Selections From This Month in the Archives

Article Outline

• Team Training and Stroke Rehabilitation Outcomes: A Cluster Randomized Trial
• Biochemicals Associated With Pain and Inflammation Are Elevated in Sites Near to and Remote From Active Myofascial Trigger Points
• Cost-effectiveness of C-Leg Compared to Non-Microprocessor-Controlled Knees: A Modeling Approach
• “To Care for Him Who Shall Have Borne the Battle and for His Widow and His Orphan” (Abraham Lincoln): The Department of Veterans Affairs Polytrauma System of Care

Dale C. Strasser, MD

Judith A. Falconer, PhD

Alan B. Stevens, PhD

Jay M. Uomoto, PhD

Jeph Herrin, PhD

Susan E. Bowen, PhD

Andrea B. Burridge, PhD

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Team Training and Stroke Rehabilitation Outcomes: A Cluster Randomized Trial 

It is accepted that teams are an important part of rehabilitation. Less understood, however, is how team processes and communication can be improved to produce better outcomes in patient care. Strasser and colleagues examine this question in an interesting study that randomized the rehabilitation teams providing stroke rehabilitation in 31 Veterans Administration hospitals into 2 groups. The intervention group received information about their team’s performance and recommendations on how to modify team processes as well as extensive training on effective team functioning. The control group, on the other hand, received only the information component. Data were collected on 3 patient outcomes: change in FIM scores, length of stay (LOS), and discharge disposition. The findings are intriguing in that while the patients of the rehabilitation teams receiving the training displayed functional gains were significantly higher than those of the control teams, disposition and LOSs did not differ between groups. • SEE PAGE 10

Jay P. Shah, MD

Jerome V. Danoff, PhD, PT

Mehul J. Desai, MD

Sagar Parikh, BA

Lynn Y. Nakamura, MD

Terry M. Phillips, PhD, DSc

Lynn H. Gerber, MD

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Biochemicals Associated With Pain and Inflammation Are Elevated in Sites Near to and Remote From Active Myofascial Trigger Points 

Myofascial pain, while it affects millions of people, remains a controversial diagnosis due to its difficult to quantitate symptoms and reliance on semi-qualitative physical examination findings. While algometry may have provided some uniformity, the nature of the syndrome’s pathognomonic taut bands and trigger points has remained illusive. Two studies suggest that this situation may be changing. The first, by Chen and colleagues (p 1658), appeared in the December 2007 issue of Archives (p 1658), and demonstrated that a modification of widely available magnetic resonance imaging techniques can both image the heretofore elusive taut bands and quantitate the physical aspects of their nature. In this issue, Shah and colleagues report on a new microanalytic technique that permits a reliable comparison of biochemical milieus (eg, pH, substance P, tumor necrosis factor alpha, interleukin [IL]-1β , IL-6, IL-8) of both active and latent myofascial trigger points as well as that of the noninvolved muscle. As Simons notes in an accompanying commentary (p 157), this growing ability to quantitate both the physical and biochemical nature of myofascial pain may presage a new era in the treatment and understanding of this frustrating condition. • SEE PAGE 16

Thor-Henrik Brodtkorb, MS, CPO

Martin Henriksson, MS

Kasper Johannesen-Munk, CPO

Fredrik Thidell, CPO

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Cost-effectiveness of C-Leg Compared to Non-Microprocessor-Controlled Knees: A Modeling Approach 

Rehabilitation professionals are often faced with the need to decide whether to recommend to a patient or a payer a conventional device with well-recognized strengths and weaknesses or a more sophisticated, higher-cost alternative with less well-quantified advantages. The cost differences are often large and the information on which to base the decision limited. Brodtkorb and colleagues address this issue for the case of prostheses where the difference between a conventional device and a growing array of microprocessor-controlled alternatives may be thousands of dollars. In particular, Brodtkorb and colleagues utilized a cost-effectiveness analysis to assess the relative benefits of conventional and microprocessor-controlled lower-extremity prostheses in terms of quality-adjusted life years (QALYs) and found that the microprocessor-equipped prosthesis yielded a QALY gain of €3218 (≈ US $4500). Although Brodtkorb and colleagues caution that the data used in this analysis were limited, it should be noted this cost per QALY is relatively modest when compared with the $50,000 per QALY often quoted as an acceptable return. • SEE PAGE 24

Barbara J. Sigford, MD

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“To Care for Him Who Shall Have Borne the Battle and for His Widow and His Orphan” (Abraham Lincoln): The Department of Veterans Affairs Polytrauma System of Care 

War injuries have played an important role in the development of rehabilitation as a specialty and in the improvement of its techniques and capabilities. This pattern is being repeated today where the widespread use of improvised explosive devices in Iraq and Afghanistan has produced a far higher proportion of complex brain and polytrauma injuries than our society has previously experienced. The U.S. Department of Veterans Affairs (VA) has been at the forefront of the U.S. efforts helping the rehabilitation and long-term care of its injured military personnel. This issue includes 6 articles, beginning with Sigford’s overview, that describe the VA’s response to the challenge and its development of an integrated polytrauma system of care. As outlined by these articles, a comprehensive system capable of providing life-long care has been established. This system includes 4 dedicated regional rehabilitation centers and extends to include multiple specialized outpatient and subacute facilities as well as local care, case management and a telemedicine network to ensure optimal access. • SEE PAGE 160