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Exploiting the placebo effect can improve recovery of heart surgery patients

January 09, 2017

Exploiting the placebo effect significantly improved the recovery of patients undergoing heart surgery according to new research published in the open access journal BMC Medicine.

Patients that were given psychological support to raise their expectations about post-surgery recovery scored lower on disability tests, had a better mental quality-of-life, reported more hours of physical activity and better fitness for work six months after surgery, compared to those that received no additional support.

Professor Winfried Rief, lead author from the University of Marburg, Germany, said: "Patients who received any level of psychological support prior to surgery were better off six months after surgery. Personalizing the patients' support by offering specific guidance on how they can achieve a faster, better recovery appeared to have the greatest benefit. Doctors should assess their patient's expectations individually to work out what level of support would be most useful. Our study also shows that a short-term psychological intervention is feasible and can be implemented easily into a cardiac surgery unit. There is also potential for cost savings as patients end up spending less time in the hospital".

This is the first time the placebo effect has been studied in heart surgery outcomes from a pre-operative perspective and is the first to study the effects in a controlled trial.

Professor Rief explained: "Our study sets out a model that can be followed to further study placebo effects for long-term patient outcomes. We utilized a 'dose' of placebo by creating three test groups that all received different levels of psychological support. Compared to the group receiving standard medical care, both of the groups receiving some level of psychological support had better recovery."

The researchers split 124 patients into three groups, an 'expect' group receiving psychological support from a therapist who specifically aimed to raise expectations, a 'support' group who received the same amount of time with the therapist but did not discuss expectations and a control group who received no additional psychological support. Data on the patient's mental quality-of-life, disability, fitness for work and physical activity levels were collected prior to the study and six months after surgery.

People in the 'expect' group were put through specific mental exercises to raise their expectations about recovery. They were asked to explain what they wanted to achieve post-surgery, how they thought they might recover and how they would return to a normal life. The therapist helped to draw up personalised plans for how the patient could achieve their goals and the patient was able to take all the notes and audio recordings with them after the session.

Professor Rief said: "We noticed a substantial effect of raising pre-operative expectations on the patient's disability and mental quality-of-life six months after surgery. This suggests that by exploiting the placebo effect we can add to the lifesaving aspects of surgery by improving recovery and psychological wellbeing of our patients."

Professor Rief added: "One patient involved in our study contacted us afterwards by sending a postcard from Italy explaining how happy she was to be able to travel. She did not think she would be able to until she had the psychological intervention. This anecdote highlights the importance of making the most of placebos to improve patient quality-of-life".

Placebo mechanisms are known to contribute substantially to the efficacy of clinical treatments. Placebo effects have been shown to effect patient-reported outcomes such as pain as well as measured clinical factors, including for example cardiovascular parameters and biological markers of the immune system. Labelling of treatments, how they are presented to patients and who presents them have all been shown to influence the placebo effect.
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Notes to editor:

1. Research article:

Preoperative optimization of patient expectations improves long-term outcome in heart surgery patients: Results of the randomized controlled PSY-HEART trial
Rief et al.
BMC Medicine 2017

DOI: 10.1186/s12916-016-0767-3

During embargo period please contact Matthew Lam for the full article.

After the embargo lifts, the article will be available at the journal website here: https://bmcmedicine.biomedcentral.com/articles/10.1186/s12916-016-0767-3

Please name the journal in any story you write. If you are writing for the web, please link to the article. All articles are available free of charge, according to BioMed Central's open access policy.

2. With an ethos of transparency and accessibility, BMC Medicine is an open access, open peer-reviewed general medical journal publishing outstanding and influential research in all areas of clinical practice, translational medicine, public health, policy, and general topics of interest to the biomedical research community. As the flagship medical journal of the BMC series, we also publish stimulating debates and reviews as well as unique forum articles and concise tutorials.

3. BioMed Central is an STM (Science, Technology and Medicine) publisher which has pioneered the open access publishing model. All peer-reviewed research articles published by BioMed Central are made immediately and freely accessible online, and are licensed to allow redistribution and reuse. BioMed Central is part of Springer Nature, a major new force in scientific, scholarly, professional and educational publishing, created in May 2015 through the combination of Nature Publishing Group, Palgrave Macmillan, Macmillan Education and Springer Science+Business Media. http://www.biomedcentral.com

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