PhD defense of Léo Druart on 06/29/2023

PhD defense of Léo Druart from TIMC ThEMAS on Thursday, june 29 at 3pm:

" Bridging placebo studies with physiotherapy: An exploratory thesis."

Jury :

  • Nicolas Pinsault, Professeur, Université Grenoble Alpes, Supervisor
  • Charlotte Blease, Associate Professor, Harvard Medical School & University Uppsala, Co-Supervisor
  • Cosima Locher, Senior Scientist, University of Zurich, Co-supervisor
  • David Beard, Professor, Univerty of Oxford, Reporter
  • Jens Gaab, Professor, University of Basel, Reporter
  • Marco Annoni, Senior Scientist, National Research Council of Italy, Examiner
  • Céline Baeyens, Professeure, Université Grenoble Alpes, Examiner


bullet  Keywords

Placebo effet; Physiotherapy; Epistemology; Contextual Factors; Placebo response; Non-specific effects of care

bullet  Abstract

This thesis explores the potential for physiotherapy to learn from and contribute to placebo studies. It argues that placebo studies may offer valuable insights into how physiotherapy interventions can be optimized for patient benefit while also contributing to placebo studies. The thesis reports on three individual studies examining the use of placebo treatments and contextual factors (CFs) in physiotherapy.

The first study is a non-inferiority randomized controlled study on healthy participants that compared the effectiveness of an open-label placebo (OLP) to a deceptive placebo (DP) in relieving experimentally induced pain. The results indicate that the OLP, when delivered with an educational video, is not inferior to the DP. The second study explored the acceptability of both these treatments through semi-structured interviews of eight trial participants who had experienced either a DP or an OLP. The results suggest the acceptability of placebo treatments depends on individual preferences. Some viewed effectiveness as the primary factor in deciding whether the treatment was acceptable, while others emphasized the importance of respecting their autonomy and voiced a preference not to be deceived, even if the treatment is effective.

The third study examined the use of CFs among healthcare professions through a web-based survey. The survey was administered in French-speaking European countries and results revealed that the use of CFs may be even more widespread than placebo treatment use. Communication was the most commonly reported CF used to elicit placebo effects. Factors grouped within the therapeutic relationship and patient characteristics categories were most often employed. The results emphasized the need for further research to gain a deeper understanding of practitioner thought processes when implementing these approaches, as well as the establishment of an ethical framework to ensure their justified use.

The thesis concludes that considerably more research is required before OLPs can be clinically utilised in physiotherapy. Ethical guidelines for the use of CFs to enhance placebo effects should be developed, and education on placebo and nocebo effects, including into healthcare ethics, should be integrated into physiotherapy training and continuing education. Future research directions could focus on developing placebo controls to better evaluate the effectiveness of physiotherapy interventions.