An international consensus definition for contextual factors: findings from a nominal group technique

Chad E Cook; Antoine Bailliard; Jennifer A Bent; Joel E Bialosky; Elisa Carlino; Luana Colloca; Jorge E Esteves; Dave Newell; Alvisa Palese; William R Reed; Jennifer Plumb Vilardaga; Giacomo Rossettini

doi:10.3389/fpsyg.2023.1178560

An international consensus definition for contextual factors: findings from a nominal group technique

Front Psychol. 2023 Jul 3:14:1178560. doi: 10.3389/fpsyg.2023.1178560. eCollection 2023.

Authors

Chad E Cook^{1

2

3}, Antoine Bailliard^{1

4}, Jennifer A Bent⁵, Joel E Bialosky^{6

7}, Elisa Carlino⁸, Luana Colloca⁹, Jorge E Esteves^{10

11}, Dave Newell¹², Alvisa Palese¹³, William R Reed¹⁴, Jennifer Plumb Vilardaga¹⁵, Giacomo Rossettini¹⁶

Affiliations

¹ Department of Orthopaedics, Duke University, Durham, NC, United States.
² Department of Population Health Sciences, Duke University, Durham, NC, United States.
³ Duke Clinical Research Institute, Duke University, Durham, NC, United States.
⁴ Occupational Therapy Doctorate Division, Duke University, Durham, NC, United States.
⁵ Department of Rehabilitation, Duke University Hospital System, Durham, NC, United States.
⁶ Department of Physical Therapy, University of Florida, Gainesville, FL, United States.
⁷ Brooks-PHHP Research Collaboration, Gainesville, FL, United States.
⁸ Department of Neuroscience Rita Levi Montalcini, University of Turin, Turin, Italy.
⁹ Departement of Pain and Translational Symptom Science and the Placebo Beyond Opinions Center, University of Maryland School of Nursing, Baltimore, MD, United States.
¹⁰ Clinical-Based Human Research Department, Foundation COME Collaboration, Pescara, Italy.
¹¹ Malta ICOM Educational, Gżira, Malta.
¹² Anglo-European College of Chiropractic University College, Bournemouth, United Kingdom.
¹³ Department of Medical Sciences, School of Nursing, University of Udine, Udine, Italy.
¹⁴ Department of Physical Therapy, University of Alabama at Birmingham, Birmingham, AL, United States.
¹⁵ Department of Psychiatry and Behavioral Sciences, Duke University, Durham, NC, United States.
¹⁶ School of Physiotherapy, University of Verona, Verona, Italy.

Abstract

Objective: Emerging literature suggests contextual factors are important components of therapeutic encounters and may substantially influence clinical outcomes of a treatment intervention. At present, a single consensus definition of contextual factors, which is universal across all health-related conditions is lacking. The objective of this study was to create a consensus definition of contextual factors to better refine this concept for clinicians and researchers.

Design: The study used a multi-stage virtual Nominal Group Technique (vNGT) to create and rank contextual factor definitions. Nominal group techniques are a form of consensus-based research, and are beneficial for identifying problems, exploring solutions and establishing priorities.

Setting: International.

Main outcome measures: The initial stages of the vNGT resulted in the creation of 14 independent contextual factor definitions. After a prolonged discussion period, the initial definitions were heavily modified, and 12 final definitions were rank ordered by the vNGT participants from first to last.

Participants: The 10 international vNGT participants had a variety of clinical backgrounds and research specializations and were all specialists in contextual factors research.

Results: A sixth round was used to identify a final consensus, which reflected the complexity of contextual factors and included three primary domains: (1) an overall definition; (2) qualifiers that serve as examples of the key areas of the definition; and (3) how contextual factors may influence clinical outcomes.

Conclusion: Our consensus definition of contextual factors seeks to improve the understanding and communication between clinicians and researchers. These are especially important in recognizing their potential role in moderating and/or mediating clinical outcomes.

Keywords: clinical outcomes; consensus research; contextual factors; nominal group technique; placebo.

Grants and funding

U24 AT011969/AT/NCCIH NIH HHS/United States