Lenora Perry

The University of Western Ontario, London, Ontario, Canada

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Publications (5)20.96 Total impact

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    ABSTRACT: Neck disorders are common, disabling, and costly. The effectiveness of patient education strategies is unclear. To assess the short- to long-term effects of therapeutic patient education (TPE) strategies on pain, function, disability, quality of life, global perceived effect, patient satisfaction, knowledge transfer, or behaviour change in adults with neck pain associated with whiplash or non-specific and specific mechanical neck pain with or without radiculopathy or cervicogenic headache. We searched computerised bibliographic databases (inception to 11 July 2010). Eligible studies were randomised controlled trials (RCT) investigating the effectiveness of TPE for acute to chronic neck pain. Paired independent review authors conducted selection, data abstraction, and 'Risk of bias' assessment. We calculated risk ratio (RR) and standardised mean differences (SMD). Heterogeneity was assessed; no studies were pooled. Of the 15 selected trials, three were rated low risk of bias. Three TPE themes emerged.Advice focusing on activation: There is moderate quality evidence (one trial, 348 participants) that an educational video of advice focusing on activation was more beneficial for acute whiplash-related pain when compared with no treatment at intermediate-term [RR 0.79 (95% confidence interval (CI) 0.59 to 1.06)] but not long-term follow-up [0.89 (95% CI, 0.65 to 1.21)]. There is low quality evidence (one trial, 102 participants) that a whiplash pamphlet on advice focusing on activation is less beneficial for pain reduction, or no different in improving function and global perceived improvement from generic information given out in emergency care (control) for acute whiplash at short- or intermediate-term follow-up. Low to very low quality evidence (nine trials using diverse educational approaches) showed either no evidence of benefit or difference for varied outcomes. Advice focusing on pain & stress coping skills and workplace ergonomics: Very low quality evidence (three trials, 243 participants) favoured other treatment or showed no difference spanning numerous follow-up periods and disorder subtypes. Low quality evidence (one trial, 192 participants) favoured specific exercise training for chronic neck pain at short-term follow-up.Self-care strategies: Very low quality evidence (one trial, 58 participants) indicated that self-care strategies did not relieve pain for acute to chronic neck pain at short-term follow-up. With the exception of one trial, this review has not shown effectiveness for educational interventions, including advice to activate, advice on stress-coping skills, workplace ergonomics and self-care strategies. Future research should be founded on sound adult learning theory and learning skill acquisition.
    Cochrane database of systematic reviews (Online) 01/2012; 3:CD005106. · 5.70 Impact Factor
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    ABSTRACT: Neck pain is common, disabling, and costly. The effectiveness of patient education strategies is unclear. To assess whether patient education strategies are of benefit for pain, function/disability, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with or without radiculopathy. Cochrane systematic review. Computerized bibliographic databases were searched from their start to May 31, 2008. Eligible studies were randomized trials investigating the effectiveness of patient education strategies for neck pain. Paired independent reviewers carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences were calculated. Because of differences in intervention type or disorder, no studies were considered appropriate to pool. Of the 10 selected trials, two (20%) were rated as of high quality. Patient education was assessed as follows: 1) eight trials of advice focusing on activation compared with no treatment, or to various active treatments, including therapeutic exercise, manual therapy, and cognitive behavioral therapy, showed either inferiority or no difference for pain, spanning a full range of follow-up periods, acuity and disorder types. When compared with rest, two trials that assessed acute whiplash-associated disorder showed moderate evidence of no difference for advice focusing on activation; 2) two trials studying advice focusing on pain and stress coping skills found moderate evidence of no benefit for chronic neck pain at intermediate- to long-term follow-up; and 3) one trial compared the effects of neck school to no treatment, yielding limited evidence of no benefit for pain, at intermediate-term follow-up in mixed acute/subacute/chronic neck pain. This review has not shown effectiveness for educational interventions for neck pain of various acuity stages and disorder types and at various follow-up periods, including advice to activate, advice on stress coping skills, and neck school. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of specific educational components.
    The spine journal: official journal of the North American Spine Society 08/2009; 9(10):859-71. · 2.90 Impact Factor
