Feature

The RACGP’s four most popular proven non-drug interventions


Doug Hendrie


25/09/2018 3:49:47 PM

Prescribing doesn’t have to mean medications – newsGP rounds up the four evidence-based interventions that have proven most popular from the HANDI guide.

Prescribing doesn’t have to mean medications.
Prescribing doesn’t have to mean medications.

Almost half of all clinical trials conducted every year are for treatments without drugs – but these treatments are much less known, less well-promoted and less used than their pharmaceutical equivalents.
 
In 2013, the RACGP Expert Committee – Quality Care (REC-QC) launched HANDI, the Handbook of Non-Drug Interventions, to make ‘prescribing’ a non-drug therapy almost as easy as writing a prescription.
 
Each of the therapies featured is rigorously reviewed and drafted and has to be supported by at least two randomised controlled trials, or one trial and supportive evidence.
 
There are now dozens of therapies featured on the HANDI site, which is designed like a pharmacopoeia.
 
Therapies range from wet combing for head lice to low-FODMAP diets for irritable bowel syndrome to exercise for cancer fatigue, through to mindfulness for lower back pain and bibliotherapy for depression.
 
Here are the four most popular non-drug interventions in HANDI, based on page views between 2013–2017:
 
#1: Stretching of the plantar fascia ligament in adults with chronic heel pain due to plantar fasciitis.
This intervention is a simple, easily performed stretch of the plantar fascia ligament in adults, which has been shown to reduce pain and improve physical function. Once taught, patients can do this themselves.
 
#2: The Epley manoeuvre (canalith repositioning) for posterior canal benign paroxysmal vertigo (BPPV).
This intervention is an effective way to help patients improve a type of vertigo believed to be brought on by debris (canaliths) in the semicircular ear canals. Once taught, patients can administer the Epley manoeuvre themselves. 
 
#3: The DASH (Dietary Approaches to Stop Hypertension) diet to prevent and control hypertension
The DASH diet is very similar to the Mediterranean diet, featuring fruits, vegetables, low-fat dairy, whole grains, fish, poultry and nuts, and limiting saturated fats, red meat and sugars. It differs in that it does not emphasise olive oil and fish and does not include wine. The diet has been shown to reduce blood pressure within two to four weeks, and changes associated with the diet predict a reduction in cardiovascular disease risk of around 13%. This diet relies on foods readily available in Australia.
 
#4: Autoinflation for glue ear in children
Glue ear (hearing loss due to otitis media with effusion) will affect four out of five children at some point, making it the most common chronic condition in childhood. For children with deafness due to glue ear, autoinflation can avoid the need for tympanoplasty tubes (grommets). The intervention works by using an inflation device to open the eustachian tube by raising intranasal pressure, and restoring hearing. Raising the intranasal pressure can be achieved by exhaling against a closed airway (ie Valsalva manoeuvre), blowing air up the nose while swallowing (ie Politzer manoeuvre) or a combination of both.



HANDI non-drug interventions non-drug therapy





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