Last month I wrote: “Falls are a major problem and the UK mandates assessing falls risk in all admitted patients despite the lack of any evidence on the validity of the tools in reducing risk and the lack of any interventions to reduce risk.” and I pointed out that environmental modification was probably the best way forward, rather than trying to change patients. Well this issue reports a rare attempt to validate a prediction tool, Predict FIRST for use in the high risk first six weeks after acute stroke. Although it succeeded to an extent, it underestimated risk. This issue also reports a study aimed at reducing falls risk in elderly people who have fallen once. Ironically although the treated group improved on measures associated with increased risk, the actual fall rate was higher (60% v 11%); more work is needed. Another study that looked at falls and attempted to reduce the risk was in people with Alzheimer’s disease where an exercise programme seemed feasible and may have reduced some risk factors. Unfortunately an imbalance in the groups (it was a small study) means that the actual effect on falls was difficult to determine. Two important studies from the Nottingham (UK) stroke research team, probably the most productive group for rehabilitation studies, are reported here. The first concerns the value or otherwise of home visits before discharge after stroke – the HOVIS trial. (People from outside the UK may not know that HOVIS is also the name of a bread flour and bread, well known in the UK!) The second addresses another important question, how to improve mood in patients with aphasia; behavioural management helps. Patello-femoral pain is the subject of two studies. The first was on a Chinese version of a scale to measure patella-femoral pain. The second study compared three treatments, finding that exercise was better than stretching or nothing. The study needs repeating as the numbers of patients were small. Chronic low back pain is another chronic pain disorder associated with much distress and disability where there are many proposed treatments but few have overwhelming success. A study reported here showed that interferential current electro-massage had a better short-term effect on pain and disability than traditional hand massage. But will the effect be maintained? The problem of maintaining early benefits was studied in patients who had constraint-induced movement therapy after stroke; allocating 10% of treatment time to a programme aimed at transferring skills from hospital to home showed that although both groups were similar at discharge, only the transfer group showed a maintained advantage at six months. This needs replicating in a full and larger RCT and the principle needs evaluation in other situations. Finally there is an interesting study on severely deaf children. I had not appreciated that balance and motor coordination was impaired in this group, but I suppose I should not be surprised that balance might be disturbed. This study on a small group of children suggests benefits from vestibular-specific neuromuscular training.
