Benefit Of Conservative Treatment Research Articles

How people with lumbar spinal stenosis make decisions about treatment: A qualitative study using the Health Belief Model

ObjectiveSurgery rates for lumbar spinal stenosis (LSS) have increased despite inherent risks, high reoperation rates, and a lack of evidence for benefit over conservative treatment. Scant research has investigated how people make decisions about treatment, which may help clinicians better support patients during the course of care. The purpose of the present study was to explore the beliefs of people with LSS and how they make decisions about treatment. DesignCross-sectional qualitative study. MethodsSemi-structured individual interviews were conducted with participants who had LSS (based on diagnostic imaging and recent symptoms). Transcribed interview data was analyzed using directed content analysis informed by the Health Belief Model. ResultsTwelve patients (mean age 75.3 years, range 63–87 years, 9 female, 6 with previous LSS surgery) participated. The Health Belief Model appeared useful for explaining decisions about treatment. Perceived threat of LSS was higher in those who had surgery. Patients who decided on surgery perceived themselves as more susceptible to surgery, often because of pathoanatomical beliefs. These patients had lower perceived control over symptoms and the treatment decision itself. Although patients saw benefit in conservative treatment because of its lower risk and ability to foster self-management, many had no or poor education and reported previous experiences with ineffective conservative treatment. ConclusionPatients with LSS make decisions about treatment by weighing the perceived threat of LSS against the perceived barriers and benefits of conservative treatment. Consistent and nonthreatening educational messages from clinicians may help these patients during their decision-making process.

Utero-cutaneous Fistula after Multiple Abdominal Myomectomies: A Case Report.

Utero-cutaneous fistula (UCF) is an extremely rare entity and only a few case reports have been published. Most UCFs develop secondary to post-partum or postoperative complications. A 42 year-old woman began to complain from bleeding and malodorous discharge through her abdominal incision scar. The fistula tract with a thickness of 8 mm was observed between the uterus and wound using magnetic resonance imaging (MRI). The risks and benefits of conservative treatment have been discussed; the patient demanded definitive treatment, so hysterectomy and excision of the fistulous tract was performed. Histopathology of the fistulous tract showed endometrial epithelization of the tract lined by granulation. There are many causes of such an extremely rare entity. Patients should be counseled for medical or surgical treatment considering their age, accompanied uterine pathologies such as fibroids and fertility expectations.

The conservative management of adolescent idiopathic scoliosis

Adolescent idiopathic scoliosis is a disorder which can exhibit considerable variation in both clinical presentation and rate of progression. Most severe scoliotic curves require surgical stabilization, however there is a group of patients with less severe presentations for whom conservative treatments are often considered as a first line of management. The most commonly utilized conservative therapies are bracing, electrical muscle stimulation and various forms of exercise. These treatments are time consuming and carry with them the potential for physical and psychological side effects. It is imperative therefore that such treatments, if they are to be utilized, should show a clear beneficial effect in limiting the progression and adverse effects of scoliosis. This paper reviews the available data from clinical trials investigating various forms of conservative therapy and discusses the outcomes of these trials in relation to the natural history of scoliosis. The author concludes that the benefits of conservative treatment are at best marginal and that there is little clear data to support the use of one treatment above any others. Published research in this area is fraught with methodological inadequacies which make it difficult to support or indeed, to categorically refute the value of any particular treatment for specific patient groups. Proposals relevant to improving the quality of future studies have therefore been included in the paper. While the present paper does not provide support for the use of conservative treatment modalities in the management of adolescent idiopathic scoliosis it is hoped that researchers will continue to address this topic and that new treatment approaches may be developed.

Traumatic Spinal Subdural Hematoma

A 15-year-old boy developed back pain and sciatica after a minor trauma. Magnetic resonance imaging revealed lumbar spinal subdural hematoma. After repeated lumbar spinal puncture and drainage of hemorrhagic fluid, spinal subdural hematoma was resolved completely. The benefits of conservative treatment by lumbar spinal puncture are discussed.