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Missouri Medicine 2022Falls occur at staggering rates across the country, with 25% of Americans over 65 reporting annual falls. The fall rate in Missourian older adults is 27.3%. Eighty-six... (Review)
Review
Falls occur at staggering rates across the country, with 25% of Americans over 65 reporting annual falls. The fall rate in Missourian older adults is 27.3%. Eighty-six percent of fall-related deaths happen over the age of 65. There are many intrinsic and extrinsic factors that contribute to falls, with some factors that can be targeted and optimized by physicians. There are nuances to the history and physical that can help physicians identify these risk factors.
Topics: Accidental Falls; Aged; Demography; Humans; Risk Assessment; Risk Factors
PubMed: 36036034
DOI: No ID Found -
Arquivos de Neuro-psiquiatria Nov 2023Detailed information about the electromyography practice in Brazil is largely unavailable.
BACKGROUND
Detailed information about the electromyography practice in Brazil is largely unavailable.
OBJECTIVE
To evaluate where and how electromyography is performed in Brazil, as well as regional disparities and the professional and academic credentials of electromyographers.
METHODS
We conducted an internet-based survey of active Brazilian electromyographers. The websites of health insurance companies, professional academies, medical cooperatives, online search engines, and social networks in each Brazilian state were screened and we evaluated the credentials of each electromyographer listed in the Brazilian Federal Medical Board (BFMB) registration website and their online in the Brazilian National Council for Scientific and Technological Development (Conselho Nacional de Desenvolvimento Científico e Tecnológico, CNPq, in Portuguese). We also evaluated the same parameters in a control group of non-electromyographer neurologists randomly matched by geographical distribution and gender.
RESULTS
We found 469 electromyographers (384 neurologists and 85 non-neurologists), with a male predominance. In total, 81.9% were BFMB-certified neurologists, 49.9%, BFMB-certified clinical neurophysiologists, and 10.4%, BFMB-certified physiatrists. Among the non-neurologists, 48.2% were physiatrists. Most electromyographers practiced in states on the Southern and Southeastern regions of Brazil. When adjusted by population, the Federal District and the states of Mato Grosso do Sul and Goiás presented the highest of eletromyographers density. Electromyographers were not more likely to have current/past academic affiliations.
CONCLUSION
In Brazil, electromyography is performed predominantly by neurologists, and half of them are BFMB-certified clinical neurophysiologists. The present study highlights regional disparities and may guide government-based initiatives, for instance, to improve the diagnosis of leprosy and the management of neuromuscular disorders within the Brazilian territory.
Topics: Humans; Male; Female; Brazil; Electromyography; Leprosy; Neurologists; Physicians
PubMed: 38035579
DOI: 10.1055/s-0043-1777007 -
American Journal of Physical Medicine &... Oct 2022Through increased temperature-related illness, exposure to wildfire smoke and air pollutants, and more frequent and intense natural disasters, climate change is...
Through increased temperature-related illness, exposure to wildfire smoke and air pollutants, and more frequent and intense natural disasters, climate change is disproportionately affecting the health of people with disabilities. Although the evidence behind the health effects of climate change is growing, there remain critical research gaps in the physiatric literature that must be addressed. Increased education throughout the medical-education continuum is also needed to prepare physiatrists to address the climate-related health effects impacting their patient populations. Physiatrists and their member organizations should advocate for policies that address climate change with a focus on the unique needs of their patient population and the inclusion of people with disabilities in the policy making process.
Topics: Climate Change; Humans; Physical and Rehabilitation Medicine; Prospective Studies; Smoke
PubMed: 35363629
DOI: 10.1097/PHM.0000000000002017 -
European Journal of Physical and... Feb 2017Mobility recovery after arthroscopic rotator cuff repair in different tears size.
BACKGROUND
Mobility recovery after arthroscopic rotator cuff repair in different tears size.
