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Evidence-based medicine is a strong movement in this century, and randomized clinical trials continue to be the best level of evidence for establishing cause-effect relationships between treatment interventions and outcomes. The field of physical medicine and rehabilitation has many excellent research questions on the effects of treatment but seems to rely mostly on weak observational methods (eg, chart review, case series, and single-group designs) for answers. This paper highlights 3 basic and relatively simple principles of good experimental design: control, randomization, and replication that were developed by R. A. Fisher for large, complex, agricultural field trials. The principles diffused readily into many scientific arenas, and Fisher even applied the principles in his backyard studies into Mendelian genetics. The thoughts of R. A. Fisher, arguably the most influential statistician of the 20th century, on the promise and challenges of randomized clinical trials in medicine should motivate rehabilitation clinicians to do their own small-scale controlled trials, with Institutional Review Board approval, when faced with equally realistic and plausible treatment options for their patients.

Objective: To determine if a computer-assisted instruction program would improve fourth-year medical students' knowledge base related to spinal cord injury, as determined by pretest and posttest scores., Design: A multimedia computer-assisted instruction program was developed and offered on a volunteer basis to an entire class of fourth-year medical students (n = 168). Effectiveness of the instructional content was evaluated with pretests and posttests, and overall user satisfaction with the module was assessed with the courseware evaluation., Results: The responses yielded 83 sets of completed pretest and posttest pairs and 80 sets of fully completed courseware evaluations. Mean posttest score was significantly higher than the mean pretest score (pretest, 6.65 +/- 1.44, vs. posttest, 7.36 +/- 1.38; df = 82, t = -4.74, P < 0.001). Courseware evaluations yielded positive ratings in all areas, including applicability and usability., Conclusions: The significantly increased posttest scores suggest that the students left the program with an expanded knowledge base in the content areas of spinal cord injury medicine covered in the computer-assisted instruction program.

Background: Neuropathic pain is a common complaint after traumatic spinal cord injury (SCI). Gabapentin, a synthetic structural analogue of GABA, has been shown to have beneficial effects in the treatment of neuropathic pain in other diagnostic groups; however, no standardized clinical trial has been performed to evaluate its efficacy after SCI., Design: A 10-week, prospective, randomized, double-blind, crossover, and placebo-controlled clinical trial., Objective: To determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain., Methods: Seven subjects with neuropathic pain, who were more than 30 days post-SCI, completed the study. Two groups received a 4-week course of gabapentin and placebo in a randomized crossover design with a 2-week washout period. The Neuropathic Pain Scale was used to record daily pain levels. Data were analyzed using the Wilcoxon signed rank test., Results: Gabapentin has some beneficial effects on certain types of neuropathic pain. There was a significant decrease of "unpleasant feeling" and a trend toward a decrease in both the "pain intensity" and "burning sensation" at the fourth week of gabapentin treatment compared with those on the placebo. No significant difference was found among other pain descriptors during the gabapentin and placebo treatment, although this may have been limited by the small sample size and low maximum dosage of gabapentin., Conclusions: Gabapentin reduces certain types of neuropathic pain in the SCI population. Future studies with larger sample sizes, higher dosages, and quicker titration will help further determine the efficacy of gabapentin in the treatment of SCI-related neuropathic pain.

Abstract: Rathore FA, Gosney JE, Reinhardt JD, Haig AJ, Li J, DeLisa JA. Medical rehabilitation after natural disasters: why, when, and how? Natural disasters can cause significant numbers of severe, disabling injuries, resulting in a public health emergency and requiring foreign assistance. However, since medical rehabilitation services are often poorly developed in disaster-affected regions and not highly prioritized by responding teams, physical and rehabilitation medicine (PRM) has historically been underemphasized in global disaster planning and response. Recent development of the specialties of “disaster medicine” and “disaster rehabilitation” has raised awareness of the critical importance of rehabilitation intervention during the immediate postdisaster emergency response. The World Health Organization Liaison Sub-Committee on Rehabilitation Disaster Relief of the International Society of Physical and Rehabilitation Medicine has authored this report to assess the role of emergency rehabilitation intervention after natural disasters based on current scientific evidence and subject matter expert accounts. Major disabling injury types are identified, and spinal cord injury, limb amputation, and traumatic brain injury are used as case studies to exemplify the challenges to effective management of disabling injuries after disasters. Evidence on the effectiveness of disaster rehabilitation interventions is presented. The authors then summarize the current state of disaster-related research, as well as lessons learned from PRM emergency rehabilitation response in recent disasters. Resulting recommendations for greater integration of PRM services into the immediate emergency disaster response are provided. This report aims to stimulate development of research and practice in the emerging discipline of disaster rehabilitation within organizations that provide medical rehabilitation services during the postdisaster emergency response. [Copyright &y& Elsevier]

Background: Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives: To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design: Qualitative literature review and secondary data analysis. Results: Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion: Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health-related rehabilitation following natural disaster is urgently required. [ABSTRACT FROM AUTHOR]