Design: Systematic review of randomized controlled trials.

Methods: Studies were identified from databases searched to May 2009: MEDLINE, EMBASE, CINAHL, Sports Discus, PEDro, AMED, Cochrane Library, National Research Register, Index Chiropractic Literature. Two reviewers selected studies meeting inclusion criteria. The methodological quality of the included studies was independently assessed by two reviewers using the PEDro quality assessment tool.

Results: Eight studies with sample sizes ranging from 14 to 125 were included in the systematic review and appraised for content. Four papers achieved a score of 6 or above indicating good quality, with the remaining four achieving 4 or lower, indicating poor quality. Synthesis showed only limited evidence to support the use of exercise in the treatment of subacromial impingement syndrome.

Conclusion: There is a need for further well-defined clinical trials on specific exercise interventions for the treatment of shoulder dysfunction including subacromial impingement syndrome.

Design: A systematic review.

Methods: MEDLINE, EMBASE, CINALH, PUBMED and PsychINFO databases were used to identify studies published between 1987 and 2008 meeting the following criteria: studies with subjects older than 18 years; diagnosis of new onset or previous acquired brain injury; medication given to improve attention and use of outcome to measure attention. Studies involving subjects in low arousal states or with neurogenerative conditions were excluded. The studies were categorized into three evidence levels: I — Randomized controlled trials; II — Prospective studies, controlled trials with methodological limitations; and III — Retrospective studies, clinical case series.

Results: Forty-seven articles were identified on initial search. Twenty-six met the pre-specified criteria. Five articles were assessed as meeting the level I evidence criteria, 12 were level II studies and 9 were level III studies. Methylphenidate can improve information processing speed but not all attention aspects in some people after traumatic brain injury. There is weak evidence for use of dopamine agonists to improve neglect/inattention after stroke. There is little evidence on the frequency of adverse effects and long-term functional benefits.

Conclusion: Although there is lack of robust evidence to recommend the routine use of medication to improve attention after traumatic brain injury and stroke, the existing evidence indicates potential for benefit in some patents and therefore further research is warranted.

Design: Prospective controlled trial.

Setting: Three rehabilitation centres and three patient self-help associations within a health care network in France.

Subjects: Forty patients with moderate to severe COPD.

Interventions: After a first four-week inpatient pulmonary rehabilitation programme, patients took part in a maintenance integrated health care programme or usual care for 12 months.

Main measures: The primary outcomes were the change in functional and emotional dimensions of quality of life measured by the St George’s Respiratory Questionnaire (SGRQ), the brief World Health Organization Quality of Life questionnaire (Brief-WHOQOL) and six specific questions using a 10-cm visual analogue scale. Secondary outcomes were change in exercise tolerance measured by six-minute walking test and cycle exercise.

Results: At one year, the maintenance intervention (n = 11) produced improvements in functional and emotional dimensions scores of quality of life and exercise tolerance. Patients in the usual aftercare group (n = 16) exhibited maintenance of functional dimension scores of quality of life, but a clinically relevant decline in emotional scores of quality of life and in six-minute walking distance one year after the pulmonary rehabilitation.

Conclusion: Patient self-help association seems to be an innovative and efficient organizational structure to support patients with COPD after pulmonary rehabilitation in real-life settings. A distinction between emotional and functional dimensions of quality of life may improve the design and evaluation of integrated health care programmes in patients with COPD.

Design: A randomized clinical study.

Setting: Orthopaedic surgery department.

Subject: Sixty patients scheduled for surgery followed by inpatient rehabilitation for degenerative lumbar disease.

Interventions: The patients were computer randomized to prehabilitation and early rehabilitation (28 patients) or to standard care exclusively (32 patients). The intervention began two months prior to the operation. The prehabilitation included an intensive exercise programme and optimization of the analgesic treatment. Protein drinks were given the day before surgery. The early postoperative rehabilitation included balanced pain therapy with self-administered epidural analgesia, doubled intensified mobilization and protein supplements.

Main measures: The outcome measurements were postoperative stay, complications, functionality, pain and satisfaction.

Results: At operation the intervention group had improved function, assessed by Roland Morris Questionnaire (P = 0.001). After surgery the intervention group reached the recovery milestones faster than the control group (1—6 days versus 3—13, P =0.001), and left hospital earlier (5 (3—9) versus 7 (5—15) days, P =0.007). There was no difference in postoperative complications, adverse events, low back pain and radiating pain, timed up and go, sit-to-stand or in life quality. Patient satisfaction was significantly higher in the intervention group compared with the control group.

Conclusion: The integrated programme of prehabilitation and early rehabilitation improved the outcome and shortened the hospital stay — without more complications, pain or dissatisfaction.

Design: A cross-sectional study of 59 participants with chronic shoulder pain of more than four months duration with a referral for diagnostic ultrasound scanning were invited to participate in the study.

