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ARRA Investments in Rehabilitation: Comparative Effectiveness Research

Public Health Burden
NIH has a long-standing interest in research in rehabilitation, including burn and stroke rehabilitation. The pain from severe burn injuries is usually excruciating and difficult to control. Strong opioid pain medication cannot alleviate all burn pain, and can have a number of adverse side effects; adjunctive interventions with no side effects are highly desirable. Post-stroke shoulder pain is a major rehabilitation problem, affecting up to 60% of moderate to severely impaired stroke survivors. Electrical stimulation therapy has been shown to be effective in reducing pain; however, clinical skill or intensive patient training is required to reliably place electrodes on a daily basis and adjust stimulation parameters to provide treatment that the patient can tolerate. ARRA funding has provided a unique opportunity to enrich the science base in rehabilitation medicine through comparative effectiveness research.

Comparative Effectiveness Studies
Comparative effectiveness studies compare the clinical outcomes, effectiveness, and appropriateness of items, services, and procedures that are used to prevent, diagnose, or treat diseases, disorders, and other health conditions. Across the United States, clinicians and patients confront important health care decisions without adequate information. Due to astonishing achievements in biomedical science, clinicians and patients often have a wide variety of choices when making decisions about diagnosis, treatment, and prevention, but it is frequently unclear which therapeutic choice works best for whom, when, and in what circumstances. Comparative effectiveness research (CER) helps provide information that helps clinicians and patients choose which option best fits an individual patient's needs and preferences. In addition, policy makers and public health professionals need to know what approaches work best to prevent illness and disease. ARRA-Funded CER related to rehabilitation includes:
  • The long-term objective of the Optimizing the Control of Pain from Severe Burns (OCPSB) project is to advance understanding of non-pharmacologic control of pain from severe burn injuries and other etiologies by applying state-of-the-art advances in virtual reality (VR) technology as a psychologically based treatment.1
  • Massive burns are associated with a persistent and sustained hypermetabolic response characterized by muscle wasting, immunodeficiency, organ dysfunction and a delay in wound healing. The NIGMS funded Effect of Insulin and Propranolol on Post Burn Hypermetablolism and Inflammation (IPPBHI) project is testing whether two commonly used drugs, either alone or in combination, can attenuate the long-lived and devastating catabolic state that follows severe burn injury.2
  • Researchers have now developed a less invasive, intramuscular method for delivering electrical stimulation therapy through implants, and are working to test whether this method is more effective than conventional best practices in reducing post-stroke shoulder pain.3

  1. 5R01GM042725-18 - Optimizing the Control of Pain from Severe Burns - Patterson, Dave (WA)
  2. 5R01GM056687-11 - Effect of Insulin and Propranolol on Post Burn Hypermetabolism and Inflammation,- Herndon, David (TX)
  3. 5R01HD059777-02 - Electrical Stimulation for Hemiplegic Shoulder Pain.

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