Effectiveness of Second Corticosteroid Injections for Carpal Tunnel Syndrome.

Effectiveness of second corticosteroid injections for carpal tunnel syndrome.

Muscle Nerve. 2012 Nov 18;
Ashworth NL, Bland JD

INTRODUCTION: A single local corticosteroid injection is an effective treatment for carpal tunnel syndrome. No study has specifically examined the effectiveness of a second injection on relapse after primary injection. METHODS: We identified a cohort of patients who had received an initial corticosteroid injection into 1 wrist and then, at a later date, a second injection into the same wrist. We compared the change in the Boston Symptom Severity Scale (SSS) and Functional Status Scale (FSS) between first and second injections. RESULTS: In 229 patients who received 2 injections the mean improvement on the SSS was 1.2 (SD = 0.8) for the first injection and 1.3 (SD = 0.9) for the second, which was not statistically significant. Improvement in FSS for the first injection was 0.4 (SD = 0.8) and 0.7 (SD = 0.8) for the second, which was statistically significant (P < 0.001). CONCLUSION: Second corticosteroid injections appear to be at least as effective as the first. Muscle Nerve, 2013. HubMed – rehab


Cognitive-Behavioral Prevention of Postconcussion Syndrome in At-Risk Patients: A Pilot Randomized Controlled Trial.

J Head Trauma Rehabil. 2013 May 1;
Silverberg ND, Hallam BJ, Rose A, Underwood H, Whitfield K, Thornton AE, Whittal ML

OBJECTIVE:: To examine the tolerability and estimate the treatment effect of cognitive-behavioral therapy (CBT) delivered soon after mild traumatic brain injury to patients at risk for chronic postconcussion syndrome (PCS). SETTING:: Tertiary rehabilitation center. PARTICIPANTS:: Twenty-eight patients with uncomplicated mild traumatic brain injury, determined to be at risk for chronic PCS based on a published algorithm that incorporates subacute postconcussion symptoms and maladaptive illness beliefs (recovery expectations and perceived consequences). They were enrolled within 6 weeks postinjury. DESIGN:: Open-label, parallel-group, randomized controlled trial, with masked outcome assessment 3 months after enrolment. Interventions were (1) treatment as usual (education, reassurance, and symptom management strategies) from an occupational therapist, or (2) treatment as usual plus CBT delivered by a psychologist. MAIN MEASURES:: Rivermead Postconcussion Symptoms Questionnaire. RESULTS:: Four participants (2:2) withdrew. Treatment credibility and satisfaction ratings were high in the CBT group. Treatment effect sizes were moderate for postconcussion symptoms (Cohen d = 0.74) and moderate-large for most secondary outcome measures (Cohen d = 0.62-1.61). Fewer participants receiving CBT had a diagnosis of PCS at follow-up (54% vs 91%, P < .05). CONCLUSION:: Our preliminary data suggest that CBT delivered soon after mild traumatic brain injury is well tolerated and may facilitate recovery in patients who are at risk for chronic PCS. A definitive clinical trial is warranted. HubMed – rehab


Assessments of Coping After Acquired Brain Injury: A Systematic Review of Instrument Conceptualization, Feasibility, and Psychometric Properties.

J Head Trauma Rehabil. 2013 May 1;
Gregório GW, Brands I, Stapert S, Verhey FR, van Heugten CM

OBJECTIVE:: To identify measures of coping styles used by patients with acquired brain injury; to evaluate the conceptualization, feasibility, and psychometric properties of the instruments; and to provide guidance for researchers and clinicians in the choice of a suitable instrument. DESIGN:: Systematic review. RESULTS:: The search identified 47 instruments, of which 14 were selected. The instruments focused on dispositional coping, situation-specific coping, or domain-specific coping. Psychometric properties were scarcely investigated. The COPE stood out in terms of psychometric properties but had low feasibility. The brief COPE, Coping Scale for Adults-short form, and Utrecht Coping List stood out in terms of feasibility, and the available psychometric properties of these instruments were good. Only the Coping With Health Injuries and Problems was used as other report. CONCLUSION:: Information on psychometric properties of coping instruments in acquired brain injury is scarcely available and limits the strength of our recommendations. For patients with mild injuries, we cautiously recommend the COPE and for patients with more severe injuries the brief COPE, Coping Scale for Adults-short form, Utrecht Coping List, and Coping With Health Injuries and Problems-other-report. Other instruments may be used to address particular issues such as coping with a specific stressful situation or illness. HubMed – rehab