From the journals

Posts in this category report and/or comments on published articles relevant to rehabilitation. Posts may cover any aspect of the paper, and the paper may cover any aspect of rehabilitation, or even not be specific to rehabilitation. There will always be a connection between the paper and rehabilitation.

Entrustability – what is it?

Mosr professions initially developed on the basis of trust. Examinations were rare. Doctors (and other professions) learned through experience. For healthcare, as science advanced and increased in importance, examinations in basic sciences were introduced. Thereafter, once qualified, further advance depended upon the trust of patients and other doctors. Even when I trained, the only examination …

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Covid, FND, and models

“Helping the Public Understand Adverse Events Associated With COVID-19 Vaccinations. Lessons Learned From Functional Neurological Disorder.” (here) Published today (9th April 2021), I think this viewpoint is brave; mentioning Covid-19 and functional disorders in the same title; challenging, because it suggests the bravery is warranted; and, to me, fascinating because it shows how the biomedical …

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NICE on chronic pain

Today, 7th April 2021, the National Institute for Health and Care Excellence, otherwise known as NICE, published its guideline on diagnosis and management of chronic pain (NG193) – see here. News programmes emphasised its advice against using analgesic drugs. I frequently saw people with chronic pain and joined a local group interested in its management, …

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Reflection on progress

This post was precipitated by reading two papers and following references and links in the papers. The post draws attention to the serendipity that can occur on reading a paper, and the enormous changes that have occurred over 40 years. On a practical level, a paper on ‘gamification’ led me to social network measures, and …

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Randomised Comparison Trials

A recently published paper discusses placebos used in randomised controlled trials, referring to the placebo medication as “the Unknown Variable in a Controlled Trial”. The short but important paper is worth reading. It made me reflect on the nature of the control in rehabilitation trials – sometimes even referred to as a placebo by the …

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AI and decision making

Rehabilitation decisions are complex because so many factors have an influence, and we do not know the extent of the impact of each factor, nor do we know about interactions between factors, and we cannot easily compute the final outcome. Artificial intelligence (AI) might help. An interesting paper, just published, shows in a well-designed randomised …

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A surfeit of guidelines?

I am writing a syllabus for doctors training in Rehabilitation Medicine. The syllabus will cover, among other things, the knowledge people need. The working party developing the syllabus suggested that, for each competency or topic, we should recommend a guideline the trainee should be familiar with. Sounds sensible? It must be sensible. The General Medical …

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Learning from failure

Designing and completing a large, well-designed randomised study is hard work. It must be very depressing when the result is negative – your programme of rehabilitation did not have any measurable effect. It happens. But we should not despair, and we should learn, and profit from failure. (The studies are here and here.) The first …

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Back pain.

Patients with chronic low back pain often have a low quality of life and treatments are not very successful. Although the strong association between psychosocial factors and persistent back pain, and the correspondingly weak association between structural abnormalities and persistent pain are both well established and widely acknowledged, treatment still focusses on the back. ‘Back …

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Systematic reviews – reviewed

Systematic reviews, with or without meta-analysis are attractive. They appear to offer much more secure answers, by taking ‘the totality of published evidence’. They can be undertaken without major financial outlay, although they may need much time from reviewers. They attract readers to a journal. They are now often required as evidence of an unmet …

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