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Τετάρτη, 15 Σεπτεμβρίου 2010

Η προσδοκία του πελάτη - ασθενή επηρεάζει το αποτέλεσμα της παρέμβασης?


Σήμερα διάβαζα ενδιαφέρον αναφορές στο http://bodyinmind.com.au/ για την σχέση της προσδοκίας του πελάτη-ασθενή στην αποτελεσματικότητα του βελονισμού. Προκύπτει ότι υπάρχει κάποια σύνδεση, από μικρή έως πολυυυύ μεγάλη.

Μου αρέσει επίσης που η Ελληνική Φυσικοθεραπευτική Εταιρεία Αλγολογίας έχει σε εξέλιξη πολύ ενδιαφέρον ΠΡΟΓΡΑΜΜΑ ΕΚΠΑΙΔΕΥΣΗΣ ΦΥΣΙΚΟΘΕΡΑΠΕΥΤΩΝ ΣΤΟ ΒΕΛΟΝΙΣΜΟ, μάλιστα με την εξής ΕΠΙΣΗΜΑΝΣΗ

Το καθεστώς εφαρμογής του Βελονισμού ανά τον κόσμο, ποικίλει ανάλογα με την
κείμενη νομοθεσία της κάθε χώρας. Στην Ελλάδα, ο βελονισμός δεν περιλαμβάνεται στις θεσμοθετημένες φυσικοθεραπευτικές πράξεις, σε αντίθεση με τα ισχύοντα σε αναπτυγμενές υγειονομικά χώρες όπως, για παράδειγμα, η Μ.Βρετανία, η
Αυστραλία, η Σουηδία, η Ολλανδία κλπ. Υπογραμμίζουμε προς τους συμμετέχοντες ότι η παροχή εκπαίδευσης στο βελονισμό δεν συνεπάγεται και νομική κατοχύρωση άσκησής του σε ασθενείς.

Η προσπάθεια της Εταιρείας μόνο με ικανοποίηση μας (χώρος των ΣΕΘ) γεμίζει και μάλλον θα δούμε πολύ μεγάλες εξελίξεις σύντομα. Ελπίζω ειλικρινά κάποιο από τα επόμενα σεμινάρια τους να είναι στην Ρεφλεξολογία!!

Οι προηγούμενοι αναφέρονται στις ακόλουθες έρευνες:
Lessons from a trial of acupuncture and massage for low back pain: patient expectations and treatment effects.
OBJECTIVE: To evaluate the association of a patient's expectation for benefit from a specific treatment with improved functional outcome.
SUMMARY OF BACKGROUND DATA: Psychosocial factors, ambiguous diagnoses, and lack of a clearly superior treatment have complicated the management of patients with chronic low back pain. The authors hypothesized that patient expectation for benefit from a specific treatment is associated with improved functional outcomes when that treatment is administered.
METHODS: In a randomized trial, 135 patients with chronic low back pain who received acupuncture or massage were studied. Before randomization, study participants were asked to describe their expectations regarding the helpfulness of each treatment on a scale of 0 to 10. The primary outcome was level of function at 10 weeks as measured by the modified Roland Disability scale.
RESULTS: After adjustment for baseline characteristics, improved function was observed for 86% of the participants with higher expectations for the treatment they received, as compared with 68% of those with lower expectations (P = 0.01). Furthermore, patients who expected greater benefit from massage than from acupuncture were more likely to experience better outcomes with massage than with acupuncture, and vice versa (P = 0.03).
CONCLUSIONS: The results of this study suggest that patient expectations may influence clinical outcome independently of the treatment itself. In contrast, general optimism about treatment, divorced from a specific treatment, is not strongly associated with outcome. These results may have important implications for clinical trial design and recruitment, and may help to explain the apparent success of some conventional and alternative therapies in trials that do not control for patient expectations. The findings also may be important for therapy choices made in the clinical setting.

