Advice Session Research Articles

The role of demographic characteristics and readiness to change in 12-month outcome from two distinct brief interventions for impaired drivers

ObjectivesThis study tested specific intervention responsivity to brief intervention in driving while impaired by alcohol and/or drugs recidivists based upon their demographic, substance use, and initial readiness to change characteristics. MethodsA nonclinical community-based sample of 184 male and female recidivists was randomly assigned to receive one of two 30-minute interventions: brief motivational interviewing (n = 92) or an information–advice session (n = 92). Dependent variables were change at the 6- and 12-month follow-ups from baseline in percentage of risky drinking days and blood assay biomarkers of alcohol misuse. Independent variables were age, gender, education, past convictions for impaired driving, and baseline alcohol and drug misuse severity and readiness to change. ResultsRecidivists who were younger, male, and exhibited more negative consequences and ambivalence towards their problem drinking improved more on alcohol-related outcomes, irrespective of intervention type. ConclusionsThe results do not convincingly indicate specific intervention responsivity based upon participant characteristics but provide preliminary guidance about which recidivists are most apt to benefit from these brief approaches.

Effects of nutritional intervention and physical training on energy intake, resting metabolic rate and body composition in frail elderly. a randomised, controlled pilot study.

To analyse the effect of nutritional intervention and physical training on energy intake, resting metabolic rate (RMR) and body composition in the frail elderly. Open, randomised, controlled pilot treatment study. Community-based research centre. Ninety-six community-dwelling frail elderly people aged 75 and older, 40% men. Four treatment arms: i) individual nutritional advice and group sessions on nutrition for the elderly, ii) physical training 2 x 45 minutes per week for 3 months, iii) combined nutritional and physical intervention and iv) control group. The outcomes were energy intake (4-day food diary); resting metabolic rate (indirect calorimetry) and body composition (anthropometry) performed at baseline, after 3 months' intervention (completed by 79 individuals), and as a follow-up at 9 months (completed by 64 individuals). The training group showed a significantly increased RMR at 3 months. Otherwise, there were no observed differences within or between the four groups. There was no correlation over time between energy intake, RMR and fat free mass. The participants with a low energy intake who managed to increase their energy intake during the study ('responders') had a statistically significantly lower BMI (21 vs. 24) and a lower fat percentage (23 vs. 30) at baseline than the 'non-responders'. The 'non-responders' showed a small but statistically significant decrease in body fat percentage at F1, and in body weight, BMI and FFM at 9 months (F3). Individual nutrition counselling and physical exercise had no effect on energy intake, RMR or fat free mass in community-dwelling frail elderly people aged 75 and older. Interventions in frail elderly people should be targeted according to the needs of the individual patients. The issues of randomisation, targeting and responders in are problematised and discussed.

Impact of Treatment With Intramuscular, Injectable, Extended-Release Naltrexone on Counseling and Support Group Participation in Patients With Alcohol Dependence

: The impact of intramuscular, injectable, extended-release naltrexone (XR-NTX; Vivitrol) on counseling and support group participation was examined in a post hoc analysis of a 24-week, randomized, double-blind study in 624 alcohol-dependent adults, most of whom were nonabstinent at baseline. : Patients were offered 6 monthly injections of XR-NTX 380 mg, XR-NTX 190 mg, or placebo (n = 205, 210, and 209, respectively) and 12 sessions of manualized brief counseling. Voluntary participation in extramural counseling (eg, couples or family therapy) and self-help support groups (eg, Alcoholics Anonymous) was permitted and assessed. : The proportion of patients attending all 12 Biopsychosocial, Report, Empathy, Needs, Direct advice, and Assessment sessions was nonsignificantly greater for XR-NTX 380 mg (45%) than for placebo (39%), as was the proportion attending extramural counseling (10% vs 7%) and support groups (13% vs 10%). Attendance rates were intermediate with XR-NTX 190-mg. Attending self-help groups was significantly (P = 0.04) related to reduced heavy drinking across all treatment groups. : XR-NTX is compatible with counseling and support group participation in the treatment of alcohol dependence.

