Placebo workshop @ the DCRM congress

Ruud Selles, Mark van der Oest, Robbert Wouters and Harm Slijper gave a workshop on how to maximize the placebo effect in rehabilitation medicine. At the Fabrique in Utrecht we gave four short talks:

• Introduction on placebo effects in healthcare

• Expectations in surgical and non-surgical treatment of thumb-base osteoarthritis and the effects on outcome

• The effects of patient's healtcare experiences on patient and clinician rated outcomes

• Designing care to optimize expectations

Followed by a lively discussion on the following statements:

• Science indicates that higher expectations lead to better outcomes. Clinicians often try to avoid overly-positive expectations. Are science and clinical practice indeed in conflict with each other? Should clinicians change their approach to managing expectations? Or is there another way around it?

• When you treat a patient, are you aware of his/her expectations about the treatment when treatment starts? Do you measure expectations or explicitly ask about it? What would you do when a patient has very low expectations?

• If you assume that positive expectations contribute to better treatment results, and if you look at current practice in rehabilitation, what are current mechanisms or practices contributing to higher expectations (placebo)? Are current mechanisms or practices contributing to lower expectations (nocebo)? What are the three main things that could be done better?

• Is it always okay to optimize placebo effects or only if there is also a (scientifically proven) ‘specific’ treatment effect?