From Concept to Practice: Integrating Contextual Factors into Neurorehabilitation Among Physical Therapists

Abstract

Background

Neurological disorders are the leading cause of global disability. To enhance neurorehabilitation effectiveness, it is essential to consider contextual factors that influence patient outcomes and the overall experience.

Objective

This study aimed to examine the integration of contextual factors into neurorehabilitation practice among physical therapists, focusing on their frequency of use, associated beliefs, ethical considerations, and communication strategies.

Methods

A cross-sectional web-based survey was disseminated to a convenience sample of physical therapy professionals via various online platforms. The survey collected demographic data and information regarding the integration of contextual factors into neurorehabilitation practice.

Results

A total of 369 physical therapists completed the survey. Respondents reported moderate use of contextual factors (43%), with verbal communication (85%), positive attitude (82%), and physical contact (75%) the most frequently employed factors. The strongest beliefs about the influence of contextual factors on therapeutic outcomes were linked to verbal communication and optimistic behavior. No significant correlations were found between respondents’ characteristics and the use of contextual factors.

Conclusion

Physical therapists recognize the importance of contextual factors such as verbal communication, positive attitudes, and a professional approach in neurorehabilitation. Enhanced training is recommended to further integrate these factors into neurorehabilitation practice and optimize patient outcomes.

Keywords

communication ethics placebo effect physical therapy patient outcomes

Get full access to this article

View all access options for this article.

References

Adams

Weatherall

Bell

(2019). A cohort study of the association between psychosocial factors and pain in patients with spinal cord injury and stroke. NeuroRehabilitation, 45(3), 419–427. https://doi.org/10.3233/NRE-192872

Almarwani

Aldawsary

(2023). Is it only nice in theory? Implementation of motor learning principles in neurorehabilitation among Saudi physical therapists. NeuroRehabilitation, 53(3), 385–395. https://doi.org/10.3233/NRE-230071

Bishop

M. D.

Mintken

Bialosky

J. E.

Cleland

J. A.

(2019). Factors shaping expectations for complete relief from symptoms during rehabilitation for patients with spine pain. Physiotherapy Theory and Practice, 35(1), 70–79. https://doi.org/10.1080/09593985.2018.1440676

Boers

Kirwan

J. R.

Wells

Beaton

Gossec

d'Agostino

M. A.

Conaghan

P. G.

Bingham III

C. O.

Brooks

Landewé

March

(2014). Developing core outcome measurement sets for clinical trials: OMERACT filter 2.0. Journal of Clinical Epidemiology, 67(7), 745–753. https://doi.org/10.1016/j.jclinepi.2013.11.013

Cieza

Causey

Kamenov

Hanson

S. W.

Chatterji

Vos

(2020). Global estimates of the need for rehabilitation based on the Global Burden of Disease study 2019: A systematic analysis for the global burden of disease study 2019. Lancet, 396(10267), 2006–2017. https://doi.org/10.1016/S0140-6736(20)32340-0

Daniel

W. W.

Cross

C. L.

(2018). Biostatistics: A foundation for analysis in the health sciences (11th ed.). John Wiley & Sons.

Danzl

M. M.

Etter

N. M.

Andreatta

R. D.

Kitzman

P. H.

(2012). Facilitating neurorehabilitation through principles of engagement. Journal of Allied Health, 41(1), 35–41.

Di Blasi

Harkness

Ernst

Georgiou

Kleijnen

(2001). Influence of context effects on health outcomes: A systematic review. Lancet, 357(9258), 757–762. https://doi.org/10.1016/S0140-6736(00)04169-6

Druart

Bailly-Basin

Dolgopoloff

Rossettini

Blease

Locher

Kubicki

Pinsault

(2023). Using contextual factors to elicit placebo and nocebo effects: An online survey of healthcare providers’ practice. PloS One, 18(9), e0268459. https://doi.org/10.1371/journal.pone.0291079

10.

Feigin

V. L.

Vos

Nichols

Owolabi

M. O.

Carroll

W. M.

Dichgans

Deuschl

Parmar

Brainin

Murray

(2020). The global burden of neurological disorders: Translating evidence into policy. Lancet Neurology, 19(3), 255–265. https://doi.org/10.1016/S1474-4422(19)30411-9

11.

Hall

A. M.

Ferreira

P. H.

Maher

C. G.

Latimer

Ferreira

M. L.

(2010). The influence of the therapist-patient relationship on treatment outcome in physical rehabilitation: A systematic review. Physical Therapy, 90(8), 1099–1110. https://doi.org/10.2522/ptj.20090245

12.

Hufford

D. J.

(2003). Evaluating complementary and alternative medicine: The limits of science and of scientists. Journal of Law, Medicine & Ethics, 31(2), 198–212. https://doi.org/10.1111/j.1748-720X.2003.tb00081.x

13.

