Rehab Journal Review

Conflicts of interest: Nothing to do with the industry. I’m likely to be biased in favor of evidence based healthcare, and against clinical studies that do not have clinically relevant hard endpoints as outcome measures.

A recently concluded MD thesis in our department studied the efficacy of an indigenously designed peroneal nerve stimulator (PNS) in gait of persons with stroke. This study from the Case Western Reserve University was done to see if there is any motor relearning with such PNS compared to usual care (AFO when necessary). The stimulator they used was a commercial product with a pressure-sensing foot-switch to detect heel rise at pre-swing (we had used a hand-operated manual switch). Better technology didn’t prove to be too beneficial though; the authors have been honest with the results in concluding “there was no motor relearning in either … groups”. More importantly, at 6 months, usual care fared as well as the stimulator in terms of functional mobility and quality of life. PNS will have to wait.

Taiwanese authors aren’t far behind in honest conclusions in their study on mirror therapy in chronic stroke. They conclude “application of mirror therapy…may not translate into daily functions in the population with chronic stroke”.

It takes just two hours to instill confidence in use of manual wheelchair among older adults who are completely inexperienced previously, as this paper reports. Let’s remember to find those 2 hours for each of our KAFO dependent functional-walkers too; will come handy sometime, somewhere.

This could have been easily dismissed as just an observational study, but the authors conclude “Long-stay home care patients who receive rehabilitation at home have improved outcomes and lower utilization of costly health services. Our findings suggest that investment in PT and OT services for relatively short periods may provide savings to the health care system over the longer term.” Encouraging words for anyone keen on population rehabilitation (a derivative of the term population medicine advocated by Muir Gray).

Robotics might be the next big thing in rehabilitation, but in this before-after clinical intervention study, there is nothing for anyone as of now, probably except for the uber-rich interested to try out some toys. I am a fan of Tony Stark’s excursions in his gizmo suit, in case you doubted that I’m an anti-technologist.

Didn’t know about wearable laser Doppler flowmetry probes; that’s the only thing to know from this study. Could someone suggest how to put these probes to better use, design a good study and come out with a clinically useful prediction model for pressure ulcer incidence.

Glad to find friend and former colleague Apurba Barman’s name in the list of reviewers acknowledged in this edition of Archives of PMR (the links would not lead to full-texts if your institution does not pay for online editions of the linked journals, please see the print edition instead. The paywalls *!@#$*)