512437
2013
CRE271210.1177/0269215513512437Clinical Rehabilitation
CLINICAL REHABILITATION
Introductory paragraph – Volume 27, Issue 12
Specialists in rehabilitation can offer their patients a huge range of interventions of many different types, delivered in different ways and aimed at influencing several if not many outcomes. This might appear great for patients, but it is a nightmare for researchers and for funders. This issue illustrates the complexity. Many interventions are related to psychology. After spinal cord injury patients may have many concerns, one of which is their emotional state. Counselling is one offered intervention, and because travel is not easy, delivering it through electronic media might be better. A systematic review of telecounselling showed how few patients have been studied – 273 – and suggested benefits in several domains – sleep, pain, quality of life – but also showed the need for much better quality research in larger populations. Rehabilitation requires patient engagement, and motivational interviewing is a popular way to increase this – but a study of 146 cardiac rehabilitation patients showed little benefit on quality of life. Even if an effective intervention is developed, unless it is delivered it cannot have an effect. Increasingly rehabilitation trials include an evaluation of the delivery of the treatment – a so-called process evaluation. A report here on a behavioural programme suggests that therapists can and do deliver the package reasonably, with some
Clinical Rehabilitation 27(12) 1058 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215513512437 cre.sagepub.com
variation among centres. Problems in rehabilitation are often life-long, and some treatments are longterm, and we need to know the long-term risks as well as benefits. Baclofen pumps are effective at controlling leg spasticity in some patients, but at what cost? In a long-term (1–22 years) study, each month about 1% of patients developed a problem, usually catheter-related. Botulinum toxin injections are also used for spasticity where one possible beneficial outcome might be a reduction in the associated pain. A systematic review using GRADE methodology (see article) did not find evidence of pain relief. Exercise is now a well supported intervention in many circumstances. A systematic review has investigated the effects of different types of exercise on osteo-arthritic knee pain; there is a short-term benefit which might be better if strengthening exercise is used. Another study here investigates both its comparison with massage and its conjunction with massage in people with multiple sclerosis. Massage seemed particularly helpful in several domains, but the study is small and needs replication urgently. Finally a novel intervention, using observation of performance as a way of improving performance is evaluated in a small pilot study – the results justify a larger trial which should be easy to undertake, and could include patients with different underlying disorders.
Copyright of Clinical Rehabilitation is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
2013
CRE271210.1177/0269215513512437Clinical Rehabilitation
CLINICAL REHABILITATION
Introductory paragraph – Volume 27, Issue 12
Specialists in rehabilitation can offer their patients a huge range of interventions of many different types, delivered in different ways and aimed at influencing several if not many outcomes. This might appear great for patients, but it is a nightmare for researchers and for funders. This issue illustrates the complexity. Many interventions are related to psychology. After spinal cord injury patients may have many concerns, one of which is their emotional state. Counselling is one offered intervention, and because travel is not easy, delivering it through electronic media might be better. A systematic review of telecounselling showed how few patients have been studied – 273 – and suggested benefits in several domains – sleep, pain, quality of life – but also showed the need for much better quality research in larger populations. Rehabilitation requires patient engagement, and motivational interviewing is a popular way to increase this – but a study of 146 cardiac rehabilitation patients showed little benefit on quality of life. Even if an effective intervention is developed, unless it is delivered it cannot have an effect. Increasingly rehabilitation trials include an evaluation of the delivery of the treatment – a so-called process evaluation. A report here on a behavioural programme suggests that therapists can and do deliver the package reasonably, with some
Clinical Rehabilitation 27(12) 1058 © The Author(s) 2013 Reprints and permissions: sagepub.co.uk/journalsPermissions.nav DOI: 10.1177/0269215513512437 cre.sagepub.com
variation among centres. Problems in rehabilitation are often life-long, and some treatments are longterm, and we need to know the long-term risks as well as benefits. Baclofen pumps are effective at controlling leg spasticity in some patients, but at what cost? In a long-term (1–22 years) study, each month about 1% of patients developed a problem, usually catheter-related. Botulinum toxin injections are also used for spasticity where one possible beneficial outcome might be a reduction in the associated pain. A systematic review using GRADE methodology (see article) did not find evidence of pain relief. Exercise is now a well supported intervention in many circumstances. A systematic review has investigated the effects of different types of exercise on osteo-arthritic knee pain; there is a short-term benefit which might be better if strengthening exercise is used. Another study here investigates both its comparison with massage and its conjunction with massage in people with multiple sclerosis. Massage seemed particularly helpful in several domains, but the study is small and needs replication urgently. Finally a novel intervention, using observation of performance as a way of improving performance is evaluated in a small pilot study – the results justify a larger trial which should be easy to undertake, and could include patients with different underlying disorders.
Copyright of Clinical Rehabilitation is the property of Sage Publications, Ltd. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use.