Ingram

Fell

Cotten

Elder

Hollis

(2011). Patient preference, perceived practicality, and confidence associated with physical therapist attire: A preliminary study. HPA Resource, 11(2), pJ2.

14.

Jesus

T. S.

Landry

M. D.

Hoenig

(2019). Global need for physical rehabilitation: Systematic analysis from the global burden of disease study 2017. International Journal of Environmental Research and Public Health, 16(6), 980. https://doi.org/10.3390/ijerph16060980

15.

Jesus

T. S.

Papadimitriou

Bright

F. A.

Kayes

N. M.

Pinho

C. S.

Cott

C. A.

(2022). Person-centered rehabilitation model: Framing the concept and practice of person-centered adult physical rehabilitation based on a scoping review and thematic analysis of the literature. Archives of Physical Medicine and Rehabilitation, 103(1), 106–120. https://doi.org/10.1016/j.apmr.2021.05.005

16.

Katz

D. I.

Dwyer

(2021). Clinical neurorehabilitation: Using principles of neurological diagnosis, prognosis, and neuroplasticity in assessment and treatment planning. Seminars in Neurology, 41(02), 111–123. https://doi.org/10.1055/s-0041-1725132

17.

Knittle

De Gucht

Maes

(2012). Lifestyle- and behaviour-change interventions in musculoskeletal conditions. Best Practice & Research Clinical Rheumatology, 26(3), 293–304. https://doi.org/10.1016/j.berh.2012.05.002

18.

Lange

Danielsson

(2024). Reaching for connection: A qualitative study of communication and interaction in video-based physiotherapy. Physiotherapy Theory and Practice, 40(12), 2865–2876. https://doi.org/10.1080/09593985.2023.2296574

19.

Langhorne

Bernhardt

Kwakkel

(2011). Stroke rehabilitation. The Lancet, 377(9778), 1693–1702. https://doi.org/10.1016/S0140-6736(11)60325-5

20.

Légaré

Stacey

Pouliot

Gauvin

F. P.

Desroches

Kryworuchko

Dunn

Elwyn

Frosch

Gagnon

M. P.

Harrison

M. B.

(2011). Interprofessionalism and shared decision-making in primary care: A stepwise approach towards a new model. Journal of Interprofessional Care, 25(1), 18–25. https://doi.org/10.3109/13561820.2010.490502

21.

Leplege

Gzil

Cammelli

Lefeve

Pachoud

Ville

(2007). Person-centredness: Conceptual and historical perspectives. Disability and Rehabilitation, 29(20-21), 1555–1565. https://doi.org/10.1080/09638280701618661

22.

Mairami

F. F.

Warren

Allotey

P. A.

Reidpath

D. D.

(2020). Contextual factors that shape recovery after stroke in Malaysia. Disability and Rehabilitation, 42(22), 3189–3198. https://doi.org/10.1080/09638288.2019.1588399

23.

Melin

Nordin

Feldthusen

Danielsson

(2021). Goal-setting in physiotherapy: Exploring a person-centered perspective. Physiotherapy Theory and Practice, 37(8), 863–880. https://doi.org/10.1080/09593985.2019.1655822

24.

Mercer

MacKay-Lyons

Conway

Flynn

Mercer

(2008). Perceptions of outpatients regarding the attire of physiotherapists. Physiotherapy Canada, 60(4), 349–357. https://doi.org/10.3138/physio.60.4.349

25.

O'Keeffe

Cullinane

Hurley

Leahy

Bunzli

O'Sullivan

P. B.

O'Sullivan

(2016). What influences patient-therapist interactions in musculoskeletal physical therapy? Qualitative systematic review and meta-synthesis. Physical Therapy, 96(5), 609–622. https://doi.org/10.2522/ptj.20150240

26.

Oyake

Sue

Sumiya

Tanaka

(2023). Physical therapists use different motivational strategies for stroke rehabilitation tailored to an individual’s condition: A qualitative study. Physical Therapy, 103(6), pzad034. https://doi.org/10.1093/ptj/pzad034

27.

Palese

Rossettini

Colloca

Testa

(2019). The impact of contextual factors on nursing outcomes and the role of placebo/nocebo effects: A discussion paper. Pain Reports, 4(3), e716. https://doi.org/10.1097/PR9.0000000000000716

28.

Parry

R. H.

(2004). Communication during goal-setting in physiotherapy treatment sessions. Clinical Rehabilitation, 18(6), 668–682. https://doi.org/10.1191/0269215504cr745oa

29.