The Back 2 Activity Trial: education and advice versus education and advice plus a structured walking programme for chronic low back pain

BackgroundCurrent evidence supports the use of exercise-based treatment for chronic low back pain that encourages the patient to assume an active role in their recovery. Walking has been shown it to be an acceptable type of exercise with a low risk of injury. However, it is not known whether structured physical activity programmes are any more effective than giving advice to remain active.Methods/DesignThe proposed study will test the feasibility of using a pedometer-driven walking programme, as an adjunct to a standard education and advice session in participants with chronic low back pain. Fifty adult participants will be recruited via a number of different sources. Baseline outcome measures including self reported function; objective physical activity levels; fear-avoidance beliefs and health-related quality of life will be recorded. Eligible participants will be randomly allocated under strict, double blind conditions to one of two treatments groups. Participants in group A will receive a single education and advice session with a physiotherapist based on the content of the 'Back Book'. Participants in group B will receive the same education and advice session. In addition, they will also receive a graded pedometer-driven walking programme prescribed by the physiotherapist. Follow up outcomes will be recorded by the same researcher, who will remain blinded to group allocation, at eight weeks and six months post randomisation. A qualitative exploration of participants' perception of walking will also be examined by use of focus groups at the end of the intervention. As a feasibility study, treatment effects will be represented by point estimates and confidence intervals. The assessment of participant satisfaction will be tabulated, as will adherence levels and any recorded difficulties or adverse events experienced by the participants or therapists. This information will be used to modify the planned interventions to be used in a larger randomised controlled trial.DiscussionThis paper describes the rationale and design of a study which will test the feasibility of using a structured, pedometer-driven walking programme in participants with chronic low back pain.Trial Registration[ISRCTN67030896]

Effects of physical training on aerobic capacity in frail elderly people (75+ years). Influence of lung capacity, cardiovascular disease and medical drug treatment: a randomized controlled pilot trial

Frail elderly people often suffer from a combination of unintentional weight loss and/or low body mass index, as well as a low physical activity level. No studies have investigated the effect of physical training alone or in combination with nutritional intervention on aerobic capacity in frail elderly people. The aim of this pilot study was to determine if a physical training program can affect aerobic capacity in frail elderly people. Ninety-six community-dwelling frail elderly people (58 women) were included in the study. Subjects were randomized to four different groups: i) physical training program (aerobic, muscle strength, balance), ii) a nutritional intervention program (individually targeted advice and group sessions), iii) a combination of these interventions, and iv) a control group. At baseline, subjects were screened for aerobic capacity, leg muscle strength, spirometry, heart disease and cardiovascular drugs. Aerobic capacity and leg muscle strength were analyzed immediately after the 3-month intervention period (1st follow-up), and after another 6 months (2nd follow-up). Subjects mean age was 83 years. The mean compliance rate with the physical training program was 65%. There were no observed effects on aerobic capacity measured as maximal workload, or work time, with or without beta-receptor blockade. Subjects in the training groups without lung disease significantly increased maximal work time when compared with subjects with lung disease. Physical training significantly increased lower extremity muscle strength compared with nutrition alone at the 1st follow-up. No serious adverse events occurred during assessment or physical training. Further studies with larger sample sizes and a more specific aerobic component in the training program are necessary before any further conclusions can be drawn.

It ain't what you do, it's the way that you do it: A qualitative study of advice for young cannabis users

Advice is a widely recommended and practised intervention with young drug users. Study of precisely how advice is given and received in any setting has, however, been limited. We qualitatively analysed 106 audio-recordings of advice sessions on cannabis use for young people within a randomised trial. Inductive data analysis was guided by a focus on practitioner behaviour which served to engage the active participation of the young drug user in the session. A cluster of 'Information Management' activities was identified together with an 'Interactive Orientation' evident in a series of specific behaviours. Participants were most successfully engaged when both were combined, understood here as 'Personalised Advice-giving'. These components identified in this exploratory study might assist further research in rectifying the absence of a solid empirical basis for effective practice in advice giving with young drug users and more widely.

Naltrexone alone and with sertraline for the treatment of alcohol dependence in Alaska natives and non-natives residing in rural settings: a randomized controlled trial.

