ABSTRACT
STUDY DESIGN: A randomized controlled trial of an educational booklet for patients with first-time neck pain. OBJECTIVE: To assess the clinical impact of a novel educational book on patients' functional outcomes and beliefs about neck pain. SUMMARY OF BACKGROUND DATA: Previous research has shown that a novel education booklet (The Back Book) had a positive impact on patients with low back pain' beliefs and clinical outcomes. The current study sought to evaluate the efficacy of a similar education booklet (The Neck Book) for neck-pain patients. METHODS: Workers' compensation patients were given either the experimental booklet, a traditional booklet or no booklet. The primary outcome measures, collected at 2-weeks, 3-months, and 6-months after baseline, were The Fear Avoidance Beliefs Questionnaire and The Neck Pain and Disability Scale. Health-related functional measures were also collected at these intervals. RESULTS: Only 34% (N = 187) of an original cohort of patients (N = 522) had data for all of the follow-up periods. For these 187 patients, repeated-measures analyses of covariance, using the baseline measure as the covariate, revealed no significant differences among the 3 groups on any of the outcome measures at any of the follow-up periods. For example, at 6-months, the experimental booklet, traditional booklet, and no-booklet groups reported The Neck Pain and Disability Scale mean scores (SDs) of 31.3 (15.5), 35.3 (17.0), and 31.8 (15.6), respectively. Similarly, there were no significant effects for The Fear Avoidance Beliefs Questionnaire scores-35.9 (21.5), 40.3 (22.1), and 38.0 (23.4), respectively. CONCLUSION: This study demonstrates that the educational booklets studied were not associated with improved outcomes in patients with neck pain receiving workers' compensation. Whether these results would apply to a nonworkers' compensation population requires further study. The loss of many patients to follow-up also makes any other firm conclusions more difficult to determine.
Subject(s)
Neck Pain/psychology , Neck Pain/therapy , Pamphlets , Patient Education as Topic/methods , Workers' Compensation , Adaptation, Psychological , Adult , Attitude to Health , Culture , Disability Evaluation , Fear/psychology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Neck Pain/prevention & control , Outcome Assessment, Health Care , Pain Measurement , Patient Compliance , Patient Education as Topic/statistics & numerical data , Sick Role , Surveys and Questionnaires , Treatment Outcome , Workers' Compensation/statistics & numerical dataABSTRACT
There is always a psychological component to any illness or injury, and unless it is appropriately addressed, such factors can complicate or delay the recovery from a work-related illness or injury. When a worker experiences delayed recovery and unexpected disability, significant contributing psychosocial factors must be assessed for and managed appropriately. A maladaptive belief or understanding about the condition and disability by a patient presents an obstacle to successful treatment. Using cognitive behavioral therapy techniques may be an effective means of managing this challenge for the clinician.
Subject(s)
Arm Injuries/rehabilitation , Attitude to Health , Cumulative Trauma Disorders/rehabilitation , Disabled Persons , Occupational Diseases/rehabilitation , Recovery of Function , Adaptation, Psychological , Anxiety/psychology , Arm Injuries/complications , Arm Injuries/psychology , Causality , Cognitive Behavioral Therapy , Cumulative Trauma Disorders/complications , Cumulative Trauma Disorders/psychology , Disabled Persons/psychology , Disabled Persons/rehabilitation , Hostility , Humans , Malingering/psychology , Medical History Taking , Motivation , Negativism , Occupational Diseases/complications , Occupational Diseases/psychology , Occupational Health , Occupational Medicine , Physician-Patient Relations , Psychophysiologic Disorders/complications , Psychophysiologic Disorders/prevention & control , Psychophysiologic Disorders/psychology , Social Support , Time FactorsABSTRACT
Carpal tunnel syndrome is a medical disease, not an injury, although symptoms may occur in association with certain physical activities of the upper extremity. The concept of work-related carpal tunnel syndrome has grown to such proportion as to be problematic for society, having spawned health care industries to support a cultural concept and a largely mythical medical paradigm. Because of these social and economic forces, cultural perceptions and expectations have adjusted to this flawed medical model. Success in improving patient management and making the best use of sound medical evidence depends on the concurrent use of educational strategies addressing social influences and attitudinal changes of practicing physicians, patients, and third-party administrators. The promotion of evidence-based medicine is key. This article discusses these controversies and suggests ways of managing carpal tunnel syndrome.