Peiris

C. L.

Taylor

N. F.

Shields

(2012). Patients value patient-therapist interactions more than the amount or content of therapy during inpatient rehabilitation: A qualitative study. Journal of Physiotherapy, 58(4), 261–268. https://doi.org/10.1016/S1836-9553(12)70128-5

30.

Pinto

R. Z.

Ferreira

M. L.

Oliveira

V. C.

Franco

M. R.

Adams

Maher

C. G.

Ferreira

P. H.

(2012). Patient-centered communication is associated with positive therapeutic alliance: A systematic review. Journal of Physiotherapy, 58(2), 77–87. https://doi.org/10.1016/S1836-9553(12)70087-5

31.

Purcell

Langridge

(2025). Redefining the role of physiotherapy in modern healthcare: A shift from pain relief to functional empowerment. Physiotherapy, 128, 101783. https://doi.org/10.1016/j.physio.2025.101783

32.

Rehman

S. U.

Nietert

P. J.

Cope

D. W.

Kilpatrick

A. O.

(2005). What to wear today? Effect of doctor's attire on the trust and confidence of patients. American Journal of Medicine, 118(11), 1279–1128. https://doi.org/10.1016/j.amjmed.2005.04.026

33.

Roberts

Bucksey

S. J.

(2007). Communicating with patients: What happens in practice? Physical Therapy, 87(5), 586–594. https://doi.org/10.2522/ptj.20060077

34.

Rossettini

Camerone

E. M.

Carlino

Benedetti

Testa

(2020). Context matters: The psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy. Archives of Physiotherapy, 10(1), 1–12. https://doi.org/10.1186/s40945-020-00082-y

35.

Rossettini

Palese

Geri

Fiorio

Colloca

Testa

(2018). Physical therapists’ perspectives on using contextual factors in clinical practice: Findings from an Italian national survey. PLoS ONE, 13(11), e0191234. https://doi.org/10.1371/journal.pone.0208159

36.

Sherriff

Clark

Killingback

Newell

(2023). Musculoskeletal practitioners’ perceptions of contextual factors that may influence chronic low back pain outcomes: A modified delphi study. Chiropractic & Manual Therapies, 31(1), 12. https://doi.org/10.1186/s12998-023-00482-4

37.

Steinmetz

J. D.

Seeher

K. M.

Schiess

Nichols

Cao

Servili

Cavallera

Cousin

Hagins

Moberg

M. E.

Mehlman

M. L.

(2024). Global, regional, and national burden of disorders affecting the nervous system, 1990–2021: A systematic analysis for the Global Burden of Disease Study 2021. The Lancet Neurology, 23(4), 344–381. https://doi.org/10.1016/S1474-4422(24)00038-3

38.

Testa

Rossettini

(2016). Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes. Manual Therapy, 24, 65–74. https://doi.org/10.1016/j.math.2016.04.006

39.

Turner-Stokes

Williams

Johnson

(2009). Goal attainment scaling: Does it provide added value as a person-centred measure for evaluation of outcome in neurorehabilitation following acquired brain injury? Journal of Rehabilitation Medicine, 41(7), 528–535. https://doi.org/10.2340/16501977-0383

40.

Wassinger

C. A.

Edwards

D. C.

Bourassa

Reagan

Weyant

E. C.

Walden

R. R.

(2022). The role of patient recovery expectations in the outcomes of physical therapist intervention: A systematic review. Physical Therapy, 102(4), pzac008. https://doi.org/10.1093/ptj/pzac008

41.

Winstein

C. J.

(2018). Thoughts about the negative results of clinical trials in rehabilitation medicine. Kinesiology Review, 7(1), 58–63. https://doi.org/10.1123/kr.2017-0063

42.

Winstein, C. (2024). Chapter 12 - Goal-oriented action: new perspectives with special emphasis on neurorehabilitation. In M. F. Levin, M. Petrarca, D. Piscitelli, & S. Summa (Eds.), Progress in motor control (pp. 349–387). Academic Press. https://www.sciencedirect.com/science/article/pii/B978044323987800002X

43.

World Health Organization. (2001). International Classification of Functioning, Disability and Health (ICF). Available from: https://www.who.int/classifications/international-classification-of-functioning-disability-and-health. Accessed March 18, 2024.

44.

World Physiotherapy. (2021). Annual membership census. Available from: https://world.physio/sites/default/files/2021-12/AMC2021-Saudi-Arabia.pdf. Accessed March 18, 2024.

45.

Zou

Wong

Abdullah

Chen

Smith

Doherty

Zhang

(2016). Examination of overall treatment effect and the proportion attributable to contextual effect in osteoarthritis: A meta-analysis of randomized controlled trials. Annals of the Rheumatic Diseases, 75(11), 1964–1970. https://doi.org/10.1136/annrheumdis-2015-208387