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PubMed1998

A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain.

BACKGROUND AND METHODS: There are few data on the relative effectiveness and costs of treatments for low back pain. We randomly assigned 321 adults with low back pain that persisted for seven days after a primary care visit to the McKenzie method of physical therapy, chiropractic manipulation, or a minimal intervention (provision of an educational booklet). Patients with sciatica were excluded. Physical therapy or chiropractic manipulation was provided for one month (the number of visits was determined by the practitioner but was limited to a maximum of nine); patients were followed for a total of two years. The bothersomeness of symptoms was measured on an 11-point scale, and the level of dysfunction was measured on the 24-point Roland Disability Scale. RESULTS: After adjustment for base-line differences, the chiropractic group had less severe symptoms than the booklet group at four weeks (P=0.02), and there was a trend toward less severe symptoms in the physical therapy group (P=0.06). However, these differences were small and not significant after transformations of the data to adjust for their non-normal distribution. Differences in the extent of dysfunction among the groups were small and approached significance only at one year, with greater dysfunction in the booklet group than in the other two groups (P=0.05). For all outcomes, there were no significant differences between the physical-therapy and chiropractic groups and no significant differences among the groups in the numbers of days of reduced activity or missed work or in recurrences of back pain. About 75 percent of the subjects in the therapy groups rated their care as very good or excellent, as compared with about 30 percent of the subjects in the booklet group (P<0.001). Over a two-year period, the mean costs of care were $437 for the physical-therapy group, $429 for the chiropractic group, and $153 for the booklet group. CONCLUSIONS: For patients with low back pain, the McKenzie method of physical therapy and chiropractic manipulation had similar effects and costs, and patients receiving these treatments had only marginally better outcomes than those receiving the minimal intervention of an educational booklet. Whether the limited benefits of these treatments are worth the additional costs is open to question.

Adult↗
PubMedDate not supplied

Macular translocation--what our patients need to know.

Age-related macular degeneration is the most common cause of rapid and irreversible central vision loss among persons older than 60 years in the United States. Vision loss occurs as a result of choroidal neovascularization in which abnormal blood vessels in the choroid bleed and scar beneath the fovea. If this is caught early, a new approach called macular translocation surgery can be considered. In this procedure, the surgeon moves (translocates) the macula to a healthy area of the retina where it may recover and maintain its function. Moving the fovea allows the surgeon to use laser to destroy the abnormal blood vessels and spare the fovea. As with any procedure, it is important for the patient to have a positive perioperative experience, to be able to report and prevent postoperative complications, arrange follow-up care and transportation, and have realistic expectations of visual outcomes. To this end, a patient education brochure has been developed to ensure a more informed, involved, and satisfied patient. Our topics include: (1) a brief description of macular degeneration, (b) perioperative examinations and procedures, (3) the procedure itself, surgical risks, and postoperative care, (4) appointments for follow-up and laser procedures a few days after surgery, and (5) possible improvements in visual outcomes. Our objectives are to describe macular translocation surgery as it pertains to the management of choroidal neovascularization in age-related macular degeneration and to identify the essential perioperative elements that patients need to know about macular translocation surgery.

Aged↗
PubMed2002

The development and pilot testing of a teaching booklet for oncology patients' self-assessment and perineal skin care.

Oncology patients often experience skin breakdown as a result of chemotherapy. Often the loss of skin integrity is neither identified nor treated until it becomes severe and painful. If patients were taught to identify early signs of breakdown and to report these symptoms to a health care provider, treatment for these conditions could begin at an early stage. Nursing staff identified the need to develop a booklet that would both instruct adult oncology patients concerning necessary perineal care following therapy and encourage them to partner with the nursing staff to provide this care through self-assessment and reporting. The focus of this article is the process of developing and pilot testing such a booklet by 27 female oncology patients undergoing peripheral stem cell transplantation. Participants were given a handheld mirror as an aid to assess perineal skin changes. Feedback from both staff and patients was very positive. As patients identified and reported perineal skin changes to the nursing staff, both patients and nurses implemented established perineal skin care protocols. This teaching booklet, The Perineal Skin Self-Assessment Guide, focuses on the partnering of nurses and patients to promote the involvement of patients in their own care.

Female↗
PubMed2001

The health information brochure: a useful tool for chiropractic practice?

BACKGROUND: It has been suggested that clinicians should be looking at new ways to enhance their patients' self-care. Patient education is one strategy that primary providers may use. OBJECTIVE: This study investigates the format in which patients would like to pursue their health education within the chiropractic clinic. METHODS: An exploratory study of chiropractic patients was undertaken to investigate patients' preferred health education formats, their commitment to pursuing health objectives, and their literacy level. Purposive sampling of 9 Australian chiropractic clinics was undertaken. Convenience sampling of patients attending these clinics resulted in 102 patients participating. Participants completed a questionnaire. A research assistant was available to clarify any questions. Data were collected and collated. A Likert scale was used to capture responses to questions ascertaining patient opinions. RESULTS: Patients considered health the most important of the life objectives listed; however, they preferred spending time with family to undertaking health- and fitness-promoting activity. More chiropractic patients opted for health information brochures than health promotion classes, personally supervised self-care programs, or practitioner-supervised self-care contracts. Patient literacy levels varied within and between clinics. CONCLUSIONS: Brochures may provide a definitive health information tool for chiropractors who limit their clinical role to primary contact and a helpful adjunct to patient education for chiropractors committed to a primary care role. However, care should be taken to select brochures consistent with the patients' literacy level. Tips for selecting and preparing suitable brochures are provided. The discrepancy between how greatly patients value health and how they prefer spending their time may have implications for successful behavior change. Brochures may not alone constitute adequate practitioner involvement.

