The effect of observational learning on the development of central sensitization

Watching other people in pain may affect one’s own experience of pain. It is unknown whether it can also modulate secondary mechanical hypersensitivity. We have addressed this question in two experiments in healthy human volunteers. In experiment 1 we tested, on a large sample (N=83), five videos of a model demonstrating high or low pain during high frequency stimulation (HFS) of the skin, a procedure known to induce secondary mechanical hypersensitivity. The aim was to select the two videos rated with the highest and lowest expected pain and fear (high pain and low pain videos). Morevoer, we have explored the correlation between empathy and fear scores. In experiment 2 (N=44), two groups of participants were randomly allocated to watching either the low or the high pain video, and subsequently underwent HFS. The high pain video group reported increased pain during HFS. The two groups differed in the magnitude of secondary mechanical hypersensitivity after HFS, but the unpleasantness scores for mechanical stimulation after HFS, as well as spread of hyperalgesia were not statistically different. Empathy scores correlated positively with fear reports in experiment 1 but not experiment 2. Unexpectedly, we found higher scores of fear of pain for the high pain video only in experiment 1. In summary, observational learning of a model demonstrating high pain seems to have a stastistically significant but small effect on pinprick hypersensitivity. Its operating mechanisms remain partially elusive.

Patient Comprehension of Trigger Finger Concepts Based on Distribution Format: A Randomized Controlled Trial of Handout Versus Video

Background: Patient comprehension is an essential part of optimizing medical outcomes. It is unknown which format is most effective in delivering this information. In addition to a face-to-face conversation, a paper handout is often given as an educational supplement at the conclusion of a visit. Secondary to advances in technology and the ubiquity of the Internet, medical videos have gained popularity. The purpose of this randomized controlled trial was to determine whether the educational material format (paper handout vs video) resulted in a difference in either comprehension of the condition or satisfaction with the delivery of the information. Methods: Patients aged ≥18 years with a diagnosis of trigger finger were prospectively enrolled and randomized to receive either a paper handout or video link with information regarding the pathophysiology, diagnosis, and treatment of trigger finger. Survey assessments were then distributed, consisting of 7 questions related to trigger finger and 1 question related to patient satisfaction. Continuous data were compared using 2-sample t tests, and categorical data were compared with χ2 tests. Alpha was 0.05. Results: Seventy-one patients were enrolled, and 60 completed their survey (response rate: 85%). The video group had significantly higher comprehension scores (82% vs 71%, P = .04) and significantly higher satisfaction scores (9.4 vs 8.6, P = .02). Conclusions: Those who received their educational material in a video format had greater comprehension of their condition and higher satisfaction compared with those receiving a paper handout. Medical providers should consider using video formats to provide supplemental educational materials to their patients.

One-Year Remission Rate of Chronic Headache Comparing Video and Face-to-Face Consultations by Neurologist: Randomized Controlled Trial

Background Chronic headache causing severe headache-related disability for those affected by the disease is under- or misdiagnosed in many cases and therefore requires easy access to a specialist for optimal health care management. Objective The goal of the research is to determine whether video consultations are noninferior to face-to-face consultations in treating chronic headache patients referred to a specialist in Northern Norway. Methods Patients included in the study were recruited from general practice referrals to a specialist at a neurological department in Northern Norway (Tromsø) and diagnosed according to the International Headache Society classification system. In a randomized controlled design, the 1-year remission rate of chronic headache (change from ≥15 to <15 headache days per month during the last 3 months), patient satisfaction with a specialist consultation, and need for follow-up consultations by general practitioners were compared between groups consulted by video and face-to-face in a post hoc analysis. Data were collected by interview (baseline) and questionnaire (follow-up). Results From a baseline cohort of 402 headache patients consecutively referred from general practice to a specialist over 2.5 years, 58.0% (233/402) were classified as chronic headache and included in this study. Response rates were 71.7% (86/120) in the video group and 67.3% (76/113) in the face-to-face group. One-year remission from chronic headache was achieved in 43.0% (37/86) in the video group and 39.5% (30/76) in the face-to-face group (P=.38). Patient satisfaction with consultations were 86.5% (32/37; video) and 93.3% (28/30; face-to-face; P=.25). A total of 30% (11/37) in the video group and 53% (16/30) in the face-to-face group consulted general practitioners during the follow-up period (P=.03), and median number of consultations was 1 (IQR 0-13) and 1.5 (IQR 0-15), respectively (P=.19). Conclusions One-year remission rate from chronic headache was about 40% regardless of consultation form. Likewise, patient satisfaction with consultation and need for follow-up visits in general practice post consultation was similar. Treating chronic headache patients by using video consultations is not inferior to face-to-face consultations and may be used in clinical neurological practice. Trial Registration ClinicalTrials.gov NCT02270177; https://clinicaltrials.gov/ct2/show/NCT02270177