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    ABSTRACT: Neck disorders are common, disabling, and costly. The effectiveness of patient education strategies is unclear. To assess whether patient education strategies, either alone or in combination with other treatments, are of benefit for pain, function, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with and without radiculopathy. Computerized bibliographic databases were searched from their start up to May 31, 2008. Eligible studies were quasi or randomized trials (RCT) investigating the effectiveness of patient education strategies for neck disorder. Paired independent review authors carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences (SMD) were calculated. The appropriateness of combining studies was assessed on clinical and statistical grounds. Because of differences in intervention type or disorder, no studies were considered appropriate to pool. Of the 10 selected trials, two (20%) were rated high quality. Advice was assessed as follows:Eight trials of advice focusing on activation compared to no treatment or to various active treatments, including therapeutic exercise, manual therapy and cognitive behavioural therapy, showed either inferiority or no difference for pain, spanning a full range of follow-up periods and disorder types. When compared to rest, two trials that assessed acute whiplash-associated disorders (WAD) showed moderate evidence of no difference for various forms of advice focusing on activation. Two trials studying advice focusing on pain & stress coping skills found moderate evidence of no benefit for pain in chronic mechanical neck disorder (MND) at intermediate/long-term follow-up. One trial compared the effects of ' traditional neck school ' to no treatment, yielding limited evidence of no benefit for pain at intermediate-term follow-up in mixed acute/subacute/chronic neck pain. This review has not shown effectiveness for educational interventions in various disorder types and follow-up periods, including advice to activate, advice on stress coping skills, and 'neck school'. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of the specific educational components.
    Cochrane database of systematic reviews (Online) 01/2009; · 5.70 Impact Factor
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    ABSTRACT: Well-conducted systematic reviews and meta-analyses provide the best quality evidence for clinical decision-making. This article presents the key role of systematic reviews in clinical decision-making, discussing the steps and pitfalls to avoid in conducting systematic reviews and meta-analyses.
    Clinics in plastic surgery 05/2008; 35(2):207-14. · 0.95 Impact Factor
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    ABSTRACT: Neck disorders are common, disabling, and costly. The effectiveness of patient education strategies is unclear. To assess whether patient education strategies, either alone or in combination with other treatments, are of benefit for pain, function, global perceived effect, quality of life, or patient satisfaction, in adults with neck pain with and without radiculopathy. Computerized bibliographic databases were searched from their start up to May 31, 2008. Eligible studies were quasi or randomized trials (RCT) investigating the effectiveness of patient education strategies for neck disorder. Paired independent review authors carried out study selection, data abstraction, and methodological quality assessment. Relative risk and standardized mean differences (SMD) were calculated. The appropriateness of combining studies was assessed on clinical and statistical grounds. Because of differences in intervention type or disorder, no studies were considered appropriate to pool. Of the 10 selected trials, two (20%) were rated high quality. Advice was assessed as follows:Eight trials of advice focusing on activation compared to no treatment or to various active treatments, including therapeutic exercise, manual therapy and cognitive behavioural therapy, showed either inferiority or no difference for pain, spanning a full range of follow-up periods and disorder types. When compared to rest, two trials that assessed acute whiplash-associated disorders (WAD) showed moderate evidence of no difference for various forms of advice focusing on activation.Two trials studying advice focusing on pain & stress coping skills found moderate evidence of no benefit for pain in chronic mechanical neck disorder (MND) at intermediate/long-term follow-up.One trial compared the effects of 'traditional neck school' to no treatment, yielding limited evidence of no benefit for pain at intermediate-term follow-up in mixed acute/subacute/chronic neck pain. This review has not shown effectiveness for educational interventions in various disorder types and follow-up periods, including advice to activate, advice on stress coping skills, and 'neck school'. In future research, further attention to methodological quality is necessary. Studies of multimodal interventions should consider study designs, such as factorial designs, that permit discrimination of the specific educational components.
    Cochrane database of systematic reviews (Online) 01/2008; · 5.70 Impact Factor