Nov 20, 2013: Jorge Fuentes: "Therapeutic Contextual Factors: Optimizing the Placebo Effect in Physiotherapy" CPA-PSD teleconference; see link to register. DESCRIPTION OF SESSION To achieve a more integrated, effective and client-centered approach to care, physiotherapy requires a comprehensive analysis of all factors that potentially could influence its clinical efficacy (Miciak et al., 2012). Variables associated with the therapist, patient, and setting may all influence clinical outcomes, in addition to the specific interventions used to address individual functional limitations. When contextual factors such as the clinician’s words, clinical environment, patient-practitioner alliance, nature of the therapist’s clothing or uniform, and the appearance and sight of the therapeutic equipment produce a positive effect on clinical outcomes they are variously known as contextual, non-specific, or placebo (Crow et al., 1999; Di Blasi et al., 2001; Benedetti, 2007). Because of the nature of therapeutic interventions (e.g. touch, care, attention), physiotherapists have an opportunity to build quality relationships with their patients. Since the placebo effect is directly associated with the degree of such interaction, the therapist becomes a major contributor to the placebo response in physiotherapy (Simmonds & Kumar 1994). While placebo is routinely present in clinical practice, researchers who have attempted to build physiotherapy’s ‘evidence base’ have consistently ignored the potential contribution of the placebo process or the non-specific factors contributing to treatment responsiveness. However, recent evidence highlights the impact of the therapeutic alliance (i.e. interaction) on pain modulation in patients with chronic low back pain (LBP) receiving physiotherapy (Fuentes et al. 2013). These results suggest that pain is context dependent, modified by contextual factors such as the therapeutic relationship between the patient and clinician. The therapeutic alliance is a concept that needs to be considered if interventions in LBP are to be more effective. By promoting nonspecific effects within therapeutic strategies, treatment responsiveness could be improved. Knowledge concerning determinants and mechanisms of placebo effects within active therapies could serve to enhance therapeutic effects through the ethical use of suggestions and optimal clinician-patient interaction. Efforts to enhance patient–clinician communication as well as systematically examining non-specific treatment factors are likely to promote effective management of chronic pain. Although further research is warranted, it seems that factors other than specific treatment may have a large role in achieving positive clinical outcomes, and exploring them is central to advancing physiotherapy practice. This session is relevant to physiotherapists working with musculoskeletal painful conditions. It may be of interest to any health professional interested in better understanding the concepts and current evidence of placebo as factor in pain modulation. Prior familiarity with these concepts is not required. OBJECTIVES Upon completion of this workshop participants will be able to: Comprehend the new conceptualization about the placebo phenomenon; Evaluate how the therapeutic context influences clinical outcomes in chronic pain; Maximize the therapeutic alliance to improve chronic pain outcomes. SPEAKER BIO Dr. Jorge Fuentes, PhD Dr. Fuentes is originally from Chile, where he completed a degree in Physical Therapy. He also completed a Master in Sciences in Rehab Sciences, and a PhD in Rehab Sciences in the Rehab Med Faculty at the University of Alberta. He is an experienced researcher with several publications, invited journal reviewer, and presentations as a guest speaker. Jorge’s research interests are in the fields of pain management and evidence-based practice. He has been involved in a number of systematic reviews, meta-analyses, and randomized controlled trials. His novel doctoral research is related to the influence of placebo and contextual factors on the physical therapy management of chronic pain.
Posted on: Wed, 09 Oct 2013 00:39:33 +0000
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