[Therapeutic decision making].
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Decision Making↗
Biomedical subjects
Christine Cedraschi
Publications and source records attributed to Christine Cedraschi.
Information and low back pain management: a systematic review.
STUDY DESIGN: A systematic search of three electronic databases was done to identify randomized controlled trials on the effect of written or audiovisual information in low back pain. OBJECTIVES: To determine whether information is an effective preventive action and/or therapy for low back pain and which type of information is most effective. SUMMARY OF BACKGROUND DATA: Information is commonly used in the primary care of low back pain and mostly delivered by booklets. METHODS: A systematic computer-aided search of the Medline, PsyclInfo, and Embase database. A rating system was used to assess the strength of the evidence, based on the methodologic quality of the randomized controlled trials, the relevance of the outcome measures, and the consistency of the results. RESULTS: Eleven randomized controlled trials were selected, including seven trials of high methodologic quality, as well as one parallel group controlled survey and one longitudinal study. Only three of the seven high-quality studies showed favorable results for information. There is strong evidence that a booklet increases knowledge and moderate evidence that physician-related cues increase the confidence in a booklet and adherence to exercises. There is limited evidence that a biopsychosocial booklet is more efficient than a biomedical booklet to shift patient's beliefs about physical activity, pain, and consequences of low back trouble. There is strong evidence that booklets are not efficient on absenteeism and conflicting evidence that they are efficient on healthcare use. There is no evidence that e-mail discussion or video programs alone are effective to reduce low back pain, disability, and healthcare costs. CONCLUSIONS: Information based on a biopsychosocial model is recommended in primary care to shift patient beliefs on low back pain. Nevertheless, information delivery alone is not sufficient to prevent absenteeism and reduce healthcare costs.
Databases, Factual↗
Radiological examination in low back pain patients: anxiety of the patient? Anxiety of the therapist?
A review of the recent literature shows that guidelines on the management of low back pain (LBP) have little impact on the use of radiological imagery. Among the factors which might account for the use of radiological examination, a review of the literature points to some that refer to the patient, others to the clinician and still others to the therapeutic interaction. This leads one to question the importance of radiological examination for both the patient and the physician. The matter at stake in this review is the relationship that may exist between this type of examination and the patient's and/or the physician's anxiety. If these aspects are associated or causally related, this relationship can be two-sided and is thus susceptible to affect the patient, the physician, or both. Some possible keys which emphasize the central role of the therapeutic relationship in this predicament are also reviewed.
Anxiety↗
[Lack of time for writing?].
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Authorship↗
Nonspecific lower-back pain: surgical versus nonsurgical treatment.
UNLABELLED: We review evidence-based treatments for patients seeking care for lower-back pain and patients who have been diagnosed with nonspecific lower-back pain. The review is based on selected systematic reviews and national and international guidelines for the treatment of lower-back pain. Additional randomized controlled trials (ie, possibly those not previously included in the latest systematic reviews) were reviewed and added based on recommended procedures for the evaluation of methodological quality (ie, strong, moderate, and weak). In acute nonspecific lower-back pain (0-4 weeks duration of pain) there is moderate to strong evidence that self-care with over-the-counter medication and maintaining activity as tolerated or treatment with a limited number of sessions of manipulative therapy is effective for pain relief. In subacute nonspecific lower-back pain (4-12 weeks duration of pain) there is weak to moderate evidence that a graded activity program including exercises and cognitive behavioral treatment in combination is more efficient than usual care with regard to return to work. There is strong evidence that these programs reduce work absenteeism. In cases of chronic nonspecific lower-back pain (> 12 weeks duration of pain) a variety of treatments are available with limited and similar efficacy on pain and disability reduction. There is moderate evidence that surgery in chronic nonspecific lower-back pain is as effective as cognitive behavioral treatment with regard to pain, function, mood and return to work. Surgical indications for chronic nonspecific lower-back pain remain ill defined. LEVEL OF EVIDENCE: Level V (expert opinion). See the Guidelines for Authors for a complete description of levels of evidence.
Analgesics↗
[Patient rooms in the hospital].
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Hospitals↗
How do patients define "good" and "bad" doctors?