Access to specialty alcoholism treatment in rural environments is limited and new treatment approaches are needed. The objective was to evaluate the efficacy of naltrexone alone and in combination with sertraline among Alaska Natives and other Alaskans living in rural settings. An exploratory aim examined whether the Asn40Asp polymorphism of the mu-opioid receptor gene (OPRM1) predicted response to naltrexone, as had been reported in Caucasians. Randomized, controlled trial enrolling 101 Alaskans with alcohol dependence, including 68 American Indians/Alaska Natives. Participants received 16 weeks of either (1) placebo (placebo naltrexone + placebo sertraline), (2) naltrexone monotherapy (50 mg naltrexone + sertraline placebo) and (3) naltrexone + sertraline (100 mg) plus nine sessions of medical management and supportive advice. Primary outcomes included Time to First Heavy Drinking Day and Total Abstinence. Naltrexone monotherapy demonstrated significantly higher total abstinence (35%) compared with placebo (12%, p = 0027) and longer, but not statistically different, Time to First Heavy Drinking Day (p = 0.093). On secondary measures, naltrexone compared with placebo demonstrated significant improvements in percent days abstinent (p = 0.024) and drinking-related consequences (p = 0.02). Combined sertraline and naltrexone did not differ from naltrexone alone. The pattern of findings was generally similar for the American Indian/Alaska Native subsample. Naltrexone treatment response was significant within the group of 75 individuals who were homozygous for OPRM1 Asn40 allele. There was a small number of Asp40 carriers, precluding statistical testing of the effect of this allele on response. Naltrexone can be used effectively to treat alcoholism in remote and rural communities, with evidence of benefit for American Indians and Alaska Natives. New models of care incorporating pharmacotherapy could reduce important health disparities related to alcoholism.

Body Movement Synchrony in Psychotherapeutic Counseling: A Study Using the Video-Based Quantification Method

Body movement synchrony (i.e. rhythmic synchronization between the body movements of interacting partners) has been described by subjective impressions of skilled counselors and has been considered to reflect the depth of the client-counselor relationship. This study analyzed temporal changes in body movement synchrony through a video analysis of client-counselor dialogues in counseling sessions. Four 50-minute psychotherapeutic counseling sessions were analyzed, including two negatively evaluated sessions (low evaluation groups) and two positively evaluated sessions (high evaluation groups). In addition, two 50-minute ordinary advice sessions between two high school teachers and the clients in the high rating group were analyzed. All sessions represent role-playing. The intensity of the participants' body movement was measured using a video-based system. Temporal change of body movement synchrony was analyzed using moving correlations of the intensity between the two time series. The results revealed (1) A consistent temporal pattern among the four counseling cases, though the moving correlation coefficients were higher for the high evaluation group than the low evaluation group and (2) Different temporal patterns for the counseling and advice sessions even when the clients were the same. These results were discussed from the perspective of the quality of client-counselor relationship.

Effects of a physical and nutritional intervention program for frail elderly people over age 75. A randomized controlled pilot treatment trial

There are few studies published that combine the interventions of physical training and nutrition. The aim of the present study was to describe the impact of a physical and nutritional intervention program for frail community- dwelling elderly people over the age of 75. Ninety-six community-dwelling elderly people (58 women) were randomized to four different groups: i) a physical training program (aerobic, muscle strength, balance), ii) a nutritional intervention program (individually targeted advice and group sessions), iii) a combination of these interventions, and iv) a control group. At baseline subjects were screened for physical performance such as muscle strength, balance, mobility and activities of daily living, as well as nutritional aspects such as energy intake, body weight and fat-free mass. These measurements were repeated immediately after the intervention, which lasted for 12 weeks, and after another 6 months. The intention-to-treat analysis indicated significant improvements in lower- extremity muscle strength in both training groups compared with the nutrition group at 1st follow-up. There were small significant changes for some of the balance measurements in the training group without nutrition treatment. The nutrition intervention did not show any significant results. This study shows the positive effect on lower-extremity muscle strength directly after the intervention. Balance training most probably needs to be more individualized in order to be effective for frail elderly people. Further studies are needed, with larger sample sizes, to investigate the effects of these types of interventions before any further conclusions can be drawn.