Main measures: Thirty-four participants met the inclusion criteria and had an ultrasound scan followed immediately by application of the following tests: Neer’s sign, Hawkins and Kennedy test, painful arc of abduction, empty and full can tests, resisted isometric shoulder abduction and resisted isometric shoulder external rotation. Using the two-way contingency table method sensitivity, specificity, likelihood ratios and overall accuracy were calculated for each physical test.

Results: Diagnostic values for each test varied considerably. The Hawkins and Kennedy test was the most accurate test for diagnosing any degree of subacromial impingement syndrome (71.0%). The most accurate tests for diagnosing subcategories of impingement were pain on resisted external rotation and weakness during the full can test (63.6%) for presence of subdeltoid fluid, pain on resisted external rotation (58.8%) for partial thickness tears and the painful arc test (62.1%) for full thickness tears.

Conclusions: As the predictive values of these tests are shown to be variable in this study it indicates that the clinical tests identified have limited use in informing diagnosis. Emphasis on the management of dysfunction may be more appropriate rather than reliance on clinical tests with inconclusive sensitivity and specificity if ultrasound scanning is not available.

Design: Qualitative methodology.

Setting: Three urban locations in southern England.

Participants: Nine African-Caribbean informal stroke carers providing support to a relative with stroke for at least six months.

Method: Semi-structured interviews were used to explore both predetermined and unexpected topics relating to any aspects of the carers’ experiences. Interview transcriptions were analysed using inductive thematic analysis.

Results: Several themes resembled those identified in previous qualitative studies with informal stroke carers from other ethnic backgrounds. However, new themes emerged which were related to the carers’ ethnicity and cultural values. These themes were ‘understanding of individual needs’, ‘battle’, ‘independence from services’, ‘faith in God’, ‘family ties’ and ‘avoiding institutionalised care.’

Conclusions: This small-scale study provides an insight into African-Caribbean stroke carers’ own perspectives. These have much in common with those of other ethnicities, but also exhibit important areas of difference. Several themes indicate issues with existing service provision. Stereotypical assumptions about informal stroke carers based on ethnicity appear to be unwarranted; there is diversity within ethnic groups. Individual contexts of ethnicity, culture and religious beliefs shape expectations and perceptions. Several themes signpost service attributes that are perceived as relevant to acceptability by African-Caribbean stroke carers. Recruitment challenges could be addressed in future projects with ethnic minority carers by collaborative planning and the development of individual relationships with key informants.

Design: Prospective cohort study

Setting: Eight Dutch rehabilitation centres.

Subjects: One hundred and forty-two patients with a spinal cord injury.

Main measures: Models were developed with the performance time and ability score at t₂ as dependent variables and t₁ scores of performance time and ability score, age, gender, body mass index, level and completeness of the lesion as independent variables. The statistical models were evaluated by comparing individual estimated scores with actual measured scores.

Results: The main independent variables to predict wheelchair skills at discharge were the t₁ performance time and ability score, age, gender and lesion level. The intraclass correlation coefficient between the estimated and actual ability score was 0.79 and for the performance time 0.86. However, the 95% limits of agreement and their confidence intervals were relatively wide for both ability score (—2.3 to 3.4, range 0—8) and performance time (—12.5 to 8.2, range 11—40 seconds).

Conclusion: The prognostic models developed in this study to predict future wheelchair skills might help planning the course of rehabilitation. The models should be used with caution in daily clinical practice, but may add useful information to clinical expertise and knowledge of the individual patient.

Design: Prospective longitudinal observational study.

Setting and subjects: Participants with a first stroke from two acute stroke units were assessed while still in hospital (baseline) and at three and six months post stroke.

Main measures: Distress was assessed with the General Health Questionnaire-12. Other measures included: NIH Stroke Scale, Barthel Index, Frenchay Aphasia Screening Test, Frenchay Activities Index, MOS Social Support Scale and social network indicators. Logistic regression was used to identify predictors of distress at each stage post stroke; and to determine what baseline factors predicted distress at six months.

Results: Eighty-seven participants were able to self-report on measures used, of whom 32 (37%) had aphasia. 71 (82%) were seen at six months, including 11 (16%) with aphasia. Predictors of distress were: stroke severity at baseline; low social support at three months; and loneliness and low satisfaction with social network at six months. The baseline factors that predicted distress at six months were psychological distress, loneliness and low satisfaction with social network (Nagelkerke R² = 0.49). Aphasia was not a predictor of distress at any time point. Yet, at three months post stroke 93% of those with aphasia experienced high distress, as opposed to 50% of those without aphasia (² (1) = 8.61, P<0.01).

Conclusions: Factors contributing to distress after stroke vary across time. Loneliness and low satisfaction with one’s social network are particularly important and contribute to long-term psychological distress.