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.


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