The PREMIER Intervention Helps Participants Follow the Dietary Approaches to Stop Hypertension Dietary Pattern and the Current Dietary Reference Intakes Recommendations

Objective To examine the influence of the PREMIER study lifestyle interventions on dietary intakes and adherence to the Dietary Approaches to Stop Hypertension (DASH) dietary pattern and the Dietary Reference Intakes (DRI). Design An 18-month multicenter, randomized controlled trial comparing two multicomponent lifestyle intervention programs to an advice only control group. Subjects/setting A total of 810 participants were recruited from local communities and randomized into the study. Individuals were eligible if they were aged 25 years or older, had body mass index between 18.5 and 45.0, not taking antihypertensive medication, and had prehypertension or stage 1 hypertension (systolic blood pressure 120 to 159 mm Hg and diastolic blood pressure 80 to 95 mm Hg). Intervention The two active intervention programs were a behavioral lifestyle intervention that implements established recommendations, and an established intervention plus the DASH dietary pattern. Both interventions consisted of intensive group and individual counseling sessions. The control group received a brief advice session after randomization and again after 6 months of data collection. Dietary intakes were collected by two random 24-hour recalls at baseline, 6 months, and 18 months. Main outcome measures The primary outcome of the PREMIER study was change in systolic blood pressure at 6 months. The main outcomes examined here include dietary variables collected by 24-hour recall at each time point. Statistical analyses Nutrient intakes were calculated and compared among the time points and the three intervention groups using mixed models with repeated measures at 6 and 18 months. Proportion of participants who met or achieved the original DASH nutrient intake levels and the DRIs were calculated and compared among the three intervention groups. P<0.01 was considered statistically significant. Results Participants in both the established intervention and established intervention plus DASH dietary pattern groups substantially reduced energy, total fat, saturated fat, and sodium intake and these reductions persisted throughout the study. Established intervention plus DASH dietary pattern group participants increased intakes of fruits, vegetables, dairy, and many vitamins and minerals; these increases were significantly greater than that of the control and established intervention groups. A majority of established intervention plus DASH dietary pattern group participants achieved at least two thirds of the DRI recommendations for most nutrients at 6 months, despite their reduction in total energy intake. Some but relatively small recidivism occurred at 18 months. Conclusions Both the established intervention and established intervention plus DASH dietary pattern group intervention were effective in helping participants follow established recommendations to control blood pressure. The advice-only control group also made some behavior changes, mainly decreasing energy and sodium intake. Only the established intervention plus DASH dietary pattern group significantly increased intakes of DASH-specific food groups, including fruits, vegetables, and dairy products, and nutrients, including protein, fiber, calcium, potassium, and magnesium. Most of the increases did not reach the levels consumed in the original DASH feeding studies. Whereas the established intervention plus DASH dietary pattern group intervention provides a useful platform to achieve the DASH dietary pattern and current DRI recommendations, intervention enhancements, including a greater emphasis on nutrient-dense foods, would likely improve this intervention.