QUESTIONS UNDER STUDY: Knowledge of hospital patients' perceptions of doctors' qualities is limited. The purpose of this study was to explore hospital patients' definitions of "good" and "bad" doctors. METHODS: Semi-structured interviews conducted with 68 consecutive hospital patients. The questions explored the characteristics of good/bad doctors. Responses were subjected to content analysis. RESULTS: The patients' mean age was 72.7 (+/- 15) years; 61% were female. Content analysis produced 9 categories connoted positively/negatively; the mean number of categories/patient response was 2.4 (+/- 1.3), ranging from 1-6. Sensitivity/insensitivity to feelings were in the forefront, together with the importance of the relational dimension and the need to provide treatment tailored to the patient's needs. Patients' responses emphasised "bad" doctors' use of medicine as self-serving and not serving the patient. CONCLUSION: This qualitative enquiry made it possible to gather information on the patients' expectations or beliefs outside physicians' or health researchers' pre-established categories. It emphasised that acknowledging possible areas of uncertainty may be less threatening for the doctor's image than exhibiting scientific proficiency unadapted to the patient's expectations and needs.
Age Distribution↗
Reliability of retrospective clinical data to evaluate the effectiveness of lumbar fusion in chronic low back pain.
STUDY DESIGN: Patients in whom a posterior spinal fusion instrumentation had been performed to treat low back pain were asked to recall their preoperative clinical status by retrospectively filling out the same 3 self-evaluation scales they had completed before surgery in a prospective fashion. OBJECTIVES: To evaluate the impact of recollection error and compare outcomes using retrospective versus prospective methodologies among a cohort of patients treated with posterior spinal fusion instrumentation. SUMMARY OF BACKGROUND DATA: Literature on spine surgery from 1990 to 2000 shows a greater increase in retrospective studies as compared to randomized controlled trials and other prospective studies. Cross-sectional studies evaluate therapeutic effectiveness by comparing the current condition with the recalled (retrospectively recorded) pretreatment condition. There are no studies analyzing the characteristics of recalled data in a cohort of patients with chronic low back pain treated with posterior spinal fusion instrumentation. METHODS: The preoperative clinical status of 58 patients, 33 women and 25 men, with a mean age of 48.3 years (22-84 years) was assessed prospectively with 3 self evaluation questionnaires and retrospectively at a mean of 37.5 months (2-58 months) after surgery using the same questionnaires. The Wilcoxon test was used to compare prospective and retrospective preoperative data and to compare prospective outcomes with outcomes determined from cross-sectional data. Agreement between prospective and retrospective measures was estimated with intraclass correlation coefficients for absolute agreement and consistency. RESULTS: Comparisons between prospective and recalled data showed significant differences, demonstrating a worse preoperative situation when using retrospective data. Assessment of treatment effectiveness showed that cross-sectional evaluation significantly improved the real surgical outcome. Both absolute agreement and consistency intraclass correlation coefficients showed poor agreement between prospective and cross-sectional data, revealing no systematic bias. Follow-up, age, and gender did not modify agreement and cross-sectional overestimation. CONCLUSIONS: Relying on a patient's recall of preoperative clinical status is not an accurate method to evaluate surgical outcome after posterior spinal fusion instrumentation. Cross-sectional studies may overestimate the effectiveness of surgery.
Adult↗
Exploring the major difficulties perceived by residents in training: a pilot study.
OBJECTIVES: To assess residents' difficulties during the first year of residency. In contrast to previous studies that mainly used structured questionnaires, a qualitative procedure was applied. METHODS: Twenty-four consecutive first-year residents in internal medicine were asked to "Please identify two to three major difficulties or concerns related to your practice of medicine within this hospital". The answers were submitted to content analysis performed by three independent researchers. Inter-rater agreement was high (kappa coefficient = 0.92). Disagreements were solved by consensus. RESULTS: Physicians' characteristics: female 37%, mean age 28 +/- 2.2 years, mean duration of postgraduate training 2.5 +/- 1.3 years. Total number of answers: 122, average answers/resident 5.1 +/- 1.3. Nine categories were extracted from content analysis: communication problems at the workplace, feelings of not being respected, constraints of collaborative work, experiencing the gap between medical school and clinical care, work overload, responsibility towards and emotional investment in patients, worries about career plans, and lack of theoretical knowledge. Residents expressed major difficulties in communicating with and being respected by seniors and peers in particular, and hospital staff in general. They also voiced problems in coping with emotions, either their own or those of their patients. CONCLUSIONS: The residents' responses stressed the complexity of blending the requirements of the physician's role when instrumental/cognitive knowledge is not sufficient to deal with problems requiring personal and relational dimensions. Learning to combine medical knowledge and practice necessitates helping students/residents identify and deal with the constraints of these requirements.
Adult↗