What does this research mean for the field?

There is a severe scarcity of direct clinical evidence in the physiotherapy literature regarding the impact of contextual factors on pain perception and recovery in musculoskeletal rehabilitation, with current claims relying primarily on indirect or conceptual sources. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.NEUTRAL.

What question did this study set out to answer?

To map how contextual factors are represented in indexed physiotherapy literature and determine the extent of empirical evidence in musculoskeletal rehabilitation.

August 23, 2026Journal of Clinical MedicineOpen Access

More than Rehabilitation: The Role of Contextual Factors in Pain Perception and Recovery: What the Physiotherapy Literature Reports—A Narrative Review with a Systematic Search Strategy

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Authors

GLGiulia C. LeonardiCentre National de la Recherche Scientifique FBF. BonannoUniversity of Messina AAAngelo AlitoUniversity of Messina

Discussion

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Implication

Narrative review reveals an absence of direct clinical evidence for contextual factors in musculoskeletal rehabilitation, highlighting a reliance on indirect and conceptual frameworks.

Key Points

To map how contextual factors are represented in indexed physiotherapy literature and determine the extent of empirical evidence in musculoskeletal rehabilitation.
Conducted a narrative review with a systematic search across PubMed and Scopus following SANRA guidelines for English-language records published from 2006 onward.
Appraised methodological quality using the Cochrane RoB2 tool for randomized trials and an adapted Newcastle–Ottawa Scale for observational and cross-sectional studies.
Categorized 8 included publications into direct clinical evidence (Tier A), indirect mechanistic or implementation evidence (Tier B), or conceptual contributions (Tier C).
Zero of the 8 included publications provided direct clinical evidence in a musculoskeletal rehabilitation population (Tier A), whereas 5 provided Tier B indirect evidence and 3 provided Tier C conceptual frameworks.
The single identified randomized controlled trial was conducted in asymptomatic volunteers and showed a high risk of bias for between-group comparisons across all outcomes.
Evidence supporting the roles of patient expectations, therapeutic alliance, non-verbal communication, and clinical environment currently rests entirely on indirect or conceptual literature.

Cite This Study

Leonardi et al. (2026) studied this question.

synapsesocial.com/papers/6a8aadd57677a3411444639a https://doi.org/10.3390/jcm15166489

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Implication

Narrative review reveals an absence of direct clinical evidence for contextual factors in musculoskeletal rehabilitation, highlighting a reliance on indirect and conceptual frameworks.

More than Rehabilitation: The Role of Contextual Factors in Pain Perception and Recovery: What the Physiotherapy Literature Reports—A Narrative Review with a Systematic Search Strategy

Discussion

Member takes

Implication

Key Points

Cite This Study

More than Rehabilitation: The Role of Contextual Factors in Pain Perception and Recovery: What the Physiotherapy Literature Reports—A Narrative Review with a Systematic Search Strategy

Discussion

Member takes

Implication

Key Points

Cite This Study

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