Measurement of contextual factors in clinical practice and research: development of an expert-informed toolkit
Contextual factors (CFs) can influence therapeutic encounters and clinical outcomes, yet their measurement remains fragmented, lacking a unified framework to guide tool selection. To identify, appraise, and synthesize CF measurement instruments into an expert-informed clinical toolkit and identify current measurement gaps. An international panel of 15 experts evaluated 227 instruments across five domains (patient/practitioner characteristics, relational dynamics, environment, and treatment) using a hybrid COSMIN-informed appraisal design. Instruments were screened for content validity and psychometric robustness. Twenty instruments were selected for inclusion in the toolkit. Despite identifying high-quality instruments for stable traits, our analysis revealed critical measurement gaps in dynamic, state-responsive processes. Specifically, there is an absence of validated, clinically feasible tools for capturing real-time clinician affective states, non-verbal synchrony, therapeutic touch, and moment-to-moment environmental or procedural interactions. This study provides the first expert-informed framework for assessing CFs. Future research should prioritize developing state-responsive instruments capable of capturing these dynamic elements as they unfold in real-world settings to better understand the contextual drivers of recovery.
Authors
- Jennifer A. Bent (ORCID: https://orcid.org/0000-0001-5315-0983)
- Amy W. McDevitt (ORCID: https://orcid.org/0000-0002-1794-8813)
- Joel E. Bialosky (ORCID: https://orcid.org/0000-0002-0137-2653)
- Elisa Carlino (ORCID: https://orcid.org/0000-0001-8472-656X)
- Luana Colloca (ORCID: https://orcid.org/0000-0002-6503-4709)
- Alessandra Garcia
- Jorge Eduardo Esteves (ORCID: https://orcid.org/0000-0001-9637-678X)
- Antoine Bailliard (ORCID: https://orcid.org/0000-0001-7809-9301)
- Alvisa Palese (ORCID: https://orcid.org/0000-0002-3508-844X)
- Giacomo Rossettini (ORCID: https://orcid.org/0000-0002-1623-7681)
- Vitaly Napadow (ORCID: https://orcid.org/0000-0003-1941-1750)
- Felicity L. Bishop (ORCID: https://orcid.org/0000-0002-8737-6662)
- William R Reed (ORCID: https://orcid.org/0000-0002-4580-485X)
- David Newell (ORCID: https://orcid.org/0000-0003-1462-3586)
- Chad E. Cook
Institutions
- University of Verona (IT)
- University of Maryland, Baltimore (US)
- University of Udine (IT)
- Campbell University (US)
- Harvard University (US)
- Medical University of South Carolina (US)
- Duke University (US)
- University of Florida Health (US)
- University of Alabama at Birmingham (US)
- University of Florida (US)
- Brooks Rehabilitation Clinical Research Center (US)
- Duke University Health System (US)
- Ospedale San Giuseppe (IT)
- Duke University Hospital (US)
- University of Southampton (GB)
- Escola Superior de Saúde Atlântica
- University of Colorado Anschutz Medical Campus (US)
- University of Turin (IT)
- University of Maryland, College Park (US)
- Universidad Europea de Madrid (ES)
- Bournemouth University (GB)
Publication Details
- Journal
- Scientific Reports
- Published
- 2026-10-15
- DOI
- https://doi.org/10.1038/s41598-026-72540-9
- Primary Topic
- Health Education and Validation
- Type
- article
- Field-Weighted Citation Impact
- 0.00
Funders
- National Institutes of Health
- National Institute of Neurological Disorders and Stroke
- National Center for Complementary and Integrative Health