Rehab Journal Review

Archives of PMR, November 2013

2112 ‘I’m asked to specify before I start my research what quantum of change in outcome would be considered as significant; if I’d known why I would do the study’. If you’ve ever wondered so after a visit to the statistician, you’re not alone, and you’re not correct. The ‘minimal important clinical difference’ for every outcome measure has to be spelt out in advance based on a comprehensive review of literature. If no precedence, then it has to be based on clinical judgment. Pronouncing these values in advance serves two purposes. 1. You don’t get carried away by the rubbish of just the p-values and statistical significance at the end of the study. 2. You are more likely to report in negative, and rightly so, if clinically significant change is not observed. This study on Whole Body Vibration for balance improvement in type-2 Diabetes clearly specifies these minimal important clinical differences. But, in spite of between-group differences in 9 out of 10 balance measures being not significant (based on the reported confidence interval ranges in Table 2), the authors have tried to somehow report this as a positive study though it is not. And, the outcome measures used have been just the surrogate measures of balance master and TUG test, and not clinical relevant outcomes such as number of falls, activity limitations/participation restriction.

2146 Potential thesis topic alert. Ultrasound elastography in soft tissues seems interesting. Here the authors claim we could actually see and quantify the tissue changes in myofascial trigger point injections using elastography. Needs replication.

2174 “In 1-year follow-up, subjects with Osseointegration Prostheses significantly increased walking ability and prosthesis-related quality of life” claims this study comparing Osseointegration Prostheses with socket prostheses. A natural evolution, perhaps, for prosthetic fitting technology, and a precursor to bionic limbs.

2203 Following up 7228 persons with TBI who survived at least one year post-trauma, the National Institute on Disability and Rehabilitation Research, USA, confirms what seems logical– “Survival was poorer than that of the general population (standardized mortality ratio=2.1; 95% confidence interval, 1.9–2.3). Age, sex, and functional disability were significant significant risk factors for mortality.”

Archives of PMR, December 2013

2357 Power of a cohort database once again. Among13746 veterans with femur fractures, 396 withspinal cord Injury were identified. Those receiving surgical Vs non surgical management were analysed and compared with non SCI veterans.  The key observation was that surgical treatment minimizes the risks of complications due to immobilization, possibly minimizing mortality as with non-SCI, and hence should be considered in appropriate SCI patients as well.

Spinal cord, December 2013

873 A systematic review on bowel management and the success rate of the various treatment modalities in spina bifida patients crystallises a couple of useful findings. Unlike neurogenic bladder management options where one method (Clean Intermittent Catheterization)  is superior to others, there is no such primus inter pares in  bowel management. “Evidence favors an individually tailored stepwise approach with surgery as a final step in case of failure of conservative measures. Continued specialized support throughout life remains important to maintain continence. Cross-over and comparative trials are needed in order to optimize treatment.” Case rested.

919 I remember New Zealand for Sachin’s first ever marauding OD I innings of 82 in 49 balls at Auckland in 1994, most of which I watched while trying to work Chemistry equations at my teacher Mr.Doss’ place.  This small study from the Kiwiland throws some light on what could possibly make rehabilitation click for persons with SCI in the long run. “In New Zealand, most people followed over 2 and a half years after sustaining a SCI retained their income and standard of living. Rates of return to work were high overall (49%). The reason for both these findings appears to be the no-fault compensation scheme for injury available to the majority of participants.” ” If such economic outcomes are also accompanied by re-integration into society and regaining of quality of life, then such a no-fault compensation scheme should be seen as a model for rehabilitation after SCI—traumatic and non-traumatic.”

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Medical research showing signs of some honest soul searching. Two medical students (you heard it right, medical students!) from Yale recently had first author publications in JAMA, doing big data analysis of (unnecessary) cardiac evaluations and (inapprpriate) drug approvals.  A Canadian study following 89835 women for 25 years (!!!) emphatically concludes ” Annual mammography in women aged 40-59 does not reduce mortality from breast cancer beyond that of physical examination or usual care “, questioning the utility of billions spent on (futile) screening worldwide. Non-maleficence.