Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Jan 1977
Clinical Trial Controlled Clinical TrialTranscutaneous electrical stimulation: a double-blind trial of its efficacy for pain.
A double-blind trial was done using a stimulator and a placebo device on patients who had chronic pain to determine the effectiveness of transcutaneous electrical stimulation in controlling pain. Ninety-three patients were studied, and 83 of these completed the Minnesota Multiphasic Personality Inventory (MMPI). Thirty-three patients had low-back pain and 24 had neuropathies. ⋯ The stimulator was significantly more effective than the placebo in neuropathies when stimulating over the related nerve trunk (P less than .005), where the stimulator response was nearly three times better than that of the placebo. The duration of subsequent relief was not significantly different after treatment with the stimulator or with the placebo device. Follow-up showed significant declines in the use and effect of the stimulator with the greatest decline noted by the depressed group.
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Arch Phys Med Rehabil · Nov 1976
Undergraduate education in rehabilitation medicine: trends in curriculum development and the impact on specialty manpower and delivery of service.
One hundred thirteen medical schools which offered full degree programs were identified and surveyed by questionnaires to obtain information which identified the existence, characteristics and involvement of physical medicine or rehabilitation medicine programs. The survey also attempted to identify specific changes which have occurred in undergraduate medical education in rehabilitation medicine since the Commission of Education and Rehabilitation Medicine survey of 1963-64. The results suggest that growth of the programs has not followed the expansion in the number of medical schools nor in the number of students enrolled. ⋯ The impact on the undergraduate medical student is not satisfactory as judged by elective enrollment and recruiting of residents. Lack of funding was found to be one of the major obstacles to curriculum development, along with a marked shortage of academic physiatrists. The impact of the changes in undergraduate medical school curricula on rehabilitation medicine has produced considerable conjoint teaching in conjunction with a large number of basic science and clinical departments.
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Each patient admitted to the 16-bed Rehabilitation Medicine Service at Medical Center Hospital of Vermont since October 1972 has received a carbon copy of his full Admission and Discharge notes, containing the complete problem list, and for each problem the relevant data, the Assessment and the Plans. The objectives were to improve patient education; to improve the patient's chances to contribute to the planning of his care; and to increase the staff's accountability to the patient. Over a period of seven months, we evaluated the effect of this maneuver for 125 consecutive patients by means of (1) a report on the patient's reactions, completed by a nurse after she reviewed the record with the patient; (2) a report by the physician stating whether he had expurgated the record for patient use, and recording his observations of patient and family reaction; (3) a questionnaire mailed to patients after discharge. ⋯ Few records were expurgated. The staff has accepted this style as crucial to an appropriate sharing of responsibility between themselves and the patients. We conclude that giving the patient his record is a safe and inexpensive aid to the rehabilitation process, and is probably mandated by the changing relationships between professionals and their clients, and by the patient's need to negotiate his own health care in an increasingly complex and mobile society.
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Fourty-four men (average age, 61.5 years) who had undergone amputation of both lower extremities were studied at a Veterans Administration hospital. Vascular insufficiency was the most frequent reason for amputation. ⋯ Twenty-nine (nearly 65%) of the 44 patients became totally independent in daily functions. However, the average time required for maximum rehabilitation was almost 30 weeks.
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Causalgia is a distressing syndrome which should be diagnosed and treated promptly. A presumptive diagnosis can be made on the basis of the existence of burning pain, autonomic dysfunction and atrophic changes. ⋯ Some patients with causalgia may be mistaken for "hysterics" or "malingerers." Treatment may require physical and occupational therapy, analgesics, tranquilizers, sympathetic block or sympathectomy. The merits of adrenergic blocking agents, percutaneous electrical stimulation, dorsal column stimulation and acupuncture are still to be evaluated.