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OBJECTIVE: How do pain intensity and functional capacity improve after rehabilitating chronic non-specific back pain? Are the changes of practical relevance for quality of life and social participation? Are they stronger than placebo effects? METHODS: Meta-analyses of short-, medium- and long-term outcomes from rehabilitation studies with standardized mean differences and MID-units were performed, as well as meta-analyses of outcomes of sham therapies. In addition, non-standardized effect measures and the amount of reliable change were determined. RESULTS: for pain intensity short-term effects were moderate, long-term effects were small, for functional capacity short-term effects were small, and no effects occurred in the long term. The effects were at no time of practical relevance. Similar results could be achieved with sham treatments. CONCLUSION: As far as pain intensity and functional capacity are concerned, the typical rehabilitee does not experience any significant improvements; a smaller proportion achieve results in the range of placebo effects.
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Dolor Crónico , Calidad de Vida , Dolor de Espalda , Alemania , HumanosRESUMEN
OBJECTIVE: It is investigated whether and how the issue of clinical significance is treated in German rehabilitation trials. METHODS: Review of 64 articles published between 2012 and 2016, which report data on at least 2 measuring times and involve German scientists and rehabilitation facilities. RESULTS: Clinical significance is mentioned in 28% of the articles, defined by 19%, and 13% provide justification for the definition. Statistics suitable for determining clinical significance are reported by 70% but no more than 28% actually use these statistics for this purpose. The most commonly used statistics are measures of effect size (45%). They are interpreted schematically according to Cohen's categories without further reflection. CONCLUSION: Determining and discussing the clinical significance of results is recognizable in the majority of cases only to some extent or non-existing.
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Ensayos Clínicos como Asunto , Rehabilitación , AlemaniaRESUMEN
OBJECTIVES: To evaluate influences of disease severity and food texture on prevalence and type of dysphagia in hospitalized geriatric patients. DESIGN: We screened for dysphagia in 161 geriatric inpatients with different forms of dementia and 30 control patients. MEASUREMENTS: Signs of aspiration were registered with 3 different food consistencies (water, apple puree, and slice of an apple) and the latency until the first swallow was documented. SETTING: Geriatric department of an academic teaching hospital in Hamburg, Germany. RESULTS: Compared with the controls, patients with dementia more often showed signs of aspiration. In the patients with dementia, signs of aspiration occurred more frequently with water (35.6%) than with a slice of an apple (15.1%) or apple puree (6.3%). We observed an inverse relationship between Mini-Mental State Examination score level and the suspected rate of aspiration, as well as with the length of latency until the first swallow of puree. CONCLUSIONS: The prevalence of dysphagia is high in patients with dementia, especially in patients with moderate to severe cognitive impairment. The relationships observed in this study encourage screening for dysphagia and adapting meal consistencies to prevent aspiration in patients with dementia.