Archives of PMR, January 2014
10 Education helps, at least for a year. That’s the finding in this American study on effectiveness of an education protocol for wheelchair use in persons with Spinal Cord Injury. The study protocol was based on evidence based guidelines published in 2005. I was curious. Turns out, unsurprisingly, that the quality of evidence for most of the 35 enlisted recommendations was poor. That is not different from most other EB guidelines for anything related to rehabilitation. THE need, therefore: less junk research. For anyone interested in doing good research, a repeat reading of Ionnidis’ wonderful article “Increasing value and reducing waste in research design, conduct and analysis” would do no harm.
87 Assessment of Participation (life in real world) is one outcome measure that could mean more than any other surrogate in-hospital assessment for rehabilitation. In this study from Utrecht, Netherlands, the authors compared their own tool ‘USER-Particpation’ against two others- ‘IMPACT-S’, ‘WHODAS-II’. The authors claim their tool was “generally satisfactory”, and that “the IMPACT-S showed the best psychometric properties”. ‘Validating a tool’ is among the many things I need to read and do more to understand better.
94 Often, an honest opinion based on clinical judgment, suggesting discharge-to-home, or outpatient follow-up for continued therapy is not received well. Neither by the referring doctors, nor the patients and family. In this background, the key findings of this meta-analysis of RCTs on Economic Evaluation of Adult Rehabilitation are heart-warming. “This review found high-level evidence that rehabilitation in the home or community is less costly than inpatient rehabilitation (for stroke)… It also found that the secondary outcomes of function, quality of life, discharge destination, and mortality were not compromised when patients received the less costly intervention…The results of cost savings without compromise to patient outcomes for rehabilitation in the home appear to be similar to rehabilitation in the community and outpatient rehabilitation services.” We need region and disability specific data for our country to see if these findings still hold good. And, to spread the message.
Archives of PMR, February 2014
269 It’s risky to draw inferences from observational studies on interventions. Against the findings of the above mentioned meta-economic-analysis, conclusions such as this must be interpreted cautiously-“The volume of inpatient rehabilitation therapy and mortality were significantly inversely related in the patients with ischemic stroke”. The association is probably true, needs to be looked into, but there is this small issue of confounders. The authors have recommended changes in practice, based on these findings. I would hesitate to do so.
Spinal Cord, January 2014
49 To cystoscope or not, ask the authors about persons with SCI on chronic indwelling catheter drainage. The answer is in favor of regular screening to pick up pre-malignant lesions, which are not quite uncommon as previously suspected, it seems. How many of those really progress to malignant lesions? We need to tread cautiously, to avoid unnecessary panic. There are lessons to be learnt from the PSA/prostate screening fiasco. Our own data would make more sense. We have a reasonably good cohort following up regularly over the last couple of decades. We haven’t had a single known mortality related to bladder malignancy. Are we missing something, or it’s just that we are different?
65 “The WISCI II (to assess walking in SCI) has high IRR and intrarater reliability and good reproducibility in the acute and subacute phase when administered by trained raters”. Yes, that’s why we intend to start using it routinely, hopefully this month onwards.
Spinal Cord, February 2014
163 Simple things bring about big changes with the right type of impact. Czech authors report that Intermittent Catheterization in tetraplegia patients might not be hard to achieve, in those with levels C5 and below. They report use of positioning splints and ‘ergohand device’ to achieve this. It’s a small group of patients, but that’s not the point. The overall health benefits of such could be significant.
I’d recently retweeted something on doctor burn-out: “If you want to discourage workers, subject them to policies and procedures that don’t make sense.” And read a related corollary ““If we want doctors to do better work, we need to give them better work to do.”
Rehab Journal Review 