Treatment Disparities for Disabled Medicare Beneficiaries With Stage I Non-Small Cell Lung Cancer
People with differing ethnic and socioeconomic backgrounds often have different access to health care resources. Iezzoni and colleagues examine the possible existence of a similar discrepancy among people with disabilities in a study involving stage I non-small cell lung cancer. The investigators performed a retrospective analysis of 11 Surveillance, Epidemiology and End Results (SEER) cancer registries and identified 9441 people with newly diagnosed stage I disease, of whom 1016 were defined as being disabled. People with disabilities were less likely to have surgery and had a significantly higher cancer-specific death rate (HR=1.37; 95% CI, 1.24−1.51) than persons without disabilities. Statistically significant cancer-specific mortality differences disappeared after adjusting for treatment differences. The authors note that many factors, such as functional status, lifestyle differences, and comorbidities, may influence their findings but that further research is needed to explore reasons for the discrepancy and whether survival of people with disabilities’ would improve if treatment disparities were lessened. • SEE PAGE 595
Raban V. Jeger, MD
Peter Rickenbacher, MD
Matthias E. Pfisterer, MD
Andreas Hoffmann, MD
Outpatient Rehabilitation in Patients With Coronary Artery and Peripheral Arterial Occlusive Disease
Cardiac rehabilitation is often recommended for patients with coronary artery disease but the relative benefits of these programs for those with significant comorbidities may be unclear. Jeger and colleagues examine an aspect of this issue in a study of 1508 patients with coronary artery disease who were enrolled in a 3-month cardiac rehabilitation program. Ninety-nine (7%) also had peripheral arterial occlusive disease (PAOD). Outcome measures included bicycle stress tests, quality of life (QOL), treatment complications, and dropout rates. Patients with PAOD tended to be older, less fit, and to have more cardiovascular comorbidity than those without the condition. At entry, subjects with PAOD achieved lower stress test workloads than those without the condition but, over the trial, the 2 groups achieved similar exercise capacity gains. QOL was similar in the 2 groups at baseline and improved in roughly equal measures in each. Complication rates were similar in the groups but the dropout rate in those with PAOD (18%) was almost twice the 10% rate of those without the condition. The authors conclude that cardiac rehabilitation should be offered to patients with PAOD but that these patients may benefit from additional efforts toward counseling and retention. • SEE PAGE 618
Amanda R. O’Brien, PhD
Nancy Chiaravalloti, PhD
Yael Goverover, OT, PhD
John DeLuca, PhD
Evidenced-Based Cognitive Rehabilitation for Persons With Multiple Sclerosis: A Review of the Literature
Much of the research on cognitive rehabilitation has involved patients with stroke or traumatic brain injury rather than those with conditions such as multiple sclerosis (MS). Work, however, is taking place in this latter area and O’Brien and colleagues provide a systematic review of its current status. Interventions were categorized into 4 groups, 3 that addressed attention, executive functioning, and learning/memory; and a fourth that either could not be well specified or addressed multiple domains. The authors found that while the evidence in the areas of executive functioning, attention, as well as the less well-specified and combined programs was too limited to support treatment recommendations, there was sufficient evidence for the use of the modified story memory technique for the remediation of learning and memory particularly for patients with moderate to severe impairments. They also believed that the evidence supported the use of self-generation as an option to improve learning and memory, in people with MS. The authors suggest that there is a significant under-attention to interventions designed to improve processing speed and emphasize the need for future studies in this area. • SEE PAGE 761
Dhiruj Kirpalani, MD
Raj Mitra, MD
Cervical Facet Joint Dysfunction: A Review
Kirpalani and Mitra provide a systematic review of the role of the facet joint in cervical pain. The authors note that while it is well established that facet-generated pain can originate from both traumatic and degenerative causes, the differential diagnosis must include, but is not limited to, lytic lesions, strain, stenosis, and diskogenic causes. Estimates for axial neck pain to have a facet cause range between 25% and 66%. Evaluation begins with a detailed examination and history to rule out nonfacet causes. Imaging typically begins with plain radiographs that include flexion, extension, and open mouth views, but advanced imaging with computed tomography or magnetic resonance imaging may be useful if the diagnosis is uncertain. Lumbar spine investigations suggest that single photon emission computed tomography, at least in a research setting, can predict the facets most likely to benefit from an intra-articular injection, although the current state of the evidence for the benefits of these injections in the neck appears conflicting. The authors conclude that there is limited evidence that radiofrequency neurotomy can provide long-term pain relief. The authors found that there was too little evidence to assess the long-term efficacy of medial branch blocks or the benefits of medication, physical therapy and manipulation, or the modalities. • SEE PAGE 770
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