AIM
To investigate, after arthroscopic rotator cuff repair, the range of motion (ROM) progression in different sized tears (small, large and massive), and evaluating ROM changes in the pre- and postoperative periods of each group.
DESIGN
Cohort study.
SETTING
Policlinico Umberto I, "Sapienza" University, Rome, Italy.
POPULATION
Ninety-two patients with reparable rotator cuff tears.
METHODS
Patients were divided in three groups: group A (small lesions), group B (large lesions) and group C (reparable massive lesions) composed by 29, 31 and 32 patients, respectively. ROM were measured preoperatively (T0), and after 45 (T1), 70 (T2) and 100 (T3) days after the arthroscopic treatment.
RESULTS
From T0 to T3, small lesions are associated to excellent results, with an improvement of all parameters; the same in patients with large lesions, except for flexion parameter; in reparable massive lesions only external and internal rotation improved.
CONCLUSIONS
Not all parameters recover in the same way: postoperative rehabilitative protocol is an integral contributor to favorable outcomes in patients with rotator cuff tears.
CLINICAL REHABILITATION IMPACT
The knowledge about ROM recovering after arthroscopic rotator cuff repair is a strategic information for the patient, as well as for the surgeon and physiatrist.
Topics: Aged; Analysis of Variance; Arthroscopy; Cohort Studies; Female; Humans; Italy; Male; Recovery of Function; Rotator Cuff Injuries; Trauma Severity Indices
PubMed: 27332786
DOI: 10.23736/S1973-9087.16.04133-2 -
PM & R : the Journal of Injury,... Mar 2023Numerous studies have indicated that intra-articular steroid injections to the hip are beneficial for short-term pain relief. However, recent studies have drawn concerns...
INTRODUCTION
Numerous studies have indicated that intra-articular steroid injections to the hip are beneficial for short-term pain relief. However, recent studies have drawn concerns of rapidly progressive osteoarthritis of the hip (RPOH) following intra-articular steroid injections. The prevalence of RPOH following intra-articular steroid injections varies widely in the literature.
OBJECTIVE
To identify the prevalence of RPOH following intra-articular steroid injections, and to compare baseline characteristics between patients with and without RPOH.
DESIGN
Case series.
SETTING
Tertiary academic hospital.
PATIENTS
A total of 924 patients (median [interquartile range; IQR] age: 59 [45-70] years; 579 female) who received an intra-articular hip steroid/anesthetic injection from January 2016 to March 2018 and had available pre- and post-injection imaging (prior to surgical intervention) were included in the study.
INTERVENTIONS
Baseline and injection-related data-including demographics, age, body mass index, medical history, laterality, and steroid type-were collected from electronic medical records.
MAIN OUTCOME MEASURES
Post-injection RPOH was determined via imaging review by a physiatry fellow, followed by an attending physiatrist and a musculoskeletal radiologist to confirm findings.
RESULTS
The majority of patients received unilateral injections into the hip, and the most common steroids used were triamcinolone and methylprednisolone. Review of pre- and post-injection imaging revealed 26 cases of RPOH, for an overall prevalence of 2.8% (95% confidence interval [CI] 1.9%-4.1%). Compared to those without RPOH, patients with RPOH were significantly older (median age [IQR]: 64 [60-73] vs. 59 [44-70] years, p = .003) and had a shorter duration of symptoms prior to their injections (median [IQR]: 3 vs. 12 [6-36] months, p < .001). Adjusted regression analyses showed that age was associated with greater odds of RPOH (odds ratio [OR], 95% CI: 1.04, 1.01 to 1.07; p = .003).
CONCLUSIONS
The prevalence of RPOH following intra-articular steroid injections into the hip was lower than previously reported but still clinically relevant. This should be considered when counseling patients prior to intra-articular hip steroid injections.
Topics: Humans; Female; Middle Aged; Osteoarthritis, Hip; Prevalence; Steroids; Triamcinolone; Methylprednisolone; Injections, Intra-Articular; Treatment Outcome
PubMed: 35596119
DOI: 10.1002/pmrj.12853 -
Archives of Rheumatology Mar 2021This study aims to investigate the frequency of myofascial pain syndrome (MPS) and its characteristics in mastalgia patients.
