Clinical Rehabilitation | 2021
Introductory paragraph
Abstract
I am pleased to see another Rehabilitation in Theory paper this month; there were none last year. It concerns the purpose of rehabilitation, and its conclusions may contrast to the wished-for purpose of payers, although the different purpose may not alter duration of involvement but should improve long-term outcome. A systematic review on the effect of standing in people with prolonged disorders of consciousness concludes “the relevant studies should provoke further questions”. Intriguing; what are they? Three randomized studies were included. Control of pain is presumably important in all healthcare, but perhaps rehabilitation services overlook pain. A study on inpatients having neurological rehabilitation found 149 (25%) had pain on arrival, and 145 had pain on leaving – not a very impressive change, also provoking further questions. Pain was central to several other studies. Shoulder pain is common, and one study compared three measures; the visual analogue scale, Shoulder Pain and Disability Index, and Constant Murley score. Myofascial pain in the neck and thoracic spine was treated using extracorporeal shock-wave therapy in a study on 48 people and seemed better than ultrasound maybe a more dramatic treatment too. Pain in the osteoarthritic knee is quite unpleasant (reportedly; I have not had it), and in a small study (n = 40) adding six sessions of ‘mobilisation with movement’ was associated with less pain and better function six months later. Needs replication now, before use. Exercise is a recommended treatment for osteoarthritis, and a systematic review investigated the effects of Tai Chi exercise. In 16 studies (n = 986 people) it seemed to benefit pain, physical functions, balance and psychological health. Tai Chi was also the focus of another systematic review on non-motor disorders seen after stroke. A reduction in depression was found, but no effects on sleep or cognition. So-called mirror neurons were the target of two studies reported in this issue. Action observation, watching someone else move, has been used as a therapy. A systematic review of studies in children with cerebral palsy found no evidence of benefit. Mirror therapy, looking at a reflection of the healthy limb moving, when used after stroke combined with electric stimulation in patients after stroke, found no benefit. Perhaps we should let mirror neurons have a rest. A large trial on using robots to improve arm function after stroke (RATULS; robot therapy did not help) has studied aspects of treatment offered to the therapy group. Fidelity. doing what was planned, was high. Goals related to self-care. Covid-19 is altering practice towards remote rehabilitation, and a timely study evaluated the effect of a smartphone app to improve self-management in people with chronic obstructive pulmonary disease. It did help. Really needs replication, but I wonder if Covid-19 will pre-empt replication. Case complexity, measured using the self-assessment INTERMED questionnaire predicted both health and social care costs in people seen after trauma. The question is, would rehabilitation targeted at more complex cases reduce those costs? Last, a letter commenting on a trial of enhanced rehabilitation after shoulder surgery. Introductory paragraph 987050CRE0010.1177/0269215520987050Clinical Rehabilitation other2020