Physiotherapist-Directed Exercise, Advice, or Both for Subacute Low Back Pain

Advice and exercise are widely recommended for subacute low back pain, but the effectiveness of these interventions is unclear. To investigate the effectiveness of physiotherapist-prescribed exercise, advice, or both for subacute low back pain. Factorial randomized, placebo-controlled trial. 7 university hospitals and primary care clinics in Australia and New Zealand. 259 persons with subacute low back pain (>6 weeks and <3 months in duration). Participants received 12 physiotherapist-directed exercise or sham exercise sessions and 3 physiotherapist-directed advice or sham advice sessions over 6 weeks. Primary outcomes were average pain over the past week (scale, 0 to 10), function (Patient-Specific Functional Scale), and global perceived effect (11-point scale) at 6 weeks and 12 months. Secondary outcomes were disability (Roland-Morris Disability Questionnaire), number of health care contacts, and depression (Depression Anxiety Stress Scales-21). Exercise and advice were each slightly more effective than placebo at 6 weeks but not at 12 months. The effect of advice on the pain scale was -0.7 point (95% CI, -1.2 to -0.2 point; P = 0.011) at 6 weeks and -0.4 point (CI, -1.0 to 0.3 point; P = 0.27) at 12 months, whereras the effect of exercise was -0.8 point (CI, -1.3 to -0.3 point; P = 0.004) at 6 weeks and -0.5 point (CI, -1.1 to 0.2 point; P = 0.14) at 12 months. The effect of advice on the function scale was 0.7 point (CI, 0.1 to 1.3 points; P = 0.014) at 6 weeks and 0.6 point (CI, 0.1 to 1.2 points; P = 0.023) at 12 months, and the effect of exercise was 0.4 point (CI, -0.2 to 1.0 point; P = 0.174) at 6 weeks and 0.5 point (CI, -0.1 to 1.0 point; P = 0.094) at 12 months. The effect of advice on the global perceived effect scale was 0.8 point (CI, 0.3 to 1.2 points; P < 0.001) at 6 weeks and 0.3 point (CI, -0.2 to 0.9 point; P = 0.24) at 12 months, and the effect of exercise was 0.5 point (CI, 0.1 to 1.0 point; P = 0.017) at 6 weeks and 0.4 point (CI, -0.1 to 1.0 point; P = 0.134) at 12 months. When administered together, exercise and advice had larger effects on all outcomes at 6 weeks (effect on pain, -1.5 [CI -2.2 to -0.7 point; P = 0.001], with similar results for other primary outcomes); however, by 12 months, there was a statistically significant effect only for function (effect, 1.1 points [CI, 0.3 to 1.8 points]; P = 0.005). Physiotherapists were not blinded. In participants with subacute low back pain, physiotherapist-directed exercise and advice were each slightly more effective than placebo at 6 weeks. The effect was greatest when the interventions were combined. At 12 months, the only effect that persisted was a small effect on participant-reported function. AUSTRALIAN CLINICAL TRIALS REGISTRY REGISTRATION NUMBER: 12605000039684.

Combination of exercise and advice was slightly better than placebo for subacute low back pain

What is the effectiveness of physiotherapistdirected exercise, advice, or both for subacute low back pain? Randomised controlled trial. 7 university hospitals and primary care clinics in Australia and New Zealand. 259 persons with non-specific, subacute low back pain lasting for at least 6 weeks, but no longer than 12 weeks. Participants were randomised to four groups: exercise and advice, exercise and sham advice, sham exercise and advice, or sham exercise and sham advice. 12 exercise or sham exercise sessions were delivered over 6 weeks. The exercise program included an individualised, progressive, submaximal program of aerobic exercise, stretches, functional activities, activities to build speed, endurance and co-ordination, and trunk and limb-strengthening exercises. Participants also received a home exercise program. The sham exercise intervention consisted of sham shortwave diathermy and sham pulsed ultrasosound. In weeks 1, 2 and 4 participants received advice or sham advice. Advice sessions aimed to encourage a graded return to normal activities. During the sham advice sessions the patients talked about their problems but received no advice. Participants were not informed whether their group allocation was active or sham for either intervention. Primary outcomes were average pain over the last week (0 to 10 scale), global perceived effect (–5 to 5 scale) and function (Patient Specific Functional Scale, 0 to 10) at 6 weeks and 12 months. The effect of exercise (the adjusted difference in outcomes between exercise and sham exercise groups) at 6 weeks was –0.8 points (95% CI –1.3 to –0.3 points) on the pain scale and 0.5 points (95% CI 0.1 to 1.0 points) on the global perceived effect scale. The effect of advice at 6 weeks was –0.7 points (95% CI –1.2 to –0.2 points) on the pain scale and 0.8 points (95% CI 0.3 to 1.2 points) on the global perceived effect scale. The effect of advice on the function scale was significant at 6 weeks and 12 months. For pain, function, and global perceived effect, the effect of combined treatments was larger than the effect of exercise or advice alone. Physiotherapydirected exercise and advice was slightly more effective than placebo at 6 weeks. The effect was greatest when the interventions were combined. At 12 months a small effect on participant-reported function was still reported.