OBJECTIVES
This study aims to investigate the frequency of myofascial pain syndrome (MPS) and its characteristics in mastalgia patients.
PATIENTS AND METHODS
The localization of pain, age, education, menopausal status, hormone replacement and employment status, and existence of comorbid diseases were reviewed on consecutive 131 female mastalgia patients (mean age 43.3±9.4 years; range, 18 to 75 years) in this prospective study conducted between June and December 2019. A total breast pain index (IBP) was obtained and mastalgia was classified according to these scores as mild, moderate, and severe. Patients were divided into four diagnostic groups of MPS, cyclic mastalgia, fibrocystic breast disease, and mastitis.
RESULTS
The total IBP was significantly higher in MPS group (129.2±49.5) than in cyclic mastalgia group (98.3±11.9) (p<0.05). However, it was significantly higher in mastitis group (230.7±17.6) compared to MPS group (p<0.05). The fibrocystic disease group was similar to MPS group in terms of total IBP (p>0.05). Considering the localization of pain according to the quadrants where the pain was felt, 57.1% of the patients who felt pain in the upper quadrants were from MPS group (p=0.001) and 45.3% of the patients who felt pain in the lower quadrants were from cyclic mastalgia group (p=0.001). Myofascial pain was observed particularly in upper quadrants and almost all was unilateral; however, cyclic mastalgia was observed bilaterally in the majority, particularly in lower quadrants.
CONCLUSION
Myofascial pain syndrome should be kept in mind as an extramammary disorder in the differential diagnosis of particularly unilateral upper quadrant mastalgia. It may be for the benefit of patients complaining of mastalgia with no primary breast disorder to be consulted with a physiatrist.
PubMed: 34046576
DOI: 10.46497/ArchRheumatol.2021.8255 -
Neurologia Mar 2024Charcot-Marie-Tooth disease (CMT) is classified according to neurophysiological and histological findings, the inheritance pattern, and the underlying genetic defect....
INTRODUCTION
Charcot-Marie-Tooth disease (CMT) is classified according to neurophysiological and histological findings, the inheritance pattern, and the underlying genetic defect. The objective of these guidelines is to offer recommendations for the diagnosis, prognosis, follow-up, and treatment of this disease in Spain.
MATERIAL AND METHODS
These consensus guidelines were developed through collaboration by a multidisciplinary panel encompassing a broad group of experts on the subject, including neurologists, paediatric neurologists, geneticists, physiatrists, and orthopaedic surgeons.
RECOMMENDATIONS
The diagnosis of CMT is clinical, with patients usually presenting a common or classical phenotype. Clinical assessment should be followed by an appropriate neurophysiological study; specific recommendations are established for the parameters that should be included. Genetic diagnosis should be approached sequentially; once PMP22 duplication has been ruled out, if appropriate, a next-generation sequencing study should be considered, taking into account the limitations of the available techniques. To date, no pharmacological disease-modifying treatment is available, but symptomatic management, guided by a multidiciplinary team, is important, as is proper rehabilitation and orthopaedic management. The latter should be initiated early to identify and improve the patient's functional deficits, and should include individualised exercise guidelines, orthotic adaptation, and assessment of conservative surgeries such as tendon transfer. The follow-up of patients with CMT is exclusively clinical, and ancillary testing is not necessary in routine clinical practice.
PubMed: 38431252
DOI: 10.1016/j.nrleng.2024.02.008 -
Frontiers in Rehabilitation Sciences 2021The coronavirus disease 2019 (COVID-19) and its impact on human functioning are gaining increased interest. Like many other lower-income countries, the Bangladesh health...
