The job of being editor has some privileges. One is that I can select articles that I am interested in because they challenge accepted wisdom, or introduce new ideas. Another is that, within reason, I can write editorials to put forward a point of view. This issue contains the first of four editorials that suggests a different way of thinking about rehabilitation service delivery - what it is and how we do it. The editorials draw on papers that I have selected over the last few years because they helped support my argument. Obviously the majority of the evidence comes from elsewhere. I know that the editorials are not perfect, but after some years of writing I had to stop and publish them. Please feel free to comment - and improve the ideas.
This issue has several papers that review bodies of evidence to help busy clinicians faced with practical problems. One open access article from a joint South African-Dutch group has reviewed the evidence available concerning the role of physiotherapy for people in intensive care units, and has synthesized the evidence to give recommendations. As this has become one of the most downloaded articles over the last 12 months, I assume they meet a clinical need. A review of the evidence concerning interventions for people who have help with personal activities at home failed to find any substantial evidence of benefit; but the quality of evidence was low and the review also revealed the variety of descriptive terms used, such as “re-ablement” (more on this online soon) which makes reviewing difficult, and shows the lack of a consistent or logically coherent framework. One study of a domiciliary programme for caregivers (of stroke patients) does describe elsewhere the intervention in detail, and finds evidence that this is probably effective. It is now being tested. Reviewing evidence on specific technologically-based treatments is simpler; but the evidence relating to ‘gait trainers’ for children with cerebral palsy is very limited, insufficient to justify their routine use. Indeed a randomized study published in this issue found that overground gait training was as effective as training with partial bodyweight support. Motor imagery is a treatment technique that has captured the imagination (!) of clinicians and researchers. A scoping review focused on its use in people with limitations on the use of their arms has shown a remarkable failure of studies to define the intervention actually used - a feature of much rehabilitation research unfortunately. Evidence on effects was very limited, again insufficient to support routine use. Finally a study on the benefits of adding a dietician to a community-based geriatric rehabilitation team found evidence of benefit - but this needs to be replicated - and, more importantly, describe what the dietician did.
