. Better understanding of the role of contextual factors including the therapeutic alliance might be key to improving the magnitude of treatment effect for discrete physical therapist interventions and enhancing clinical outcomes of physical therapy episodes of care.
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Affiliation(s)
- Faris Alodaibi
- Rehabilitation Science Department, King Saud University, Riyadh, Saudi Arabia
| | - Jason Beneciuk
- University of Florida Department of Physical Therapy, Gainesville, Florida, USA
| | - Rett Holmes
- Physical Therapy at St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Stephen Kareha
- Physical Therapy at St Luke's University Health Network, Bethlehem, Pennsylvania, USA
| | - Deanna Hayes
- Focus on Therapeutic Outcomes, Inc, Knoxville, Tennessee, USA
| | - Julie Fritz
- Department of Physical Therapy and Athletic Training, University of Utah, 383 Colorow Drive, Room 391, Salt Lake City, UT 84108, USA
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Rossettini G, Camerone EM, Carlino E, Benedetti F, Testa M. Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy. Arch Physiother 2020; 10:11. [PMID: 32537245 PMCID: PMC7288522 DOI: 10.1186/s40945-020-00082-y] [Citation(s) in RCA: 49] [Impact Index Per Article: 12.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 05/25/2020] [Indexed: 12/22/2022] Open
Abstract
Background Placebo and nocebo effects embody psychoneurobiological phenomena where behavioural, neurophysiological, perceptive and cognitive changes occur during the therapeutic encounter in the healthcare context. Placebo effects are produced by a positive healthcare context; while nocebo effects are consequences of negative healthcare context. Historically, placebo, nocebo and context-related effects were considered as confounding elements for clinicians and researchers. In the last two decades this attitude started to change, and the understanding of the value of these effects has increased. Despite the growing interest, the knowledge and the awareness of using the healthcare context to trigger placebo and nocebo effects is currently limited and heterogeneous among physiotherapists, reducing their translational value in the physiotherapy field. Objectives To introduce the placebo, nocebo and context-related effects by: (1) presenting their psychological models; (2) describing their neurophysiological mechanisms; (3) underlining their impact for the physiotherapy profession; and (4) tracing lines for future researches. Conclusion Several psychological mechanisms are involved in placebo, nocebo and context-related effects; including expectation, learning processes (classical conditioning and observational learning), reinforced expectations, mindset and personality traits. The neurophysiological mechanisms mainly include the endogenous opioid, the endocannabinoid and the dopaminergic systems. Neuroimaging studies have identified different brain regions involved such as the dorsolateral prefrontal cortex, the rostral anterior cingulate cortex, the periaqueductal gray and the dorsal horn of spine. From a clinical perspective, the manipulation of the healthcare context with the best evidence-based therapy represents an opportunity to trigger placebo effects and to avoid nocebo effects respecting the ethical code of conduct. From a managerial perspective, stakeholders, organizations and governments should encourage the assessment of the healthcare context aimed to improve the quality of physiotherapy services. From an educational perspective, placebo and nocebo effects are professional topics that should be integrated in the university program of health and medical professions. From a research perspective, the control of placebo, nocebo and context-related effects offers to the scientific community the chance to better measure the impact of physiotherapy on different outcomes and in different conditions through primary studies.
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Affiliation(s)
- Giacomo Rossettini
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy
| | - Eleonora Maria Camerone
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy.,Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Elisa Carlino
- Department of Neuroscience, University of Turin Medical School, Turin, Italy
| | - Fabrizio Benedetti
- Department of Neuroscience, University of Turin Medical School, Turin, Italy.,Plateau Rosà Laboratories, Plateau Rosà Laboratories, Zermatt, Switzerland
| | - Marco Testa
- Department of Neuroscience, Rehabilitation, Ophtalmology, Genetics, Maternal and Child Health, University of Genova, Campus Universitario di Savona, via Magliotto 2, 17100 Savona, Italy
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