Weekly Literature Review: Language, Fear, and Human Connection in Rehab

This week’s research roundup explores a powerful theme in rehabilitation science: how language, fear, and subtle communication dynamics shape clinical outcomes. From acute MSK injury to neurologic rehabilitation and geriatric care, these studies remind us that effective therapy isn’t just what we do—it’s how we deliver it.

Monday: When Language Hurts

Study Overview
A randomized controlled trial tested whether a physical therapist’s use of negative language during patient education could elicit nocebo effects—namely, increased anxiety and maladaptive illness beliefs. Even brief, under-one-minute videos caused measurable effects.

Key Findings

• Negative language increased anxiety significantly (Cohen’s d = 0.72).

• It worsened beliefs around pain duration, treatment control, and concern.

• Surprisingly, participants rated the negative-language provider as more credible—possibly due to use of technical terminology.

• Bonding and engagement ratings were similar between groups, suggesting language itself was the primary factor influencing outcomes.

Clinical Insight
Patient education is not neutral. What we say—and how we say it—can shift recovery trajectories. Empowering language promotes better beliefs and reduces anxiety, even in short encounters.

Citation
Linskens, F. G., et al. (2023). Negative language use of the physiotherapist in low back pain education impacts anxiety and illness beliefs: A randomized controlled trial in healthy respondents. Patient Education and Counseling, 110, 107649.
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Tuesday: Reducing Fear of Falling in Neurologic Rehab

Study Overview
This systematic review and meta-analysis synthesized findings from 61 studies (53 included in meta-analysis) to examine the effectiveness of physical therapy interventions for reducing fear of falling (FOF) in Parkinson’s disease, multiple sclerosis, stroke, and spinal cord injury.

Key Findings

• Parkinson’s: Gait and balance training together reduced FOF more than gait training alone (MD = 11.80). Home-based programs were also effective.

• Multiple sclerosis: Home and leisure-based exercise significantly reduced FOF (MD = 15.27), surpassing usual care.

• Stroke and SCI: Evidence was inconclusive, though trends support the use of multifactorial programs.

• Across diagnoses, balance training alone was not consistently effective.

Clinical Insight
Reducing fear of falling requires more than balance work. Home-based, personalized, and multimodal approaches are especially effective in Parkinson’s and MS populations. FOF must be treated as a central therapeutic target, not an incidental symptom.

Citation
Abou, L., et al. (2020). Effectiveness of physical therapy interventions in reducing fear of falling among individuals with neurologic diseases: A systematic review and meta-analysis. Archives of Physical Medicine and Rehabilitation.
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Wednesday: Addressing Fear-Avoidance in Sudden-Onset Injuries

Study Overview
This scoping review focused on fear-avoidance beliefs and behaviors (FABs) in individuals with sudden-onset musculoskeletal injuries—ACL ruptures, fractures, burns—and how rehabilitation professionals can intervene early to prevent long-term disability.

Key Findings

• Effective strategies included early education with multimedia, graded exposure to feared tasks, pain neuroscience education (PNE), cognitive behavioral strategies, and graded motor imagery.

• Multimodal programs (education + exercise + manual therapy) showed the most promise.

• Exercise or manual therapy alone did not consistently reduce FABs.

• Late or very short education was less effective.

Clinical Insight
Early, psychologically-informed rehabilitation matters. Interventions should target patient beliefs and perceptions alongside physical impairments to prevent chronicity and disengagement.

Citation
Lu, J., et al. (2025). Rehabilitation interventions for fear-avoidance beliefs and behaviors in sudden onset musculoskeletal conditions: A scoping review. Journal of Burn Care & Research.
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Thursday: The Language Buffer in Fear Conditioning

Study Overview
This experimental study examined how language—native versus foreign—affects fear acquisition. Using skin conductance and pupil dilation as physiological measures, researchers evaluated how fear responses change based on the language used during conditioning.

Key Findings

• Participants using their native language showed stronger physiological fear responses than those using a foreign language.

• Foreign language use appeared to buffer emotional reactivity—possibly due to emotional detachment or increased cognitive load.

• Both groups learned the associations, but emotional intensity was reduced in the foreign language group.

Clinical Insight
In bilingual or multilingual contexts, using a foreign language may help patients process emotionally charged topics with less distress. This insight has potential implications for exposure therapy and trauma-informed care.

Citation
García-Palacios, A., et al. (2018). The effect of foreign language in fear acquisition. Scientific Reports, 8, 1157.
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Friday: Nonverbal Communication Predicts Recovery in Older Adults

Study Overview
This two-part study analyzed how physical therapists’ nonverbal communication during early therapy sessions affected recovery in older adults. Observers watched short video clips and coded therapist behaviors, which were then correlated with patient outcomes.

Key Findings

• Therapists who avoided eye contact, did not smile, or remained seated during interactions were associated with worse physical, cognitive, and emotional outcomes.

• Expressive behaviors (smiling, nodding, engaging facially) predicted better outcomes in mobility, cognition, and mood—effects that persisted for months.

• Even 20-second video segments were sufficient for older adults to form strong impressions of warmth or indifference.

Clinical Insight
Empathy has a nonverbal signature. How we sit, look, and gesture carries significant weight—especially in geriatric care. Providers must be as conscious of nonverbal cues as they are of treatment plans.

Citation
Ambady, N., et al. (2002). Physical therapists’ nonverbal communication predicts geriatric patients’ health outcomes. Psychology and Aging, 17(3), 443–452.
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Closing Reflection:

This week’s literature underscores a vital truth in rehabilitation: our words, presence, and demeanor are part of the intervention. Whether it’s the phrasing of a diagnosis, the delivery of education, or a fleeting facial expression, patients interpret meaning well beyond the clinical content.

It’s time we elevate communication as a core therapeutic skill, worthy of as much attention as protocols and programs.

Stay tuned for next week’s review, and feel free to share or discuss these findings with colleagues working to blend evidence-based care with emotionally intelligent practice.

#PhysicalTherapy #RehabilitationScience #HealthCommunication #PainScience #Neurorehab #MusculoskeletalHealth #EmpathyInHealthcare #GeriatricCare #ValueBasedCare #ClinicianEducation