Ep. 13 - Dr. Mark Bishop: The Specifics of Nonspecific Effects in Therapy

At the Voice of the Patient, we are dedicated to enhancing our ability as health care providers to truly listen to others and to establish a therapeutic alliance. In some cases, we can benefit from listening to the experience and mindset of other providers, such as Dr. Mark Bishop, PT, PhD.

Dr. Bishop is an Associate Professor in the Department of Physical Therapy. Dr. Bishop received his entry-level training in Australia and has extensive experience working as a physical therapist. His research interests are in the management of musculoskeletal conditions, particularly pain, by orthopedic physical therapy. He also researches nonspecific effects in physical therapy, including the role of the expectations of providers and patients in therapeutic outcomes.

We discuss many aspects of the therapeutic alliance, including therapist expectations, patient expectations, and placebo. We talk about research from Dr. Bishop and other scientists that have tested the role of expectancy in treatment, and Dr. Bishop shares advice for providers to maximize outcomes in an evidence-based manner. 

Further reading:

• Journal articles on expectations:
  • Individual Expectation: An Overlooked, but Pertinent, Factor in the Treatment of Individuals Experiencing Musculoskeletal Pain. Bialosky, Bishop, and Cleland, 2010.
  • The influence of expectation on spinal manipulation induced hypoalgesia: An experimental study in normal subjects. By Bialosky, Bishop, et al. 2008.
  • Patient expectations of benefit from common interventions for low back pain and effects on outcome: secondary analysis of a clinical trial of manual therapy interventions. By Bishop et al., 2011.
• Journal articles on placebo:
  • Placebo response to manual therapy: something out of nothing? By Bialosky, Bishop, et al. 2011
  • Placebo, Nocebo, and Expectations: Leveraging Positive Outcomes. By Benz and Flynn, 2013. 
  • Placebo and the new physiology of the doctor-patient relationship. Benedetti, 2013. 
  • Understanding placebo and nocebo responses for pain management. Colloca and Grillon, 2014. 
• Journal articles on equipoise:
  • Review of clinical equipoise and personal equipoise. By Chad Cook and Charles Sheets. 
  • Early use of thrust manipulation versus non-thrust: RCT. Cook et al., Man Ther, 2013.
• Objective measures of expectations
  • Development of the Stanford Expectations of Treatment Scale.
  • .css-j9qmi7{display:-webkit-box;display:-webkit-flex;display:-ms-flexbox;display:flex;-webkit-flex-direction:row;-ms-flex-direction:row;flex-direction:row;font-weight:700;margin-bottom:1rem;margin-top:2.8rem;width:100%;-webkit-box-pack:start;-ms-flex-pack:start;-webkit-justify-content:start;justify-content:start;padding-left:5rem;}@media only screen and (max-width: 599px){.css-j9qmi7{padding-left:0;-webkit-box-pack:center;-ms-flex-pack:center;-webkit-justify-content:center;justify-content:center;}}.css-j9qmi7 svg{fill:#27292D;}.css-j9qmi7 .eagfbvw0{-webkit-align-items:center;-webkit-box-align:center;-ms-flex-align:center;align-items:center;color:#27292D;}