The water myth, what patients want from treatments and more

Janet Wright rounds up the research; It’s time to mop up the water myth

It’s time to mop up the water myth

Physios appreciate good advice that’s easy for patients to understand. But if you or your patients are struggling to swallow two litres of water a day in the belief that it’s essential, give yourselves a break.

This ‘water myth’ been debunked many times – on the unshakeable grounds that there is no good evidence to support it.

Organisations such as Hydration for Health warn that most people don’t drink enough water, and that we’re at risk of dehydration without even knowing it.

‘Evidence is increasing that even mild dehydration plays a role in the development of various diseases,’ says the Hydration for Health website. Water supporters claim drinking more can aid fitness and even mental capacity. And the myth circulates endlessly on the Internet.

But as Glasgow GP Margaret McCartney notes in the BMJ, ‘there is still no evidence that we need to drink more than we naturally want‘.

‘Hydration for Health has a vested interest: it is sponsored and was created by French food giant Danone,’ she says. The company produces Volvic, Evian and Badoit bottled waters.

In the UK, we each buy on average 33 litres of bottled water a year, a figure that has risen in tandem with the spread of the water myth.

The myth probably grew from a misunderstanding of a biology textbook: the average person loses about two litres a day through natural bodily processes. But, say scientists. we regain most of the fluid we need in the food we eat, and the rest could as well come from other drinks as plain water.

‘Hydration for Health has presented no quality evidence. Examination of  the evidence presented by Danone shows it to be weak and subject to selection bias,’ says Dr McCartney. The water myth ‘is not only nonsense, but is thoroughly debunked nonsense’.
BMJ 2011; 343: d4280


Who needs X-rays?

A patient’s idea of successful treatment for back pain may be very different from that of a health professional or a researcher.

Experts go by outcome measures such as pain scores and disability questionnaires, says Michael Yelland of Griffith University, Australia, looking at research into the subject.

But for many patients, the experience of treatment, and the feeling of having been taken seriously, may be more important.

Not surprisingly, pain relief is most patients’ main concern. For those off work, getting back to work comes next in importance, whereas those at work seek functional improvement, followed by increase in strength and range of movement, acquired knowledge and a positive shift in attitude, says Prof Yelland.

As the pain becomes long-term, the amount of relief they expect dwindles. But what they do want is active management, specialist referrals, advice and investigations.

‘A high priority for patients is to be treated with respect,’ he says. ‘They desire an accurate diagnosis and for this to be explained clearly and confidently. This helps legitimise their pain. Patients believe that adequate physical examination and investigations are needed for them to gain this confidence.’

That means patients tend to want diagnostic tests, especially X-rays, says Prof Yelland. Even though the use of X-rays makes little if any difference to the physical outcome, they make patients feel more satisfied and less depressed.

‘What is needed here is extra time in educating the patient to reduce the expectation of X-rays,’ he says.

Int Musculoskeletal Med 2011; 33, 1, 1–2; doi 10.1179/175361511X12965803070667


Comments and conclusions

Injury-prevention programmes need to be tailored to individual players’ positions on the field, say Rugby Football Union researchers.

They studied 2,484 injuries among 899 professional players over four seasons. ‘Although three common body locations caused a high proportion of days of absence due to match injury for forwards (shoulder, knee, ankle/heel) and backs (shoulder, hamstring, knee), there were significant differences in injury profile between individual positions,’ they said.

The programmes should also take account of each player’s injury history, they said.

Brooks JHM, Kemp SPT Br J Sports Med 2011; 45, 765–775; doi:10.1136/bjsm.2009.066985

The number of older people admitted to hospital after a fall increases dramatically in colder winters, researchers from  the North West Public Health Observatory at  Liverpool John Moores University have found.

‘With responsibility for health improvement moving to local councils, they will have to balance the cost of winter public health measures, like gritting, with the healthcare cost,’ said the team.

Beynon C et al. Environ Health 2011; 10: 60; doi: 10.1186/1476-069X-10-60

Presenteeism – forcing yourself to work when you’re ill – can do long-term health damage as well as reducing productivity, says Kevin Dew, of Victoria University of Wellington in New Zealand. And it’s more common in the caring professions. Senior staff can help by discouraging over-commitment to work, he says.
BMJ 2011; 342: d3446

Look out for eating disorders in athletes of both sexes, psychiatrist and ex-sportsman Dr Alan Currie of Northumberland Tyne and Wear NHS Trust told the International Congress of the Royal College of Psychiatrists in Brighton. Among athletes, some 20 per cent of women and eight per cent of men have an eating disorder, compared with 10 per cent of women and less than one per cent of men overall.

‘If an athlete hurts a ligament there’s a whole team of people on hand to help them, but if they have a mental health problem like an eating disorder they can be on their own,’ he said, urging sports organisations to be aware of mental-health needs.

Janet Wright

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