***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: The primary aim of this study was to test the effect of a Protection Motivation Theory (PMT)-based patient education intervention on physiotherapy patients ' beliefs about their injury and physiotherapy , intentions to adhere , rehabilitation adherence , and ankle function . A secondary aim was to explore the relationships between the patients ' injury and physiotherapy beliefs , intentions , adherence behaviours , and ankle function . A r and omized controlled trial was undertaken in New Zeal and ; 71 people with ankle sprains were allocated to either PMT present video information or two control groups ( non-PMT information about ankle sprains and no formal information ) before commencing their course of physiotherapy . The two information groups watched a video about ankle sprains and physiotherapy before answering the Beliefs about Ankle Sprains and Physiotherapy Scale and behavioural intentions question naires that measured the PMT constructs . Adherence was assessed at each treatment and ankle function was measured before and after the physiotherapy program . After viewing the video , the PMT present information group 's beliefs about severity , vulnerability , and response efficacy were significantly higher than the other two groups . The groups did not differ significantly on their self-efficacy , intentions , rehabilitation adherence , and post-physiotherapy program ankle function . Significant correlations existed between the patients ' PMT-based beliefs and intentions , intentions and adherence , and adherence and post-physiotherapy ankle function . With the exception of self-efficacy , the findings indicate that persuasive information grounded in PMT does enhance physiotherapy patients ' beliefs about their injury and treatment OBJECTIVE To evaluate a clinic-based multimedia intervention for diabetes education targeting individuals with low health literacy levels in a diverse population . RESEARCH DESIGN AND METHODS Five public clinics in Chicago , Illinois , participated in the study with computer kiosks installed in waiting room areas . Two hundred forty-four subjects with diabetes were r and omized to receive either supplemental computer multimedia use ( intervention ) or st and ard of care only ( control ) . The intervention includes audio/video sequences to communicate information , provide psychological support , and promote diabetes self-management skills without extensive text or complex navigation .  HbA(1c ) ( A1C ) , BMI , blood pressure , diabetes knowledge , self-efficacy , self-reported medical care , and perceived susceptibility of complications were evaluated at baseline and 1 year . Computer usage patterns and implementation barriers were also examined . RESULTS Complete 1-year data were available for 183 subjects ( 75 % ) . Overall , there were no significant differences in change in A1C , weight , blood pressure , knowledge , self-efficacy , or self-reported medical care between intervention and control groups . However , there was an increase in perceived susceptibility to diabetes complications in the intervention group . This effect was greatest among subjects with lower health literacy . Within the intervention group , time spent on the computer was greater for subjects with higher health literacy . CONCLUSIONS Access to multimedia lessons result ed in an increase in perceived susceptibility to diabetes complications , particularly in subjects with lower health literacy . Despite measures to improve informational access for individuals with lower health literacy , there was relatively less use of the computer among these participants Inhaled medication is important in the treatment of chronic obstructive pulmonary disease ( COPD ) . In this paper a comparison of the long-term efficacy of three instruction-models is presented . A total of 152 COPD - patients were r and omized into one of four groups : Personal- , video- , group-instruction and a control group . Inhalation technique was assessed by means of checklists , on which essential inhalation manoeuvres were identified . Up to 9 months later , 148 patients returned for follow-up assessment . Prior to instruction 61 % of patients in the control group had a perfect score on essential actions , compared to 62 , 65 and 53 % for those receiving group- , personal- and video-instruction respectively . At follow-up these percentages were 49 , 97 , 75 and 76 % . For group-(35 % ) and video-instruction ( 24 % ) the increase from baseline was significant . Examining the different inhalers under investigation , it is striking , that only 24 % of all patients with a Metered Dose Inhaler ( MDI ) performed all essential checklist items correctly , versus 96 % for those using a Diskhaler . The fact that for the MDI this percentage improved to 90 % post-instruction , shows that time spent on instruction , is time well spent . We conclude that group instruction seems superior to personal counselling , and equally effective or even better than video instruction . Personal instruction should not be dismissed and a combination with video