Using a 360° Virtual Reality or 2D Video to Learn History Taking and Physical Examination Skills for Undergraduate Medical Students: Pilot Randomized Controlled Trial

Background Learning through a 360° virtual reality (VR) or 2D video represents an alternative way to learn a complex medical education task. However, there is currently no consensus on how best to assess the effects of different learning materials on cognitive load estimates, heart rate variability (HRV), outcomes, and experience in learning history taking and physical examination (H&P) skills. Objective The aim of this study was to investigate how learning materials (ie, VR or 2D video) impact learning outcomes and experience through changes in cognitive load estimates and HRV for learning H&P skills. Methods This pilot system–design study included 32 undergraduate medical students at an academic teaching hospital. The students were randomly assigned, with a 1:1 allocation, to a 360° VR video group or a 2D video group, matched by age, sex, and cognitive style. The contents of both videos were different with regard to visual angle and self-determination. Learning outcomes were evaluated using the Milestone reporting form. Subjective and objective cognitive loads were estimated using the Paas Cognitive Load Scale, the National Aeronautics and Space Administration Task Load Index, and secondary-task reaction time. Cardiac autonomic function was assessed using HRV measurements. Learning experience was assessed using the AttrakDiff2 questionnaire and qualitative feedback. Statistical significance was accepted at a two-sided P value of <.01. Results All 32 participants received the intended intervention. The sample consisted of 20 (63%) males and 12 (38%) females, with a median age of 24 (IQR 23-25) years. The 360° VR video group seemed to have a higher Milestone level than the 2D video group (P=.04). The reaction time at the 10th minute in the 360° VR video group was significantly higher than that in the 2D video group (P<.001). Multiple logistic regression models of the overall cohort showed that the 360° VR video module was independently and positively associated with a reaction time at the 10th minute of ≥3.6 seconds (exp B=18.8, 95% CI 3.2-110.8; P=.001) and a Milestone level of ≥3 (exp B=15.0, 95% CI 2.3-99.6; P=.005). However, a reaction time at the 10th minute of ≥3.6 seconds was not related to a Milestone level of ≥3. A low-frequency to high-frequency ratio between the 5th and 10th minute of ≥1.43 seemed to be inversely associated with a hedonic stimulation score of ≥2.0 (exp B=0.14, 95% CI 0.03-0.68; P=.015) after adjusting for video module. The main qualitative feedback indicated that the 360° VR video module was fun but caused mild dizziness, whereas the 2D video module was easy to follow but tedious. Conclusions Our preliminary results showed that 360° VR video learning may be associated with a better Milestone level than 2D video learning, and that this did not seem to be related to cognitive load estimates or HRV indexes in the novice learners. Of note, an increase in sympathovagal balance may have been associated with a lower hedonic stimulation score, which may have met the learners’ needs and prompted learning through the different video modules. Trial Registration ClinicalTrials.gov NCT03501641; https://clinicaltrials.gov/ct2/show/NCT03501641

