Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Mar 2008
Comparative StudyCognitively impaired stroke patients do benefit from admission to an acute rehabilitation unit.
To determine whether cognitively impaired stroke patients benefit (defined as having an improved level of functional independence and capable of being discharged home) from admission to an acute rehabilitation unit. ⋯ Our results suggest that despite severe neurologic impairment(s) and disability, cognitively impaired stroke patients make significant functional gains while undergoing rehabilitation and many can be discharged home. Based on these results, stroke patients with cognitive impairments benefit from rehabilitation and should be given the same access to acute rehabilitation services as stroke patients who are cognitively intact.
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Arch Phys Med Rehabil · Mar 2008
ReviewThe basis for recommending repeating epidural steroid injections for radicular low back pain: a literature review.
To determine the current evidence to support guidelines for frequency and timing of epidural steroid injections (ESIs), to help determine what sort of response should occur to repeat an injection, and to outline specific research needs in these areas. ⋯ There does not appear to be any evidence to support the current common practice of a series of injections. Recommendations for further research are made, including a possible study design.
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Arch Phys Med Rehabil · Mar 2008
Randomized Controlled TrialMirror therapy improves hand function in subacute stroke: a randomized controlled trial.
To evaluate the effects of mirror therapy on upper-extremity motor recovery, spasticity, and hand-related functioning of inpatients with subacute stroke. ⋯ In our group of subacute stroke patients, hand functioning improved more after mirror therapy in addition to a conventional rehabilitation program compared with a control treatment immediately after 4 weeks of treatment and at the 6-month follow-up, whereas mirror therapy did not affect spasticity.
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Arch Phys Med Rehabil · Mar 2008
ReviewInterventions in chronic pain management. 4. Monitoring progress and compliance in chronic pain management.
This self-directed learning module highlights the monitoring of progress and compliance in chronic pain management. It is part of the chapter on chronic pain in the Self-Directed Physiatric Education Program for practitioners in physical medicine and rehabilitation. Specifically, the first module focuses on the use of pain rating scales to monitor progress, and the second and third learning objectives focus on evaluating abuse potential and interpreting drug screens. The fourth objective discusses issues pertaining to closure of a workers' compensation complaint, including when to declare that a patient meets the requirements for the designation maximal medical improvement. ⋯ To discuss monitoring of a patient's progress and compliance by describing how pain rating scales are used, what screening procedures are available to help identify patients at risk for drug abuse, and what the basis is for declaring a patient as having reached maximal medical improvement.
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Arch Phys Med Rehabil · Mar 2008
ReviewChronic pain and opiates: balancing pain control and risks in long-term opioid treatment.
The risks and benefits of opioid analgesics for chronic pain conditions and diseases are discussed in the context of the concern about the public health problems of poorly managed pain and prescription drug abuse and addiction. New strategies for risk management in treating patients with chronic pain are described. Opioids for chronic pain may be used effectively in the context of clinical strategies for risk management and selectively tailored, biopsychosocial pain management. ⋯ To present the case for balanced use of opioid therapy in the treatment of chronic pain conditions.