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DW. Following on from paper on children's services to adult service transition, I saw this project summary today (contact email at bottom of image). Manchester (UK) leading on transformation of paediatric rehabilitation services.
@naomiwarddavis@NofEkidsrehabpic.twitter.com/GKS2ShSQY5
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DW. One challenge in rehabilitation is quantifying complexity, espectially of environment/context. Quantification of environment factors has been used https://doi.org/10.1001/jamanetworkopen.2019.19928 … based on a paediatric framework. Could complement INTERMED or OCCAMhttp://cre.sagepub.com/content/28/5/499 …
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DW. Is case management effective? (continued). A large trial (n = 8050) found that intensive case management of severely injured patients increased healthcare use and costs by 6 years, with no evidence of patient benefit. https://doi.org/10.1007/s10926-015-9615-0 … Interesting!
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DW. An educational article on intra-articular injections of steroids for osteo-arthritis of the knees emphasises the importance of exercise & weight loss, & finds weak evidence of benefit from steroids. Long-term benefits are unproven, risks are unknown.https://doi.org/10.1136/bmj.l6923 …
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DW. Authors often describe their rehabilitation trials as 'double-blind, placebo-controlled'. The claims are rarely credible - how can patients or therapists not know what they are receiving/doing? Blinding of observers, not patients is most importanthttps://www.bmj.com/content/368/bmj.l6802 …
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DW. Another trial shooting down a popular idea: a multi-component intervention for older (?; only aged 60+ which makes me really old!) people discharged from hospital after back or leg disorders did not improve outcome. https://journals.sagepub.com/doi/full/10.1177/0269215519901155 … We should welcome negative trials.
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DW. Case management is a popular solution to the problems of rehabilitation. A trial (n = 82) finds no support for the enthusiasm. https://journals.sagepub.com/doi/full/10.1177/0269215519897106 … Nor did a study in for head injury (n = 162) https://doi.org/10.1136/bmj.308.6938.1199 … or vocational rehab (n = 8050)https://doi.org/10.1007/s10926-015-9615-0 …
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DW. I have recently bemoaned the poor quality of some submissions. Help is at hand. A free SAGE webinar on March 3rd may help some https://uk.sagepub.com/en-gb/eur/how-to-get-published-webinar … and also try the equator-network resource https://www.equator-network.org/toolkits/writing-research/ …
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DW. Handover of children to adult services is not well done. A 5 year programme suggests 3 simple changes: involve parents, give child self-management skill, meet adult team before transition. Also change culture & priority, organise, collaborate. Simple!https://www.rcpjournals.org/content/clinmedicine/20/1/74 …
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DW. Rehabilitation in ITU; here is an amazing resource. 2000 papers on the matter, broken down into different topics. Quality controlled selection. Use - and support. http://www.mobilization-network.org/Network/Publications.html …
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Clinical Rehab proslijedio/la je Tweet
Every doctor in England & Wales should download this, & file it in an easily discovered place. Clear and sensible guidance, well written. It emphasises it is GUIDANCE (i.e. not the law), but as with medical guidance, you should justify NOT following it. https://www.bailii.org/ew/cases/EWCOP/2020/2.pdf …https://twitter.com/TorButlerCole/status/1219519841914277888 …
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DW. Anyone reporting scientific paper has a responsibility to uphold high standards of ethical behaviour in all areas of practice, including reporting (publishing) their research - https://publicationethics.org/ There are training resources available - https://publicationethics.org/resources/elearning/introduction-publication-ethics-0 … Read & use
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DW. Terrible submission (2); a bad week! Submission of a systematic review of 'physiotherapy for post-stroke fatigue' - no further detail. Searches said to be in an appendix (not submitted!F). Last search mid 2017. Consider your submission carefully; check you submit it all.
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DW. Be careful & respectful when submitting a paper. Today I received a paper with chunks in the author's native language. I noted a submission in May 2019; the same paper, same mistakes. Rejected then as a redundant review. Covering letter 2020 did not mention last submission
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DW. A disappointing result from this systematic review; early mobilisation in ITU had little detectable benefit (12 RCTs, 1322 patients). Some minor differences favouring early mobilisation. https://jintensivecare.biomedcentral.com/articles/10.1186/s40560-019-0413-1 … Large trial like this recommended.https://jamanetwork.com/journals/jama/fullarticle/2759412 …
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An amazing resource; almost too many references, but quicker than searching yourself (and some quality control added)https://twitter.com/earlymobility1/status/1218257226009391104 …
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DW. Repetitive peripheral magnetic stimulation is a painless & simple way to stimulate peripheral nerves to cause muscle contraction, an alternative to neuromuscular electrical http://stimulation.So far only 4 trials (139 people). https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD011968.pub3/full … No conclusion possible
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DW. Giving patients on a rehabilitation ward "something to do when not 'in therapy'" should improve outcome - practice improves performance. A new trial evaluated that. A small effect was found, not enough to be definitive. https://doi.org/10.1177/0269215519901153 … This needs urgent replication.
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DW. Two articles on person-centred care: http://dx.doi.org/10.1016/j.healthpol.2017.09.003 … https://onlinelibrary.wiley.com/doi/full/10.1111/jgs.13866 … I think they encapsulate the values and processes of rehabilitation.
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Clinical Rehab proslijedio/la je Tweet
An advance decision not to be treated might over-ride the autonomy of a future 'new' person after an illness. An article raising the issue, but not answering it. Perhaps a full Advance Decision should specify that it is intended to over-ride a future self?https://jamanetwork.com/journals/jama/fullarticle/2758270 …
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