http://www.ncbi.nlm.nih.gov/pubmed/11458142

The impact of patient expectations on outcomes in four randomized controlled trials of acupuncture in patients with chronic pain.Abstract
In a pooled analysis of four randomized controlled trials of acupuncture in patients with migraine, tension-type headache, chronic low back pain, and osteoarthritis of the knee we investigated the influence of expectations on clinical outcome. The 864 patients included in the analysis received either 12 sessions of acupuncture or minimal (i.e. sham) acupuncture (superficial needling of non-acupuncture points) over an 8 week period. Patients were asked at baseline whether they considered acupuncture to be an effective therapy in general and what they personally expected from the treatment. After three acupuncture sessions patients were asked how confident they were that they would benefit from the treatment strategy they were receiving. Patients were classified as responders if the respective main outcome measure improved by at least fifty percent. Both univariate and multivariate analyses adjusted for potential confounders (such as condition, intervention group, age, sex, duration of complaints, etc.) consistently showed a significant influence of attitudes and expectations on outcome. After completion of treatment, the odds ratio for response between patients considering acupuncture an effective or highly effective therapy and patients who were more sceptical was 1.67 (95% confidence interval 1.20-2.32). For personal expectations and confidence after the third session, odds ratios were 2.03 (1.26-3.26) and 2.35 (1.68-3.30), respectively. Results from the 6-month follow-up were similar. In conclusion, in our trials a significant association was shown between better improvement and higher outcome expectations.
PMID: 17257756 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/17257756

Is acupuncture analgesia an expectancy effect? Preliminary evidence based on participants' perceived assignments in two placebo-controlled trials.
Abstract
This purpose of this article is to contrast the analgesic efficacy of acupuncture following dental surgery with the analgesic effects based on the expectation of benefit in two independently conducted placebo-controlled trials evaluating acupuncture as an adjunctive therapy for dental surgery. Both trials used pain following dental surgery as the outcome variable, and both included a blinding check to ascertain patients' beliefs regarding which treatment they were receiving. Although no statistically significant analgesic effect was observed between the acupuncture and placebo groups, participants in both experiments who believed they received real acupuncture reported significantly less pain than patients who believed that they received a placebo. Patients' beliefs regarding the receipt of acupuncture bore a stronger relationship to pain than any specific action possessed by acupuncture. These results also support the importance of both employing credible controls for the placebo effect in clinical trials and evaluating the credibility of those controls.
PMID: 15677384 [PubMed - indexed for MEDLINE]
http://www.ncbi.nlm.nih.gov/pubmed/15677384

θα προσθέσω και αυτό:
Η Θεραπευτική Άξια Της Λευκής Μπλούζας
Δημοσιεύθηκε από Ομάδα Ενημέρωσης ΕΛΙΓΑΣΤ 2 Ιανουαρίου 2007

Σε ένα εξωτερικό Ιατρείο, σε 300 ασθενείς επιδείχθηκαν φωτογραφίες Ιατρών με 4 διαφορετικά στύλ : επαγγελματική εμφάνιση με λευκή μπλούζα, χειρουργική πράσινη στολή, κοστούμι και γραβάτα, καθημερινό ντύσιμο.

Οι συμμετέχοντες ερωτήθηκαν ως προς το ποιός Ιατρός, σύμφωνα με την εμφάνισή του, θα κέρδιζε περισσότερο την εμπιστοσύνη τους ώστε να συμμορφωθούν με τις υποδείξεις του και να επιστρέψουν για επανεξέταση. Συνολικά, όσοι απάντησαν επέλεξαν την λευκή μπλούζα (76%), ενώ κάθε ένα από τα υπόλοιπα στύλ έλαβε ποσοστό κάτω του 10%.

Μην ξεχάμε οτι και ο Ιπποκράτης είχε την άποψη οτι ο Ιατρός θα πρέπει να είναι καθαρός, καλοντυμένος και αρωματισμένος...

ΕΜΜΑΝΟΥΗΛ ΣΥΜΒΟΥΛΑΚΗΣ, Γαστρεντερολόγος