Randomized controlled trial of exercise for chronic whiplash-associated disorders

Whiplash-associated disorders are common and incur considerable expense in social and economic terms. There are no known effective treatments for those people whose pain and disability persist beyond 3 months. We conducted a randomized, assessor-blinded, controlled trial at two centres in Australia. All participants received 3 advice sessions. In addition the experimental group participated in 12 exercise sessions over 6 weeks. Primary outcomes were pain intensity, pain bothersomeness and function measured at 6 weeks and 12 months. Exercise and advice was more effective than advice alone at 6 weeks for all primary outcomes but not at 12 months. The effect of exercise on the 0–10 pain intensity scale was −1.1 (95%CI −1.8 to −0.3, p = 0.005) at 6 weeks and −0.2 (0.6 to −1.0, p = 0.59) at 12 months; on the bothersomeness scale the effect was −1.0 (−1.9 to −0.2, p = 0.003) at 6 weeks and 0.3 (−0.6 to 1.3, p = 0.48) at 12 months. The effect on function was 0.9 (0.3 to 1.6, p = 0.006) at 6 weeks and 0.6 (−0.1 to 1.4, p = 0.10) at 12 months. High levels of baseline pain intensity were associated with greater treatment effects at 6 weeks and high levels of baseline disability were associated with greater treatment effects at 12 months. In the short-term exercise and advice is slightly more effective than advice alone for people with persisting pain and disability following whiplash. Exercise is more effective for subjects with higher baseline pain and disability.

Poverty and health: Primary care patients living at the interface

Background There is strong evidence associating poverty with poor health, and welfare benefits are an important means of maximising the income of deprived people in the United Kingdom (UK). The welfare benefits system is complex, and many need help in understanding their entitlements and in completing the applications. Research has shown that primary care is a suitable setting for the provision of welfare benefits advice. Objective of study To explore associations between changes in health status and increased income resulting from advice in primary care. Setting Welfare benefits advice services provided in primary care settings. Methods Structured interviews with those receiving welfare benefits advice in primary care, shortly after the advice session, and 6 and 12 months later. Results This paper reports six cases in detail to illustrate the interplay between financial, social and health aspects of the lives of deprived patients. Two patients recognised the role of an income increase in improving their health-related quality of life; in two cases, social and health issues outweighed the benefits of income increase; and two patients had, despite advice, experienced a reduction in income that they believe affected their health for the worse. Conclusion The simple relationship between poverty and health at a population level is not necessarily reflected in the lives of individuals. Nevertheless, there is a clear if modest role for benefits advice as part of a holistic approach to health in primary care.

A randomised clinical trial of activity-focussed physiotherapy on patients with distal radius fractures

Physiotherapy is considered by some authorities to be an important aspect of management in patients following distal radius fractures. There is evidence of improvement in impairment with physiotherapy; however, there is no evidence to support early return of functional activity. Traditional physiotherapy management has focussed on improving impairment; however, there are no trials with emphasis on skill acquisition via motor re-learning principles. Forty-one participants with conservatively managed distal radius fractures were studied in a randomised, single-blinded, prospective trial. Two treatment options were compared: exercise and advice versus activity-focussed physiotherapy with measurement periods of 6 weeks after removal of cast and follow-up at 24 weeks. Participants allocated to the exercise and advice group consulted a physiotherapist an average of 0.9 (SD 0.4) times, while the participants allocated to the more intensive activity-focussed group consulted with physiotherapy a mean of 4.4 (SD 2.3) times. At both 6 and 24 weeks there were no significant differences between the groups for change in impairment (as measured by grip strength, range of motion of wrist flexion and extension and pain intensity), activity limitation and participation restriction, as measured by the Patient-Rated Wrist Evaluation (PRWE). Exercise and advice given by a physiotherapist were equally as effective as activity-focussed physiotherapy in recovery both at 6 and 24 weeks. The results suggest that after removal of cast from fracture of distal radius, patients may routinely require no more than a single session of advice and exercise provided by a physiotherapist.