Adult↗
PubMed2001

Unsubstantiated claims in patient brochures from the largest state, provincial, and national chiropractic associations and research agencies.

OBJECTIVE: To determine the presence or absence of claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or are intrinsically untestable. DESIGN: A survey of patient education and promotional material produced by national, state, and provincial societies and research agencies in Canada and the United States. METHOD: Patient brochures were solicited from the 3 largest provincial, 3 largest state, and the 3 largest national professional associations in the United States and Canada. Similar requests were made of 2 research agencies supported by the national associations. Brochures were reviewed for the presence or absence of unsubstantiated claims. RESULTS: Of the 11 organizations sampled, 9 distribute patient brochures. Of these 9 organizations, all distribute patient brochures that make claims for chiropractic services that have not been scientifically validated. CONCLUSION: The largest professional associations in the United States and Canada distribute patient brochures that make claims for the clinical art of chiropractic that are not currently justified by available scientific evidence or that are intrinsically untestable. These assertions are self-defeating because they reinforce an image of the chiropractic profession as functioning outside the boundaries of scientific behavior.

Canada↗
PubMedDate not supplied

A study of parent/grandparent education for managing a febrile illness using the CALM approach.

INTRODUCTION: The purpose of this study was to examine the effectiveness of fever management education in increasing knowledge, confidence, comfort, and satisfaction of the parent/grandparent. METHOD: A randomized repeated measures design was used to evaluate the effectiveness of an educational brochure and video. After baseline data were collected on parent/grandparents of children receiving standard care, each site was randomized into two groups: Group 1 parents were given a video and brochure about fever management as they left the clinic/office; Group 2 were shown the video and given the brochure before seeing their health care provider. The parent/grandparents of 216 children, mean age 21.8 months, completed the Fever Management Questionnaire (FMQ) at 48-72 hours, 1, 3, and 6 months post-education. RESULTS: Knowledge scores of parents/grandparents in both CALM groups were significantly higher than those in the control group at 48 hours and 1-month post-visit. By 6 months, the knowledge level of the parent/grandparents in CALM2, those who viewed the video in the office, was significantly different from the other two groups. Satisfaction, comfort, and confidence of all three groups were high at all three points. Parents/grandparents in both CALM groups were highly satisfied with the education they received. DISCUSSION: Educating parent/grandparents about fever management using written and video materials is effective in increasing knowledge about fever management.

Adolescent↗
PubMed2003

Promoting the health and well being of older carers: a proactive strategy.

Research has indicated that carers are concerned about their ageing status, their deteriorating health and their ability to continue to care for their dependants. Given that the health care system will become increasingly reliant on carers the health care needs of carers should be a concern for all health care professionals. This paper describes the first stage of a project designed to enhance older carers health promotion knowledge and skills and improve their health promoting behaviors. This stage investigated the mental and physical health status of older carers. It also sought information on older carers' levels of participation in health related and social activities and identification of barriers to participation in these types of activities. The results highlighted that carers responding to the survey experienced compromised physical and mental health. Many carers reported being unable to participate in social and health-type activities as they were unable to leave the care recipient. Of note, is that carers identified their own mental fragility and felt they needed further emotional support.

Aged↗
PubMed2004

The effects of warnings and an educational brochure on computer working posture: a test of the C-HIP model in the context of RSI-relevant behaviour.

This study tested whether warnings can result in a better working posture with respect to RSI prevention compared with an educational brochure. By using a warning, the information provision on how to prevent RSI can be shorter and only interrupts with the task at hand for a short time. Five conditions were created to compare the effects on position adjustments of a warning displayed on the computer screen, a warning hanging on the wall, an educational brochure, a neutral interruption on the computer screen, and no intervention. Systematic observations of respondents' working postures showed that the computer warning led to significantly more correct position adjustments than the educational brochure and the two control situations, whereas the wall warning condition did not differ significantly from all other conditions. Questionnaires were used to study whether the number of position adjustments in the conditions could be explained by Wogalter's communication-human information processing (C-HIP) model. The questionnaire data suggest that the effect of the computer warning is caused by heightened attention for this type of intervention. The other stages of the C-HIP model--knowledge, attitude change, and motivation--might not be necessary in this situation in the explanation of behavioural changes. The conclusion is that warnings may be able to successfully replace educational brochures to produce behavioural changes.

Adult↗
PubMed1984

Psychological preparation as a method of reducing the stress of surgery.

Studies of the preparation of adult patients for surgery are reviewed. While many show that preparation reduces stress, the studies are criticized for methodological and conceptual inadequacies. In particular, studies often fail to measure a range of stress responses, and also fail to provide measures over a sufficient time span to fully assess the effect of preparation on stress responses which are known to have differing rates of responsiveness. The experimental study was specifically designed to overcome these problems. Eighty patients undergoing a minor gynecological operation (laparoscopy for sterilization or infertility investigation) were allocated to one of three groups: routine care only (Control 1); routine care plus a minimally informative preparatory booklet (Control 2); or routine care plus a maximally informative preparatory booklet (Experimental group). Patients in the special preparation condition showed lower stress responses on measures of preoperative anxiety. At both one- and six-week follow ups they showed reduced state anxiety and elevated postdischarge vigor scores. They also showed less pain after surgery and recovered faster in hospital and in the first six days after going home. They returned to normal activities faster than patients in the two control groups. There were no differences on measures of postoperative symptoms, medication use, or reported time to return to normal health. The results are discussed in terms of previous studies of psychological preparation, and current concepts of stress. Suggestions for the design of preparatory interventions are made which match the type and timing of the intervention to the target stress response.

Adult↗