Qualitative studies, the investigation of experiences and opinions through careful questioning and data analysis, can be extremely important in improving healthcare. In this issue there is a detailed investigation into the experiences of both patients and staff when faced with incontinence of urine after stroke. It particularly concerned with the effects of increased staff training. Patients still find communication difficult, but training started to improve staff skills. “Improving but still a long way to go.” might be the summary. The lack of previous research into incontinence after stroke, compared with research into motor recovery, probably demonstrates our lack of concern. The second study concerns patient-centred goal setting, a phrase we would all agree with if asked but … is it actually practiced? A detailed study suggests that it not practiced as espoused, and highlights many reasons why this may be true, spanning most aspects – people, organizational systems, social culture etc. However a third study of an intervention aimed at caregivers found that the treatments delivered in a trial were delivered much as intended. This is impressive, because in many process evaluations a low level of compliance is found. Measures are essential both in research and in practice. We encourage detailed and critical evaluations, to improve our use of existing measures. A large study(n = 684) from Norway evaluated a communy used measure, the timed up and go (TUG) test. It was found not to be useful as a predictive measure when used five days after hip fracture – a surprise to me as I would expect mobility early on to be quite closely associated with mobility at 12 months. A substantial proportion of patients could not perform the test. This measure was also one of many in a pilot study of visual cues in people with Parkinson’s disease who were training on a treadmill. The timed up and go test did detect a beneficial effect, so it seems sensitive to change and difference. Giving your intervention a good name always helps. MSinvgor8 is an intervention aiming to reduce the effects of fatigue in people with multiple sclerosis. This internet-based therapy when email contact was added in, led to a a large effect; this study needs early replication, given the importance of fatigue in people with multiple sclerosis – and many other neurological conditions. The intervention was derived from a qualitative study of patients. Another way to develop interventions is through using a theory, and the biopsychosocial model of illness was used to develop a tailored programme which was much more effective that standard therapy for people with chronic neck pain. Moreover the internet-delivered programme was as effective as a face-to-face delivery. Digital technology underlies many interventions being developed, and ‘virtual reality’ is a term applied to a range of different interventions. A systematic review of virtual reality (Nintendo Wii etc) used after stroke to improve balance found significant benefits – including improve mobility measured by the timed up and go. Finally another technology, not digital, that is becoming widely investigated is whole body vibration. A systematic review (4 studies, 201 patients) of its use in people with chronic obstructive pulmonary disease found not strong evidence of benefit – an no evidence of harm.
