Abstract
Knowledge advances when there is constructive debate and criticism – this is the basis of the scientific method. This issue has five letters relating to three papers; one was published in 2017 and important points are made about it. Reading the letters will help you think more critically (and, I hope, constructively). The frequency of sleep problems in hospital inpatients are often studied. A study here investigates whether sleep problems might affect recovery after stroke. Pancreatic cancer has a poor prognosis, but a study here suggests that rehabilitation exercise can, nevertheless, have a beneficial effect upon aspects of a patient’s life. The remaining five papers in this issue are systematic reviews, three concerning Musculo-skeletal conditions. Blood-flow restriction, a ‘treatment’ which only recently entered my consciousness, was the topic of one review; does it improve outcome from exercise in patients with knee osteoarthritis? Well, it depends! In five studies involving 190 patients, an effect on muscle strength was found but no detected effect was found on pain or mobility function. The patient may benefit, but may not. Another ‘treatment’ about which I know little is dry needling. A systematic review of studies in lateral epicondylitis (tennis elbow) found seven studies (320 patients) suggesting a short-term benefit. Evidence was lacking about longer-term effects. The third Musculo-skeletal condition studied was low back pain and the review focused on the effects of hip-strengthening exercises. Five studies (309 patients) were identified. The evidence was weak but the exercises might reduce pain. No effect of disability was detected. The fourth review investigated whether using functional electrical stimulation to induce or support static cycling movement assisted people after stroke. The short answer, from seven trials (273 patients) is ‘no’. The last considered whether training people with Parkinson’s disease on a dual task activity benefitted them. The short answer from 11 studies (322 patients) was yes, and in several ways including gait and balance. But still a small number of patients, with few in each study.