Judith Chapman

Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self-management booklet and doctor advice to take exercise for back pain.

Study Design. Randomized controlled factorial trial. Objective. To assess the effectiveness of a booklet and of physician advice to take regular exercise. Summary of Background Data. Educational booklets are one of the simplest interventions for back pain but have not been shown to alter pain and function. Although there is evidence that advice to mobilize is effective, doctors have also been advised to encourage regular exercise—but there is no evidence that such advice alone improves outcomes. Method. Eight doctors from six practices randomized 311 patients with a new episode of back pain using sealed numbered opaque envelopes to receive a detailed self-management booklet, advice to take regular exercise, both, or neither. All groups were advised to mobilize and to use simple analgesia. Patients were telephoned during the first week after entry into the study, and after 3 weeks to assess a validated numerical pain/function score (0 = no pain normal activities to 100 = extreme pain no normal activities). Patients also returned a postal questionnaire in the first week with the Aberdeen pain and function scale, a knowledge score, and a reliable satisfaction scale (mean score of 4 items: 0 = not satisfied to 100 = extremely satisfied). Results. Pain/function scores were obtained in 239 (77%) patients. There were interactions between exercise and booklet groups for both pain/function scores and the Aberdeen scale, which are unlikely to have been chance findings (P = 0.009 and P = 0.012, respectively). In comparison with the control group, there were reductions in the pain/function score in the first week with a booklet (−8.7, 95% CI −17.4 to −0.03) or advice to exercise (−7.9; −16.7 to 0.8) but much less effect with both together (−0.08, −9.0 to 8.9). Similarly, the Aberdeen scale was lower in the booklet group (−3.8, −7.7 to 0.07) and in the exercise advice group (−5.3; −9.3 to −1.38) but much less with both combined (−1.9, −5.8 to 2.1). There was no significant difference between groups in pain/function scores by week 3, when 58% reported being back to normal. Satisfaction was increased in booklet (7.9, 1.3 to 14.4) and exercise groups (7.4, 0.8 to 13.9)), and a booklet also increased knowledge (Kruskal-Wallis &khgr;2 27.2, P = 0.001). Conclusion. Doctors can increase satisfaction and moderately improve functional outcomes in the period immediately after the consultation when back pain is worst, by using very simple interventions: either by endorsing a self-management booklet or by giving advice to take exercise. Previous studies suggest that simple advice and the same written information provide reinforcement. This study supports evidence that it may not be helpful to provide a detailed information booklet and advice together, where the amounts or formats of information differ.

The influence of assessments on students' motivation to learn in a therapy degree course

This paper reports a study which attempted to examine the influence of a varied assessment programme on student motivation to learn in an undergraduate therapy degree course.

The back home trial: general practitioner-supported leaflets may change back pain behavior.

Study Design. A single-blind randomized controlled trial of a leaflet developed for people with acute low back pain was compared with the usual general practitioner management of back pain. Objective. To test the effectiveness of a patient information leaflet on knowledge, attitude, behavior, and function. Summary of Background Data. Despite the commonality of back pain in general practice, little evidence on the effectiveness of simple interventions such as leaflets and advice on self-management has been reported. On the basis of a five-stage needs analysis, a simple leaflet was developed that considered the views of patients and health professionals. Methods. For this study, 64 patients with acute back pain were assigned to the leaflet or control group. The participants were visited at home after 2 days, 2 weeks, then 3, 6, and 12 months, where they completed a range of self-report measures. Behavioral aspects were discreetly recorded by a “blinded” researcher. Primary outcomes were knowledge, attitude, behavior, and function. Results. In all, 272 home visits were undertaken. The findings show that at 2 weeks, knowledge about sitting posture was greater in the leaflet group (P = 0.006), which transferred to a behavioral difference (sitting with lumbar lordosis support) when participants were unaware that they were being observed (P = 0.009). This difference remained significant at 3 months. Patients in the leaflet group also were better at maintaining a wide base of support when lifting a light object than the control subjects throughout all five assessments. There were no significant differences in the functional outcomes tested. Conclusions. This trial demonstrates that written advice for patients can be a contributory factor in the initial general practitioner consultation because it may change aspects of knowledge and behavior. This has implications for the management of acute back pain, with potential health gain.

Literacy levels required to complete routinely used patient-reported outcome measures in rheumatology

OBJECTIVE To assess the reading levels required to complete patient-reported outcome measures (PROs) commonly used in rheumatology clinical and research settings. METHODS Ten PROs written in English were evaluated. Four reviewers critiqued each measure blindly using two standardized readability indexes and a final readability score for each PRO was agreed. RESULTS Only six of the PROs met the recommended reading level for health education literature. CONCLUSION Many people completing PROs will not be able to understand what they are answering and will be unable to give an accurate perspective on their condition.

Occupational Therapy Students' Approaches to Learning: Considering the Impact of Culture

Learning approaches describe the way that individuals approach tasks or learning situations and are influenced by individual characteristics and specific learning contexts. Cultural factors are likely to have an impact on various aspects of learning, yet the literature disagrees over the extent to which culture influences approaches to learning. With increasing cultural diversity in student cohorts and the contributions of culturally Western therapists to occupational therapy programmes in developing nations, this issue is worthy of exploration within the context of pre-registration education. The Approaches to Study Inventory was used to explore differences in the approaches to learning of United Kingdom and Bangladeshi occupational therapy students studying in their home countries. Significant differences between the groups revealed that the Bangladeshi students displayed both stronger tendencies for deep approaches to learning (p<0.05) and for less integrated superficial approaches to learning (p< 0.05). This apparent contradiction required careful consideration. There is no single correct way to learn. This studys results reinforce the need for cultural sensitivity in not only clinical but also educational contexts. The cultural biases underpinning the constructs of deep and superficial learning approaches are explored. Educators are encouraged to recognise the potential for culture to influence how students engage within the learning environment and how they themselves construct learning opportunities.

Physiotherapy Health Education Literature

Summary This paper describes a survey of the reading levels and design of leaflets distributed by a physiotherapy service. Physiotherapists design health education leaflets to inform patients and reinforce recommendations made in a session of therapy. The effectiveness of these leaflets depends largely on whether patients can read and understand them. A questionnaire survey in physiotherapy departments spanning two National Health Service trusts in Southampton showed that while physiotherapists were generally happy with the accuracy of their leaflets, they were less satisfied with their appearance. An analysis using Gunnings Fog Index Formula demonstrated that only 33% of the leaflets were written at or below the recommended reading level for health education literature, ie grade 9. The average reading level of the leaflets was grade 10. The survey underlines the need for physiotherapists to review the health information literature they are giving to patients. If they want patients to use it to inform and motivate themselves and to change health behaviours, then the written information must be attractive, readable and easy to understand. Suggestions are made for improving the quality and readability of leaflets.

Can Women with Post-menopausal Osteoporosis Benefit from an Exercise Programme?

The current trend in physiotherapy towards encouraging both symptomatic and apparently normal individuals to participate in regular aerobic exercise continues to increase. Areas of therapy intervention may include rehabilitation of cardiac and respiratory patients, health related benefita in poet-natal and ante-natal care, weight reduction, primary prevention of coronary heart disease and enhancement of aerobic fitness.