Selections From This Month in the Archives

Article Outline

• The Efficacy of Telephone Counseling for Health Promotion in People With Multiple Sclerosis: A Randomized Controlled Trial
• Neutral Functional Realignment Orthosis Prevents Hand Pain in Patients With Subacute Stroke: A Randomized Trial
• The Effectiveness of Inpatient Rehabilitation in the Acute Postoperative Phase of Care After Transtibial or Transfemoral Amputation: Study of an Integrated Health Care Delivery System
• Evidence of Beneficial Effect of Physical Therapy After Lower-Extremity Trauma

Charles H. Bombardier, PhD

Mary Cunniffe, MSW

Rohini Wadhwani, BA

Laura E. Gibbons, PhD

Kimberly D. Blake, PhD

George H. Kraft, MD

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The Efficacy of Telephone Counseling for Health Promotion in People With Multiple Sclerosis: A Randomized Controlled Trial 

Health promoting activities, such as exercise, are beneficial for people with disabilities but are often costly and require close supervision. Bombardier and colleagues assessed the benefits of a less intensive motivational interviewing (MI) approach to health promotion in a randomized controlled trial involving 130 adults with multiple sclerosis. The intervention consisted of a single in-person MI followed by 5 scheduled telephone counseling sessions. Outcome measures were assessed at the beginning and end of the 12-week trial with the subjects in the treatment group reporting statistically significantly greater improvements than their control group counterparts in terms of physical activity, stress management, fatigue, mental health, and walking speed. The investigators conclude that a telephone counseling-based MI approach to health promotion merits further study. • SEE PAGE 1849

Elisabeth Bürge, MPTSc

Danièle Kupper, OT

Axel Finckh, MD, MSc

Susan Ryerson, PT, ScD

Armin Schnider, MD

Béatrice Leemann, MD

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Neutral Functional Realignment Orthosis Prevents Hand Pain in Patients With Subacute Stroke: A Randomized Trial 

Although upper-extremity orthotics, whether for positioning, spasticity control, or functional assistance are often a part of stroke rehabilitation, evidence of their effectiveness is limited. Bürge and colleagues studied the effects of a neutrally positioned hand and wrist orthotic on hand pain, mobility, and edema in 30 patients with stroke and severe motor deficits. All subjects participated in an inpatient stroke rehabilitation program with half also instructed to wear the orthosis at least 6 hours/day. At the end of the 13-week trial, the orthotic group reported fewer subjects with hand pain (1 vs 8 in the control group) (P=.004) but no differences were noted in terms of hand mobility or swelling. The authors conclude that while this orthosis appears beneficial in reducing hand pain, it doesn't display a significant effect on mobility and edema. • SEE PAGE 1857

Margaret G. Stineman, MD

Pui L. Kwong, MPH

Jibby E. Kurichi, MPH

Janet A. Prvu-Bettger, ScD

W. Bruce Vogel, PhD

Greg Maislin, MS, MA

Barbara E. Bates, MD

Dean M. Reker, PhD

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The Effectiveness of Inpatient Rehabilitation in the Acute Postoperative Phase of Care After Transtibial or Transfemoral Amputation: Study of an Integrated Health Care Delivery System 

Stineman and colleagues utilized Veterans Affairs Medical Center databases to assess the impact of inpatient rehabilitation (defined as either consultation or treatment in a skilled rehabilitation unit) on the outcomes of 2673 veterans undergoing lower-extremity amputations. The authors found that patients receiving inpatient rehabilitation were no more likely to be provided with a prosthetic limb than those who did not but that they did have a significantly increased likelihood of 1-year survival and were far more likely to be discharged home. The findings support the benefits of acute postamputation rehabilitation. Elucidation of its optimal nature requires continued investigation. • SEE PAGE 1863

Renan C. Castillo, PhD

Ellen J. MacKenzie, PhD

Kristin R. Archer, PT, MS, DPT

Michael J. Bosse, MD

Lawrence X. Webb, MD, for the LEAP Study Group

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Evidence of Beneficial Effect of Physical Therapy After Lower-Extremity Trauma 

Castillo and colleagues investigated the benefits of physical therapy (PT) in 384 patients following severe lower-extremity trauma. Patients were examined 5 times over a 2-year period with an orthopedist and PT independently determining whether they would benefit from PT; unmet needs were determined on the basis of whether the patients received therapy. Patients with unmet needs as assessed by a PT were less likely to improve in terms of range of motion (ROM), stair climbing, gait quality, walking speed, and FIM scores than those whose needs had been met. Patients with unmet needs as evaluated by an orthopedist, were significantly worse off than their met needs counterparts only in terms of ROM. The authors conclude that PT after severe lower-extremity trauma appears beneficial but that an improved uniformity in the provision of therapy is needed. • SEE PAGE 1873