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Studying optimal healing environments: challenges and proposals.

Abstract

The concept of optimal healing environments has strong face validity, but it is difficult to operationalize the complexity of the human dimensions that comprise the process of healing. Only rigorous evidence can justify the tremendous resources necessary to create optimal healing environments. This article outlines the current challenges of studying optimal healing environments from a clinical epidemiology perspective and discusses the major potential obstacles to include human resources, relationship-centered care competencies, dysfunctional educational and health care systems, research competencies, credibility, dispersed and unfocused current evidence base, and the actual logistical methodological difficulties. The concept of optimal healing environments is a paradigm shift in the delivery and study of medical care, and such an initiative will likely take decades to transition. However, there are feasible activities that can currently be undertaken to expedite this transition, chief of which is establishing a coalition of influential societies to forge an agenda on several fronts. Research activities presently should focus on validating and simplifying measurement tools for healing-related outcomes constructs, expanding the versatility and use of qualitative methods, as well as synthesizing research evidence to help clarify the current evidence base and the future research agenda.

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BibTeXRIS

Patrick G O'Malley. 2005. Studying optimal healing environments: challenges and proposals.. https://doi.org/10.1089/acm.2005.11.s-17

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The long-term effect of multidisciplinary back training: a systematic review.

STUDY DESIGN: Systematic review of randomized controlled trials. OBJECTIVES: To determine the long-term effect of multidisciplinary back training on the work participation of patients with nonspecific chronic low back pain. SUMMARY OF BACKGROUND DATA: Chronic low back pain is influenced by multiple factors. Multidisciplinary back training represents one of the options to take this multiplicity into account. So far, only evidence of the short-term effectiveness of this approach in terms of work participation is available. METHODS: Electronic databases were searched and the references of various articles were screened for relevant publications. Ten studies met the inclusion criteria. All included studies were evaluated for their methodologic quality. RESULTS: Five of the studies had a low methodologic quality. All high-quality studies found a positive effect on at least one of the 4 outcome measures used. Based on our criteria, effectiveness was found for the outcome measures of work participation and quality of life. No effectiveness was found for experienced pain and functional status. The intensity of the intervention seems to have no substantial influence on the effectiveness of the intervention. CONCLUSION: In the long-term, multidisciplinary back training has a positive effect on work participation in patients with nonspecific chronic low back pain.

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