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Background Context effects are well known and were described as integral part of the clinical setting (1). The conscious use of contextual factors (CF) has been recently proposed as an effective modality capable to influence the physiotherapy outcome by facilitation of placebo responses. (2) To date, the knowledge about CF adoption in clinical practice of physical therapists is absent. Objectives The aim of this study was to investigate frequency of use, beliefs and attitudes about contextual factors among Italian physical therapists specialized in manual therapy (OMTs) Methods An invitation to participate in an online survey was sent to 906 OMTs through the database of the Master in Musculoskeletal Rehabilitation (MRDM) of University of Genova by SurveyMonkey Software®. These likely correspond to more than 85% of the whole OMTs population in Italy. A 17 items questionnaire and two clinical scenarios assessed behaviour, beliefs and attitudes of OMTs about CF adoption in clinical practice and data were analysed by descriptive statistic. Results 906 OMTs were invited to participate in the survey and 558 responded (62%). The majority of OMTs uses CF in their practice frequently (52%). They believe that an actual effect of CF can occur in acute pain (57%), chronic pain (78%) and rheumatologic disorders (56%). OMTs consider the use of CF ethically acceptable when it exerts beneficial psychological effects and their effectiveness was shown during clinical experience (31%). They disagree on the adoption of CF when they are based on deception, undermine the trust between OMT and patients, create legal problems or produce side effects (17%). 38% of respondents do not communicate the use of CF to their patients and they adopt CF as addition to other physical therapy interventions with the aim of optimizing clinical responses (20%). Expectation and psychological mechanisms are believed to be the main aspects behind placebo and nocebo effects induced by CF (7%). Conclusions The use of CF is quite common among Italian OMTs and they mostly had positive attitudes towards their use and effectiveness. References Di Blasi Z, Harkness E, Ernst E, Georgiou A, Kleijnen J. Influence of context effects on health outcomes: a systematic review. Lancet. 2001 Mar 10;357(9258):757–62. Testa M, Rossettini G. Enhance placebo, avoid nocebo: How contextual factors affect physiotherapy outcomes. Man Ther. 2016;24:65–74. Disclosure of Interest None declared

Background Placebo and nocebo represent psycho-neuro-immuno-endocrinological responses commonly encountered in nursing care (1,2). A new paradigm proposed the contextual factors (CF) as mediators and moderators of these responses (3). To date, the knowledge about the awareness of CF and their use in nursing is scant. Objectives The goal of this study was to examine frequency of use, beliefs and attitudes of Italian specialised nurses regarding the contextual factors. Methods In December 2016, through SurveyMonkey Software®, an online survey was conducted by sending a questionnaire to the members of four Italian Nursing Association, grouping nurses specialized in Neuroscience, Medical, Geriatric and Diabetic care. Behaviours, beliefs and attitudes of nurses about the implementation of CF in clinical practice were assessed by a 17 items questionnaire and resulting data were analysed by descriptive statistic. Results Of the 1411 members of the involved Nursing Associations invited to participate to the survey 425 responded (30.1%). An high number of respondent nurses adopts CF often in their practice (42%). They believe that CF can positively influence acute pain (47.5%), chronic pain (61%) and rheumatologic disorders (42%). 34% of responders consider the use of CF, if it can determine beneficial psychological effects, as ethically accep table. 15.5% responders oppose to the adoption of CF when based on deception or if they undermines trust between nurses and patients. A relevant number of nurses (24%) do not communicate the use of CF to their patients and 19% implement CF as addition to other nursing interventions to optimize clinical responses. Nurses explain the power of CF through patient9s expectation and psychological mechanism (11%). Conclusions The Italian specialised nurses use CF quite frequently and believe that their use has the capacity of positively influencing the clinical outcome. Larger surveys are needed to understand the proportion of use of CF by nurses in common clinical practice in Italy. References Miller LR, Miller FG. Understanding placebo effects: Implications for nursing practice. Nurs Outlook. 2015 Sep-Oct;63(5):601–6. Hauser W, Hansen E, Enck P. Nocebo phenomena in medicine: their relevance in everyday clinical practice. Dtsch Arztebl Int. 2012 Jun;109(26):459–65. Palese A, Rossettini G, Testa M. Placebo and nocebo responses in nursing practice: a discussion paper on the role of contextual factors. In revision at Nurs Inq. Disclosure of Interest None declared