title: Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes.
abstract: BACKGROUND
  Placebo and nocebo represent complex and distinct psychoneurobiological phenomena in which behavioural and neurophysiological modifications occur together with the application of a treatment. Despite a better understanding of this topic in the medical field, little is known about their role in physiotherapy.
  
  
  OBJECTIVE
  The aim of this review is: a) to elucidate the neurobiology behind placebo and nocebo effects, b) to describe the role of the contextual factors as modulators of the clinical outcomes in rehabilitation and c) to provide clinical and research guidelines on their uses.
  
  
  CONCLUSIONS
  The physiotherapist's features, the patient's features, the patient-physiotherapist relationship, the characteristics of the treatment and the overall healthcare setting are all contextual factors influencing clinical outcomes. Since every physiotherapy treatment determines a specific and a contextual effect, physiotherapists should manage the contextual factors as a boosting element of any manual therapy to improve placebo effects and avoid detrimental nocebo effects.
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy. Electronic address: marco.testa@unige.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Testa
authors.affiliation: Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, University of Genova, Campus of Savona, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Rossettini
mesh_terms: D006801:Humans; D009140:Musculoskeletal Diseases / Q000628:therapy*; D026201:Musculoskeletal Manipulations / Q000379:methods*; D064786:Nocebo Effect; D059408:Pain Management / Q000379:methods*; D026741:Physical Therapy Modalities; D015990:Placebo Effect; D016896:Treatment Outcome
keywords: Musculoskeletal manipulations; Nocebo effect; Pain; Physical and rehabilitation medicine; Physical therapy modalities; Placebo effect