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The role of expectancies in the placebo effect and their use in the delivery of health care: a systematic review.

University of Surrey, Systematic Review Group, UK.
Health technology assessment (Winchester, England) (Impact Factor: 5.12). 02/1999; 3(3):1-96.
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    ABSTRACT: Background: Trust and expectation are important aspect of doctor patient relationship and its role in patient's satisfaction and medication adherence is unclear. Objective: To study the levels of trust and expectation on psychiatrist and its relationship with patient's satisfaction and treatment adherence. Methods: One hundred and twenty three consecutive outpatients were recruited on follow-up if they satisfied the selection criteria. They were assessed with socio-demographic and clinical proforma designed for this study, Patient Trust Scale, Patient Satisfaction Survey, Patient Expectations Questionnaire and Medication Adherence Rating Scale. Results: There was a high mean score on trust scale (Mean 38.9, SD 8.5) and expectation questionnaire (Mean 13.5, SD 3.3). On Kruskal-Wallis H test significant group differences were observed in nuclear vs joint family type (c 2 = 18.496, h 2 = .151, df = 1, Sig. = .000) and knowledge of treatment option (medication only vs medication + psychotherapy) treatment option (c 2 = 18.100, h 2 = .148, df = 2, Sig. = .000) and occupational status (employed vs unemployed) (c 2 = 3.165, h 2 =.029, df = 1, Sig. = .056) on the score of PTS. Similar differences were also observed in method of treatment sought before (no treatment vs allopathic) (c 2 = .065, h 2 = .065, df = 3, Sig. = .005), knowledge about treatment option (medication only vs medication + psychotherapy) (c 2 = .026, h 2 = .161, df = 2, Sig. = .000) and occupation (employed vs unemployed) (c 2 = .061, h 2 = .061, df = 1, Sig. = .006) on the score of PEQ. On regression analysis (R 2 = .723, F = 156.46, p = .000) value of the score on patient satisfaction was statistically significant as predicted by score on measure of expectation (beta =-0.095, t =-1.966, p = 0.052) and trust (beta = .842, t = 17.504, p = .000). Discussion: Levels of patients trust and expectation on physician varies with knowledge about treatment option & occupational status, and significantly associated with levels of satisfaction. Ram D, Gowdappa B / Arch Clin Psychiatry. 2015;42(1):13-7
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    ABSTRACT: Background. Therapeutic ultrasound (US) is an electrophysical therapy that is commonly used by sports physiotherapists, but its mechanism of action is unclear. There is little evidence that US therapy is more effective than sham US therapy, and any clinical benefits may be due to a placebo effect. Objective. To investigate whether US has a specific effect that renders it effective in its own right, or whether its effect is placebo driven. Methods. In a double-blind controlled trial, delayed-onset muscle soreness (DOMS) was experimentally induced in both bicep muscles of 15 females. Sham US was applied to one bicep (n=15 biceps) and pulsed active US to the other bicep (n=15 biceps) of each participant, 48 and 72 h after induction of DOMS. Primary and secondary outcomes were pain reported on the McGill Pain Questionnaire (MPQ) and range of movement (ROM) (elbow extension) measured by goniometry, respectively. Results. Results showed significant improvements in pain and ROM over the intervention periods, but there was no difference between interventions. Conclusion. US and sham US therapy improve pain equally when treating DOMS of the biceps in the context of a therapeutic encounter. This analgesic effect is placebo driven. Clinicians can influence the analgesic effect of US by managing the therapeutic context. Management of patients' anxiety may also boost the analgesic effect of US. Therapeutic ultrasound (US) is an electrophysical therapy that is commonly used by sports physiotherapists, but its mechanism of action is unclear. [1] There is little evidence that US therapy is more effective than sham US therapy, and any clinical benefits may be due to a placebo effect. [2] The term 'placebo effect' is used when a treatment that is known to have no specific physiological efficacy produces a positive therapeutic outcome. It is heavily reliant on the context of treatment and on the patient's expectation of benefit. [3] Physiotherapists enhance placebo value by using positive therapeutic relationships and educating their patients about the anticipated effects of treatment. [4] Delayed-onset muscle soreness (DOMS) is pain or discomfort that develops in muscles after exercise that is unfamiliar. [5] DOMS is self-limiting and easily induced experimental setting. Clinical findings include muscular tenderness and loss of range of movement (ROM), flexibility and strength. Symptoms develop gradually and peak after 24-48 h, resolving within 72 h. [6] The efficacy of US in treatment of DOMS has been investigated by a few studies of poor methodological quality. [2] Methods This study investigated the effect of US in the treatment of DOMS, and was designed to explore whether US has a specific effect, or whether it works via a placebo effect. A double-blind controlled trial was designed to compare the effects of active US v. sham US on the symptoms of experimentally induced DOMS of the biceps muscle group. The primary outcome was pain, measured by the McGill Pain Questionnaire (MPQ);
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    ABSTRACT: Placebo effects are documented in a number of clinical and experimental studies. It is possible to benefit from placebo effects in clinical practice by using them as effects additive to those of documented and effective treatments. The purpose of this paper is to discuss how doctors and other health workers may benefit from placebo effects within an ethical framework. A narrative review of the literature relating to placebo effects in clinical practice was performed. We searched PubMed and selected textbooks on placebo effects for articles and book chapters relating to placebo effects in clinical practice. By drawing on placebo effects, doctors may access patients’ self-healing potentials. In practice, doctors may best benefit from placebo effects by influencing the patient’s expectations through communication. An important principle is to give the patient information stating that a particular treatment is effective, as long as this is based on realistic optimism. A patient-centered style involving elements such as developing trust and respect, exploring the patient’s values, speaking positively about treatments, and providing reassurance and encouragement might aid in activating placebo effects. The total effect of a documented treatment will partly depend on how well the placebo effects have been activated. Thus, placebo effects can be understood as a form of supplemental treatment.
    Psychology Research and Behavior Management 01/2015; 8:41-45. DOI:10.2147/PRBM.S75670

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