Individual Active Treatment Combined With Group Exercise for Acute and Subacute Low Back Pain

Randomized controlled trial. To compare two fast-access evidence-based interventions for the treatment of simple low back pain. People aged 18-65 with a new episode of simple back pain causing them to be off work or on modified work for less than 1 year. A district general hospital using a consultation/treatment room and a rehabilitation gym. One group received a back advice booklet and one session of advice and then followed the normal route of care as directed by their general practitioner. The other group received the back booklet and one session of advice and also a back program. The back program consisted of a full assessment, immediately followed by one individual treatment, and then exercise classes over 1 to 2 weeks. (1) Rate of return to work, (2) pain scores and health status, and (3) cost effectiveness of interventions versus the financial cost to the individual or employer. On average, those receiving the individual treatment and group exercise took 7 days less off work. This represented a 35% reduction in the amount of time taken off work since study entry. The estimated cost saving of providing the extra service of a simple back program ranged between 250 pound (367 US dollars, 300 euro) and 578 pound (850 US dollars, 694 euro) for each patient. The results indicate that the costs of this active back program are more than reimbursed as a consequence of earlier return to work.

Routine physiotherapy is as effective as one advice and assessment session for reducing disability in people with low back pain

QuestionDoes routine physiotherapy reduce functional disability compared with a single assessment and advice session in people with low back pain?Study designRandomised controlled trial.Main resultsIn people with low back pain, with or without leg pain or neurological signs, there was no significant difference in functional disability between physiotherapy and assessment and advice alone at 12 months (mean change in Oswestry disability index: −3.27 with advice and assessment v −2.23 with physiotherapy, mean difference −1.04, 95% CI −3.70 to 1.59).Authors’ conclusionsFor the treatment of low back pain, routine physiotherapy is as effective as one general advice and assessment session.

Brief motivational intervention for adolescent smokers in medical settings

This study evaluated the efficacy of using a brief motivational intervention to reduce smoking among adolescent patients treated in a hospital outpatient clinic or Emergency Department. Patients aged 14–19 years ( N=85) were randomly assigned to receive either one session of motivational interviewing (MI) or standardized brief advice (BA) to quit smoking. The assessment and intervention were conducted in the medical setting proximal to the patient's medical treatment. Patients were proactively screened and recruited, and were not seeking treatment for smoking. Follow-up assessments were conducted at 1, 3, and 6 months post-intervention. Self-report data indicated that 7-day abstinence rates at 6-month follow-up were significantly higher in the MI group than in the BA group, but this difference was not confirmed biochemically. Self-reported smoking rate (average cigarettes per day) was significantly lower at 1, 3, and 6 months follow-up than it was at baseline. Cotinine levels indicated reduced smoking for both groups at 6 months, but not at 1 month. At 3-month follow-up, only those in MI showed cotinine levels that were significantly reduced compared to baseline. Findings offer some support for MI for smoking reduction among non-treatment-seeking adolescents, but overall changes in smoking were small.

Randomised controlled trial of physiotherapy compared with advice for low back pain

Objective To measure the effectiveness of routine physiotherapy compared with an assessment session and advice from a physiotherapist for patients with low back pain.Design Pragmatic, multicentre, randomised controlled trial.Setting Seven...

Obsessive-compulsive disorders in children and adolescents--a review

Presented is a review of the literature on the medium- and long-term course of obsessive-compulsive disorder (OCD) with onset in childhood or adolescence. Using the data bank MEDLINE, relevant studies published since 1983 were investigated. Older studies were included if their results complemented those of recent studies. Follow-up studies point to a rather unfavorable course of childhood OCD. At the time of follow-up investigations, 30% to 70% of the patients still suffered from obsessive-compulsive symptoms or had a diagnosis of OCD. Other clinical disorders were diagnosed in 20% to 95% of them. One to two thirds of former patients had received at least one diagnosis of a personality disorder. Multicomorbidity was common. Impairment of the patients' psychosocial adjustment especially affected relationships and sexuality. Most of the variables examined in childhood or adolescence had no significant predictive power as to the course of obsessive-compulsive disorders. Differences between the results of the follow-up studies can partly be explained by the different study designs employed. Results on the course of childhood OCD point to the high stability of the disorder and the accompanying rate of comorbidity. This has to be taken into account in the diagnosis (supplementary diagnosis of comorbid disorders and family diagnostics) and therapy of childhood OCD (offering long-term therapeutic advice and booster sessions, treatment of comorbid disorder, inclusion of the family).