Videotaped
modelling and film distraction reduced the proportion of patients failing to
complete a prescribed course of hyperbaric oxygen therapy.
Clinical
Bottom Line:
1.
A combination of videotaped modelling and distraction by film significantly
reduced the proportion of patients withdrawing from hyperbaric treatment.
Appraised
by:
Mike Bennett, Dept of Diving and Hyperbaric Medicine, Prince of Wales Hospital,
Sydney; Friday, 15 January, 1999
Clinical
Scenario:
A patient presenting for hyperbaric oxygen treatment for a problem wound.
Three-part
Question:
When administering hyperbaric oxygen therapy, does the use of modelling and
distraction techniques as compared to an explanation and reassurance approach,
result in any decrease in patient anxiety or a reduction in the number of
patients requesting termination of treatment?
Search
Terms:
Behaviour therapy/*methods, Attention.
The
Study:
Non-blinded
randomised controlled trial with intention-to-treat. Adult patients referred for
HBOT for a variety of non-emergency indications.
Control
group (N = 6; 6 analysed): Patients were given a standard preparation talk by
hyperbaric unit staff prior to entry to the chamber for their first treatment.
Experimental
group (N = 5; 5 analysed): As above but also watched a 9 minute video about the
hyperbaric experience which included a patient describing a number of coping
strategies. Patients were also permitted to watch a video of choice for
distraction during the first treatment.
The
Evidence:
|
Outcome |
Control
rate |
Video
rate |
Relative
risk reduction |
Absolute
risk reduction |
NNT |
|
Did
not complete prescribed course |
0.83 |
0 |
100% |
0.83 |
1 |
|
95%
CI: |
|
|
|
0.54
to 1.13 |
1
to 2 |
|
Failure
to complete one treatment |
0.33 |
0 |
100% |
0.33 |
3 |
|
95%
CI: |
|
|
|
0.04
to 0.71 |
NNT=1
to INF NNH=23 to
INF |
Non-Event
Outcomes Control
group Experimental
group
P-value
Distress
rating before
Treatment
(scale 0-10)
5.8
3.5
<0.05
Comments:
1.
Very high rate of failure to complete course of therapy in the control group is
probably unusual in most settings.
2.
Presumed to be associated with monoplace rather than multiplace facility. It is
not clear how applicable these results would be in a multiplace facility where
patients witness actual coping behaviour.
3.
Anxiety scores during treatment seem to support main findings but are not
presented in detail.
Expiry date: January 2005
References:
1.
Allen KD, Danforth JS, Drabman RS. Videotaped modeling and film distraction for
fear reduction in adults undergoing hyperbaric oxygen therapy. Journal of
Consulting and Clinical Psychology 1989; 57:554-558.