The coronavirus disease 2019 (COVID-19) and its impact on human functioning are gaining increased interest. Like many other lower-income countries, the Bangladesh health and rehabilitation sector was adversely affected by COVID-19. Multiple challenges were identified for preparedness and medical rehabilitation during COVID-19 surges. Appropriate supervision of multispecialty long COVID clinics and attention to rehabilitation teamwork are important. Rehabilitation plays a key role in the management of patients with COVID-19 and can reduce the length of hospital stay and improve health outcomes. While waiting for people to be fully vaccinated; ensuring equitable access to COVID-19 vaccination, health care, and rehabilitation services among people with disabilities should be a part of the core mission during the pandemic. All levels of care including, critical, post-acute, or long covid clinic scale-up of rehabilitation services are needed. A physiatrist-led rehabilitation team approach is vital for the adaptation of rehabilitation interventions to improve the functional outcomes of persons with impairment and disability affected by COVID-19.
PubMed: 36188760
DOI: 10.3389/fresc.2021.746061 -
AMA Journal of Ethics Oct 2016Although progress has been made in diversifying medical school admissions and faculty, this has not extended to physicians with physical disabilities. To improve our...
Although progress has been made in diversifying medical school admissions and faculty, this has not extended to physicians with physical disabilities. To improve our understanding of medical students and physicians with physical and sensory disabilities, the authors propose systematically gathering information on the needs and experiences of four groups: physicians who had disabilities before beginning practice, physicians whose disabilities were incurred during their medical careers, physicians drawn from those two groups, and patients of physicians with disabilities. It is hoped these data would be used by counselors, administrators, and admissions committees in advising medical school applicants with disabilities and in revising institutional policies with a view to increasing matriculation and graduation rates of medical students with disabilities.
Topics: Comprehension; Disabled Persons; Education, Medical; Health Knowledge, Attitudes, Practice; Humans; Learning; Organizational Policy; Physicians; School Admission Criteria; Schools, Medical; Students, Medical
PubMed: 27780024
DOI: 10.1001/journalofethics.2016.18.10.stas1-1610 -
Wiener Klinische Wochenschrift Nov 2019Hemophilia is a congenital bleeding disorder with an estimated frequency of 1:10,000 births. Repeated joint bleeding is a hallmark of the disorder and leads to painful...
BACKGROUND
Hemophilia is a congenital bleeding disorder with an estimated frequency of 1:10,000 births. Repeated joint bleeding is a hallmark of the disorder and leads to painful hemophilic arthropathy. Regular exercise can help improve joint stability and function, reduce the risk of injury and bleeding and improve physical fitness and quality of life. This method paper describes an online training concept aiming to offer access to appropriate exercise instructions for people with hemophilia who are not able to attend regular training at a hemophilia center.
METHODS
The online exercise program is accessible through the homepage of the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University Vienna as well as through scanning a QR code printed on information material using a smart phone or tablet.
RESULTS
The program contains exercises to improve mobility, coordination, muscular strength and flexibility. A brief introduction is given by a hematologist, a pediatrician and a physiatrist. An introductory video informs about contraindications and essential precautions, such as medical attendance and sufficient factor therapy to consider before starting the training. Another video gives advice on the exercise composition. The demonstrated exercises are explained by a physician and are available for adults and children. To individualize training recommendations and offer further diagnostic tools and physical treatment options as necessary, the Department of Physical Medicine, Rehabilitation and Occupational Medicine of the Medical University of Vienna will establish consultation hours for people with hemophilia.
CONCLUSION
As hemophilia is an orphan disease, patients are mainly treated in specialized centers. For patients who live far from these centers or have limited access to a training there for other reasons, the physical medicine consultation hour and the implementation of online exercise instructions offer individually adapted exercise information for a regular home-based training to benefit from increased physical fitness and joint stability.
Topics: Adult; Arthralgia; Child; Exercise; Exercise Therapy; Hemophilia A; Humans; Physical Fitness; Quality of Life
PubMed: 31535221
DOI: 10.1007/s00508-019-01548-1