instruction might prove to be effective as well BACKGROUND Metered dose inhalers ( MDIs ) are not easy to use well . Every MDI user receives a manufacturer 's patient information leaflet ( PIL ) . However , not everyone is able or willing to read written information . Multimedia offers an alternative method for teaching or reinforcing correct inhaler technique . OBJECTIVE The aim of this study was to compare the effects of brief exposure to the same key information , given by PIL and multimedia touchscreen computer ( MTS ) . METHODS A single-blind r and omized trial was conducted in 105 fluent English speakers ( 53 % female ; 93 % White ) aged 12 - 87 years in London general practice s. All patients had had at least one repeat prescription for a bronchodilator MDI in the last 6 months . Inhaler technique was videotaped before and after viewing information from a PIL ( n = 48 ) or MTS ( n = 57 ) . Key steps were rated blind using a checklist and videotape timings . The main outcome measures were a change in ( i ) global technique ; ( ii ) co-ordination of inspiration and inhaler actuation ; ( iii ) breathing-in time ; and ( iv ) information acceptability . RESULTS Initially , over a third of both groups had poor technique . After information , 44 % ( MTS ) and 19 % ( PIL ) were rated as improved . Co-ordination improved significantly after viewing information via MTS , but not after PIL . Breathing-in time increased significantly in both groups . Half the subjects said they had learned ' something new ' . The MTS group were more likely to mention co-ordination and breathing . CONCLUSIONS Short-term , multimedia is as least as effective as a good leaflet , and may have advantages for steps involving movement . MTS was acceptable to all age groups . The method could be used more widely in primary care The value of mailed educational videotapes as a means of enhancing compliance with drug therapy was studied . Members of a health maintenance organization with a pharmacy cl aim for benazepril , metoprolol , simvastatin , or transdermal estrogen  were r and omly assigned to a study group or a control group . Subjects in the study group were mailed one of four videotape programs giving information on the drug prescribed and the inferred disease state . Control subjects received no educational material s.  Subjects were enrolled from July 1 , 1993 , through January 2 , 1994 .  Refill data were collected from July 1 , 1993 , through April 1 , 1994 . The medication possession ratio ( MPR ) was calculated as the total number of days ' supply of a drug obtained by a member divided by the number of days between the time of enrollment and April 1 , 1994 , or the date the member was terminated from the plan . A subject was deemed compliant if his or her MPR was > or = 0.80 . There were no significant differences in mean MPRs between the study group ( n = 1993 ) and the control group ( n = 2253 ) . None of the mean MPRs was > or = 0.80 , although 44 % of control subjects and 46 % of study -group subjects were compliant . Of 97 respondents to a survey mailed to a r and omly selected subset of the study group , almost 87 % reported that they had viewed the videotapes , and of these subjects , about 88 % said they found them very useful or somewhat useful . A one-time mailing of videotapes to patients , with no individual follow-up , did not increase compliance with the medications monitored CONTEXT As the availability of and dem and for genetic testing for hereditary cancers increases in primary care and other clinical setting s , alternative or adjunct educational methods to traditional genetic counseling will be needed . OBJECTIVE To compare the effectiveness of a computer-based decision aid with st and ard genetic counseling for educating women about BRCA1 and BRCA2 genetic testing . DESIGN R and omized controlled trial conducted from May 2000 to September 2002 . SETTING AND PARTICIPANTS Outpatient clinics offering cancer genetic counseling at 6 US medical centers enrolled 211 women with personal or family histories of breast cancer . INTERVENTIONS St and ard one-on-one genetic counseling ( n = 105 ) or education by a computer program followed by genetic counseling ( n = 106 ) . MAIN OUTCOME MEASURES Participants ' knowledge , risk perception , intention to undergo genetic testing , decisional conflict , satisfaction with decision , anxiety , and satisfaction with the intervention . Counselor group measures were administered at baseline and after counseling . Computer group measures were administered at baseline , after computer use , and after counseling . Testing decisions were assessed at 1 and 6 months . Outcomes were analyzed by high vs low risk of carrying a BRCA1 or BRCA2 mutation . RESULTS Both groups had comparable demographics , prior computer experience , medical literacy , and baseline knowledge  of breast cancer and  genetic testing , and both counseling and computer use were rated highly . Knowledge scores increased in both groups ( P<.001 ) regardless of risk status , and change in knowledge was greater in the computer group compared with the counselor group ( P = .03 ) among women at low risk of carrying a mutation . Perception of absolute risk of breast cancer decreased significantly after either intervention among all participants . Intention to undergo testing decreased significantly after either intervention among low-risk but not high-risk women . The counselor group had lower mean scores on a decisional conflict scale ( P = .04 ) and , in low-risk women , higher mean scores on a satisfaction-with-decision scale ( P = .001 ) . Mean state anxiety scores were reduced by counseling but were within normal ranges for both groups at baseline and after either intervention , regardless of risk status . CONCLUSIONS An interactive computer program was more effective than st and ard genetic counseling for increasing knowledge of breast cancer and genetic testing among women at low risk of carrying a BRCA1 or BRCA2 mutation . However , genetic counseling was more effective than the computer at reducing women 's anxiety and facilitating more accurate risk perceptions . These results suggest that this computer program has the potential to st and alone as an educational intervention for low-risk women but should be used as a supplement to genetic counseling for those at high risk The Buteyko Breathing Technique ( BBT ) is promoted as a drug-free asthma therapy . It is based on the premise that raising blood PaCO2 through hypoventilation can treat asthma . Our study was design ed to examine whether the Buteyko Breathing Technique , as taught by a video , is an efficacious asthma therapy . Thirty-six adult subjects with mild to moderate asthma were r and omized to receive either a BBT or placebo video to watch at home twice per day for 4 weeks . Asthma-related quality of life , peak expiratory flow ( PEF ) , symptoms , and asthma medication intake were assessed both before and after intervention . Our results demonstrated a significant improvement in quality of life among those assigned to the BBT compared with placebo ( p = 0.043 ) , as well as a significant reduction in inhaled bronchodilator intake ( p = 0.008 ) . We conclude that the BBT may be effective in improving the quality of life and reducing the intake of inhaled reliever medication in patients with asthma . These results warrant further Goals of workBased on meta-analyses regarding the preparation of patients for potentially threatening medical procedures , a DVD , incorporating behavioral role modelling , was developed to prepare patients for chemotherapy and assist them to self-manage side effects . It was hypothesized that patients who watched the DVD ( vs those who did not ) would report ( 1 ) lower anxiety ; ( 2 ) higher self-efficacy related to coping with treatment side effects ; ( 3 ) fewer supportive care needs ; and ( 4 ) higher satisfaction with information received . It was further hypothesized that these effects would be stronger in those perceiving their treatment intent to be curative rather than palliative . Material s and methods Quasi-experimental design using a historical control group was employed . Participants were scheduled to receive their first ever chemotherapy treatment . Group 1 ( usual care ; n = 50 ) was prospect ively recruited before the release of the DVD and group 2 ( DVD plus usual care ; n = 50 ) after the release . Before commencing chemotherapy , all patients completed reliable and valid measures of self-efficacy , anxiety , and supportive care needs . Data was stratified according to perceived treatment intent . Independent sample t tests were performed for each group ( curative vs palliative).Main results Significant differences were found between the usual care and intervention groups : for self-perceived curative patients in relation to self-efficacy for seeking social support ( p = 0.044 ) , with increased confidence in those watching the DVD , and for self-perceived palliative patients in relation to their satisfaction with information about side effects ( p = 0.026 ) , with increased satisfaction in those watching the DVD . Overall , significant differences were found between self-perceived curative vs palliative patients on measures of self-efficacy and supportive care needs , with self-perceived curative patients reporting more confidence and fewer needs . Conclusions The educational DVD was considered highly acceptable by patients and was found to increase self-efficacy and reduce supportive care needs . Hence , it is appropriate to give to patients before face-to-face chemotherapy education . Additional pretreatment education is recommended , particularly for self- 
    Output:
    
The effectiveness of video-assisted patient education is a matter of presentation format .
Videos that only provide spoken or graphically presented health information are inappropriate tools to modify patient behavior .
Videos showing real people doing something are more effective .
PRACTICE IMPLICATION S If research ers wish to improve a skill , a model patient enacting the behavior seems to be the best-suited presentation format .
If research ers aim to modify a more complex behavior a narrative presentation format seems to be most promising