The landscape of physical therapy is evolving. While evidence-based interventions remain the foundation of our practice, research increasingly shows that treatment success is not just about what we do but also all of the conditions surrounding the treatment [1]. Contextual factors, the often-overlooked elements surrounding a patient’s treatment experience, play a crucial role in shaping clinical outcomes, perhaps as much or more than our treatment techniques.

From the moment a patient steps into your clinic, they are influenced by a complex interplay of psychological, social, and environmental factors that shape their perception of care and, ultimately, their recovery. These factors impact patient participation, therapeutic alliance, and overall success in rehabilitation. Yet, many clinicians still focus predominantly on biomechanics and pathology, missing the broader context that contributes to meaningful change.

In this five-part series, Why Contextual Factors Will Transform Your Practice, we will delve into the essential elements that influence clinical outcomes beyond traditional interventions. We will explore how a deeper understanding of these factors can help you cultivate stronger patient relationships, enhance engagement, and improve long-term success rates.

This introductory post will set the stage by explaining why contextual factors matter, how they impact patient care, and why every physical therapist should integrate them into their practice.

The Science Behind Contextual Factors in Clinical Outcomes

The idea that factors beyond direct treatment influence recovery is not new. Research by Rossettini et al. [2] and others has demonstrated that contextual factors—such as patient expectations, the therapeutic alliance, and the clinician’s communication style—can significantly affect pain perception, adherence to treatment, and overall patient satisfaction.

Consider the placebo and nocebo effects. Studies show that patients’ beliefs about their treatment, shaped by factors like clinician confidence, empathy, and communication, can directly influence physiological responses [2]. If a patient believes a treatment will help, their body often responds positively, even if the intervention itself is inert. Conversely, if a patient doubts the effectiveness of an approach or senses uncertainty from their therapist, outcomes may be less favorable—even with the most well-supported treatment plans.

What does this mean for you as a clinician? It means that understanding and leveraging these factors is just as important as choosing the right exercises or manual therapy techniques. Your ability to create a positive, engaged, and trusting therapeutic environment is critical to success.

The Five Key Contextual Factors We Will Explore

Each post in this series will provide an in-depth look at one of the five essential contextual factors that shape patient outcomes:

1. The Patient – Patients bring their own expectations, fears, and past experiences into the clinic. This post will explore how to assess and shape expectations to improve engagement and adherence.
2. The Therapist – How you deliver information matters just as much as what you say. We’ll cover effective communication strategies, verbal and nonverbal cues, and ways to cultivate an empathetic and confident presence.
3. The Therapeutic Relationship – A strong patient-provider relationship is the foundation of effective care. We’ll discuss the key components of the therapeutic alliance—bond, agreement on goals, and agreement on tasks—and provide strategies to strengthen it in your clinical practice.
4. The Treatment – The way interventions are framed and delivered can impact patient response. We’ll examine how treatment expectations, perceived effectiveness, and clinician confidence shape outcomes.
5. The Environment – A patient’s social support, work environment, and psychological state all contribute to recovery. This section will discuss how to integrate psychologically informed care (PIP) to address these influences and tailor treatment accordingly.

Why This Matters for Your Practice

If you’ve ever treated a patient who should be improving based on their diagnosis and prescribed interventions but isn’t, contextual factors may be the missing link. Patients are not just biomechanical puzzles to be solved—they are individuals with unique beliefs, emotions, and life circumstances that shape their healing process.

By integrating these principles into your practice, you can:

• Improve patient engagement and adherence to treatment plans.
• Reduce frustration when patients don’t respond as expected.
• Enhance patient satisfaction and trust in your care.
• Foster long-term success beyond the treatment room.

Incorporating an understanding of contextual factors does not require abandoning evidence-based practice; rather, it enhances it. When combined with skilled clinical reasoning and high-quality interventions, these insights create a powerful, patient-centered approach to care.

What to Expect in the Series

Each post in this series will provide practical strategies, real-world examples, and actionable steps to help you integrate these concepts into your daily clinical interactions. Our goal is to empower you with the knowledge and skills to create a more engaging, effective, and fulfilling practice.

As you follow along, consider reflecting on your own experiences:

• Have you noticed patients responding differently based on how you communicate?
• Do you see differences in engagement between patients with strong versus weak therapeutic alliances?
• How often do you explore a patient’s expectations before beginning treatment?

These reflections will help you connect the material in this series to your real-world practice, making the concepts more tangible and applicable.

Join the Conversation

This series is just the beginning of a larger discussion on how physical therapists can evolve their approach to create better patient outcomes. We encourage you to share your thoughts, experiences, and questions as we explore each topic in depth.

We’ll also be sharing bite-size insights and takeaways on Instagram and LinkedIn to keep the conversation going.

Are you ready to transform your practice by understanding the factors that truly drive success?

Read the first installment!

It Starts With the Patient: Why Contextual Factors Will Transform Your Practice

Let’s elevate physical therapy together—one informed interaction at a time.

Looking for More?

This blog series is just a small window into the larger framework we teach inside our full course at Patient Success Systems.

If you’re finding this content useful, the course offers a deeper, more structured path. We explore the science behind contextual factors, break down communication strategies, and provide practical tools you can use to improve outcomes—day in and day out.

Whether you're new to these ideas or ready to refine your skills, the course is designed to meet you where you are and support your growth as a clinician who leads with thoughtfulness and precision.

👉 Learn more about the full course here.
Because when you strengthen the context around care, everything changes.

1. Ezzatvar, Y., Dueñas, L., Balasch-Bernat, M., Lluch-Girbés, E., & Rossettini, G. (2024). Which portion of physiotherapy treatments’ effect is not attributable to the specific effects in people with musculoskeletal pain? A meta-analysis of randomized placebo-controlled trials. JOSPT, 54(6), 391-399.

Rossettini, G., Camerone, E. M., Carlino, E., Benedetti, F., & Testa, M. (2020). Context matters: the psychoneurobiological determinants of placebo, nocebo and context-related effects in physiotherapy. Archives of Physiotherapy, 10, 1-12.