In acute whiplash injuries, early physiotherapy has been shown to reduce pain and increase cervical movement, but the cost-effectiveness of this treatment has been questioned. It is unclear whether the benefits result from manipulative physiotherapy or from the patient's ability to perform the accompanying home exercise programme when instructed about its importance. In a single blind prospective randomized trial 71 patients who received out-patient physiotherapy were shown to have significant improvement in severity of neck pain (P< 0-01) and cervical movement (P< 0-01) at 1 and 2 months post-injury when compared with 33 patients who received analgesia and a cervical collar. Sixty-six patients who were offered comprehensive advice for home mobilization by a physiotherapist showed a similar improvement. There appears to be no difference in effectiveness between outpatient physiotherapy and home mobilization.
Prediction of outcome for brain-injured individuals will facilitate effective rehabilitation programme planning which will ultimately improve the patient's quality of life. A sample of traumatic brain-injured subjects who had completed their rehabilitation were contacted post-discharge to identify predictive factors for return to work/school. Subjects were given a telephone interview and their charts were examined retrospectively along five subsets of variables in the predictive matrix: sociodemographics, chronicity, indices of severity, physical impairment, and cognitive functioning. Forty-five subjects were used as the study sample to investigate their vocational and educational outcome, and to generate the best predictive model for return to work/school. Twenty subjects made up the test sample used to evaluate the generalizability of the predictive model. Performance IQ score of the Wechsler Adult Intelligence Scale-Revised emerged as the most significant predictor of return to work/school. Implications of these findings for treatment and rehabilitation are discussed.
The value of a program for the rehabilitation of osteoporotic patients (PRO) was assessed from a 4-year follow up of 139 patients referred to the program over its initial 2 years of operation. The program consisted of educational seminars, social activities and regular exercise supervision. Patients had annual clinical assessments, and bone mass measurements by neutron activation analysis (reported as CaBI). Fitness was assessed by performance on a treadmill (reported in terms of VO2max, ml/kg/min). Seventy-eight of the 139 patients remained in the program over the 4-year follow-up. This unusually high level of commitment to the program is indicative of the psychological value that patients have derived from it. The effect of the program on the osteoporosis process was inconclusive. Group 2, the 37 patients who obtained the greatest improvement in fitness (VO2max > 6 ml/kg/min), had a significantly greater reduction in back pain than did group 1, the 36 with less significant improvement (VO2max < or = 6 ml/kg/min). The bone mass and incidence of vertebral fractures on entry into the program were not significantly different between the two groups. Group 2 had on average a greater increase in bone mass over the 4 years; mean increases in CaBI, (+/- SD) were 0.09 +/- 0.09 and 0.05 +/- 0.10 for groups 2 and 1 respectively. Group 2 had on average fewer new vertebral fractures (0.08 +/- 0.36 and 0.28 +/- 0.75 for groups 2 and 1 respectively).(ABSTRACT TRUNCATED AT 250 WORDS)
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