Telemedicine Video Follow-Up for Bariatric Surgery Patients: What Do Patients Prefer? A Prepandemic Pilot Randomized Clinical Trial

While the safety of video follow-up in bariatric surgery is established, patients’ perception of telemedicine visits remained unknown. A randomized clinical trial evaluating patients’ perception of video postoperative follow-up (F/U) visits was conducted in the pre COVID-19 era. 24 patients were randomized in the preoperative clinic to receive either in-person or video F/U, and then surveyed about their experience and preference. The majority reported that if they had to do it over, they would prefer a video visit. Among those who received video visits, 11/12 reported that the lack of physical contact was acceptable. 82% of the video group expressed that their visit was better or as good as an in-person visit, while 9% were not sure, and 9% reported that video was worse. This finding suggests that postoperative video follow-up visits are acceptable among bariatric surgery patients and should be offered as an alternative to traditional visits.

Differences in the Effectiveness of Health Promotion through Video and Interactive Dialogue on Smoking Cessation Interest Among Teenagers in Palembang

Cigarettes have long been recognized as a risk factor for various health problems, and are the world's largest preventable cause of death1. Teenagers are more easily influenced especially by social groups to do negative things, such as smoking2. Currently the trend to start smoking is increasing among teenagers. This study aims to compare the effectiveness of health promotion presented in the form of audio-visual and interactive dialogue on interest in quitting smoking in teens in Palembang. This research is an analytic study through a quasi-experimental approach with a pretest-posttest two group research design without control group. The research sample consisted of 206 teenage smokers, divided into 2 groups, namely 103 teenage in the video group and 103 teenage in the interactive dialogue group. This study uses paired t-test, Wilcoxon, and Mann Whitney test. This study reveals that health promotion through video media and interactive dialogue is effective to elevate the knowledge and interest in smoking cessation among teenagers (p = 0.000 α = 0.05). The mean value of knowledge and interest in the interactive dialogue group is higher than in the video group. However, there was no difference concerning effectiveness of health promotion through interactive dialogue and videos on the knowledge and interest in quitting smoking among teenagers. (p = 0.21 α = 0.05).

Patient Adherence With At-Home Hand and Wrist Exercises: A Randomized Controlled Trial of Video Versus Handout Format

Background: Patient adherence is important for maximizing patient outcomes. The purpose of this randomized controlled trial was to determine patient adherence and confidence in home therapy exercises of the hand and wrist at multiple time points when distributed by either paper handout or video. Methods: Patients were prospectively enrolled and randomized in orthopedic clinics to either the handout or video exercise group. Exclusion criteria included patients less than 18 years old. Questionnaires were electronically distributed each week for 4 weeks following enrollment. Questionnaires assessed the frequency of exercise performance, percentage of exercises utilized, and confidence in performing the exercises correctly. The handout and video groups were compared via 2-sample t tests for continuous data and χ2 tests for categorical data. Results: Of the 89 patients enrolled, 71 patients responded to the initial follow-up survey (80% of randomized patients), and 54 of these patients (76%) completed all surveys at each time point. The handout group (37 patients) and the video group (34 patients) had no differences in response rate or demographics. There were no differences in frequency, exercise utilization rate, or confidence in performing exercises between groups at week 1. However, the video group reported higher exercise utilization and confidence than the handout group at subsequent time points. Conclusions: Video-format distribution of home therapy exercises is superior to that of paper handout distribution for the distal upper extremity rehabilitation. Patients in the video group utilized more exercises and had higher confidence in completing them correctly following initiation of the exercise program.

Preparing Patients with Early Stage Prostate Cancer to Participate in Clinical Appointments Using a Shared Decision Making Training Video

Background Rates of shared decision making (SDM) are relatively low in early stage prostate cancer decisions, as patients’ values are not well integrated into a preference-sensitive treatment decision. The study objectives were to develop a SDM training video, measure usability and satisfaction, and determine the effect of the intervention on preparing patients to participate in clinical appointments. Methods A randomized controlled trial was conducted to compare a plain-language decision aid (DA) to the DA plus a patient SDM training video. Patients with early stage prostate cancer completed survey measures at baseline and after reviewing the intervention materials. Survey items assessed patients’ knowledge, beliefs related to SDM, and perceived readiness/intention to participate in their upcoming clinical appointment. Results Of those randomized to the DA + SDM video group, most participants (91%) watched the video and 93% would recommend the video to others. Participants in the DA + SDM video group, compared to the DA-only group, reported an increased desire to participate in the decision (mean = 3.65 v. 3.39, P < 0.001), less decision urgency (mean = 2.82 v. 3.39, P < 0.001), and improved self-efficacy for communicating with physicians (mean = 4.69 v. 4.50, P = 0.05). These participants also reported increased intentions to seek a referral from a radiation oncologist (73% v. 51%, P = 0.004), to take notes (mean = 3.23 v. 2.86, P = 0.004), and to record their upcoming appointments (mean = 1.79 v. 1.43, P = 0.008). Conclusions A novel SDM training video was accepted by patients and changed several measures associated with SDM. This may be a scalable, cost-effective way to prepare patients with early stage prostate cancer to participate in their clinical appointments. [Box: see text]

Improving children's cooperativeness during magnetic resonance imaging using interactive educational animated videos: a prospective, randomised, non-inferiority trial

Introduction: A previous prospective, randomized controlled trial showed that animated videos shown to children before their magnetic resonance imaging (MRI) scan reduced the proportion of children needing repeated MRI sequences and improved confidence of staying still for at least 30 minutes. Children preferred the interactive video. We hypothesize that the interactive video is non-inferior to showing two videos (regular and interactive) in improving children’s cooperativeness during MRI scans. Methods: In this Institutional Review Board-approved prospective, randomized, non-inferiority trial, 558 children aged 3 to 20 scheduled for elective MRI scan from June 2017 to March 2019 were randomized into interactive video only and combined (regular and interactive) videos groups. Children were shown the videos before their scan. Repeated MRI sequences, general anesthesia (GA) requirement, and improvement in confidence of staying still for at least 30 minutes were assessed. Results: In the interactive video group (n = 277), 86 (31.0%) children needed repeated MRI sequences, 2 (0.7%) needed GA, and the proportion of children who had confidence in staying still for greater than 30 minutes increased by 22.1% after the video. In the combined videos group (n = 281), 102 (36.3%) children needed repeated MRI sequences, 6 (2.1%) needed GA, and the proportion of children who had confidence in staying still for greater than 30 minutes increased by 23.2% after videos, not significantly different from the interactive video group. Conclusion: The interactive video group demonstrated non-inferiority to the combined videos group.

The Effect of Visual and Auditory Information on Illness Perceptions and Patient Satisfaction in Knee Osteoarthritis

Aim To evaluate the effect of visual and auditory information about knee osteoarthritis on illness perception and patient satisfaction with electronic guidance. Method In this randomized controlled and single-blind study, 100 patients with osteoarthritis were included in two groups (50 video group, 50 control group). The video group was informed about knee osteoarthritis by a physician and then watched a video. The control group was only informed about knee osteoarthritis by the same physician. Before and after the information, Visual Analog Scale, a Likert scale for patient satisfaction, and the Brief Illness Perception Questionnaire (B-IPQ) were filled. Results In the analysis of covariance (ANCOVA), after the information, a statistically significant difference was found in the personal control, concern, coherence subgroups in the video group compared to the control group (p<0.001, p=0.002, p<0.001, respectively). According to the likert scale, the satisfaction level of the patients in the video group was significantly higher compared to the control group (p<0.001). Conclusion It has been shown for the first time in the literature that visual and auditory information is provided by watching video information about osteoarthritis with an electronic guide. It could be ensured that the patients' control, concern, knowledge, and satisfaction levels could be improved via this application.