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Orthopedic NursingPhysical Medicine and Rehabilitation (PM&R) is a rapidly expanding field. Physicians who practice PM&R are known as physiatrists and provide care primarily for patients...
Physical Medicine and Rehabilitation (PM&R) is a rapidly expanding field. Physicians who practice PM&R are known as physiatrists and provide care primarily for patients who have disabilities or physical impairments affecting the musculoskeletal system, brain, and spinal cord. Physiatrists may work in an inpatient or outpatient setting, with outpatient physiatrists being an invaluable resource in treating patients experiencing pain. It is worthwhile to refer patients experiencing hip, knee, or back pain to a PM&R specialist because of their skill in making specific and accurate diagnoses, as well as providing a wide range of modalities to treat pain and augment function such as management of pain medications, osteopathic manipulative therapy, trigger point injections, intra-articular steroid injections, orthobiologic therapy, and interventional spinal procedures. Emphasis is on the use of the least invasive modality before employing more invasive treatments. The need for physiatrists to help individuals maximize function and enhance quality of life is increasing with the aging population, expanding workforce of older adults, and a growing population of people with a disability, especially since the COVID-19 pandemic.
Topics: Humans; Aged; Pandemics; Quality of Life; Knee Joint; Physical and Rehabilitation Medicine; Back Pain
PubMed: 38266261
DOI: 10.1097/NOR.0000000000000999 -
European Geriatric Medicine Apr 2024We assess masticatory performance using color-changeable chewing gum, which shifts from yellow-green to red upon chewing. Previous studies used a colorimeter to reveal...
PURPOSE
We assess masticatory performance using color-changeable chewing gum, which shifts from yellow-green to red upon chewing. Previous studies used a colorimeter to reveal the cut-off a* values of the gum's color (a* represents the degree of color between red and green) to determine which foods are masticable (masticable meat, masticable soft side dish, and inadequate masticatory performance). Since a more convenient method is required, we examined the validity and reliability of visual measurement using a color scale to indicate masticable foods by observing the chewing gum's color.
METHODS
Fifty patients (male, 48%), aged ≥ 65 (mean, 82.6) years were enrolled. Using color-changeable chewing gum, three groups were formed according to the cut-off a* values: masticable meat, masticable soft side dish, and inadequate masticatory performance. For the color scale classification, one physiatrist and one dietitian simultaneously, individually, and visually determined the chewing gum color and classified it into one of the three groups. Criterion-related validity was evaluated using the kappa coefficient of agreement between the results from the two methods. Inter-rater reliability was examined using the kappa coefficient of agreement between the three groups judged by the two raters on a color scale.
RESULTS
The kappa coefficients of the agreement for the classifications were 0.908 and 0.909 for the physiatrist and dietitian, respectively. The inter-rater agreement between two raters on the color scale was 0.938 for the kappa coefficient.
CONCLUSION
The color scale indicated masticable foods without a colorimeter. This method can be useful in older adult facilities and homes.
Topics: Humans; Male; Aged; Chewing Gum; Reproducibility of Results; Color; Meat; Mastication
PubMed: 38214866
DOI: 10.1007/s41999-023-00916-5 -
American Journal of Physical Medicine &... Aug 2023Inpatient rehabilitation facilities treat patients with extensive postacute care rehabilitation needs. Physiatrists are uniquely trained in the complexities of such...
OBJECTIVE
Inpatient rehabilitation facilities treat patients with extensive postacute care rehabilitation needs. Physiatrists are uniquely trained in the complexities of such patients; however, not all inpatient rehabilitation facilities use physiatrists as medical leadership. This study identifies the training background and credentials of medical directors in all inpatient rehabilitation facilities within the United States.
DESIGN
Using Internet search, e-mail, and telephone communication, the following data were collected: medical director credential and specialty information, board certification rates and years of practice experience, as well as bed numbers for each inpatient rehabilitation facilities listed on The Centers for Medicare and Medicaid Services Website. Data were collected between November 2019 and November 2020.
RESULTS
Of the 1114 open facilities, 85% have medical directors with a doctor of medicine degree, while 13% have a doctor of osteopathic medicine degree. Two percent reported no physician medical director. Physiatry is the most common specialty (80%), followed by internal medicine, family medicine, neurology, orthopedic surgery, general surgery, and medicine/pediatrics. The mean number of beds per facility is 35.6 (median, 24; range, 4-350). There is an average of 11.4 inpatient rehabilitation facility beds per 100,000 people nationally.
CONCLUSIONS
Physiatry is the predominant specialty to fulfill medical leadership at inpatient rehabilitation facilities, although there remains room for growth. In addition, doctor of medicine degrees greatly outnumber doctor of osteopathic medicine degrees in medical leadership.
Topics: Aged; United States; Humans; Child; Inpatients; Leadership; Medicare; Rehabilitation Centers; Physical and Rehabilitation Medicine
PubMed: 36728973
DOI: 10.1097/PHM.0000000000002172 -
Cureus Oct 2023Introduction In recent years, online search engines have become a source of information about medical issues. We aimed to evaluate the public's interest in...
Introduction In recent years, online search engines have become a source of information about medical issues. We aimed to evaluate the public's interest in osteoarthritis and minimally invasive treatments of osteoarthritis in the last 10 years using Google Trends (GT). Methods Interventional physiatrist analyzed 14 selected terms (joint pain, joint pain treatment, joint cartilage damage, narrowing of the joint, osteoarthrosis, osteoarthritis, intra-articular injection, intra-articular steroid, intra-articular hyaluronic acid, intra-articular plasma rich platelet (PRP), essential oil for joint pain, joint pain supplements, home remedies for joint pain, and stem cell for joint) related with osteoarthritis and minimally invasive treatments of osteoarthritis in physical medicine and rehabilitation discipline. All keywords were searched in the GT application using the 'all categories,' 'web search,' and 'worldwide' filters. The last 10 years have been divided into two equal parts, each spanning five years (from January 1, 2013 to December 31, 2017, and January 1, 2018 to December 31, 2022). Public interest in the 14 keywords mentioned above was recorded for these two periods, and the GT for all 14 keywords were compared across the two five-year periods. Results Searching rates for the terms 'joint pain,' 'joint pain treatment,' 'joint cartilage damage,' 'narrowing of the joint,' 'osteoarthritis,' 'intra-articular injection,' 'intra-articular PRP,' and 'joint pain supplements' have increased significantly in the last five years (p= 0.001, p= 0.001, p= 0.005, p= 0.001, p= 0.001, p= 0.004, p= 0.001, and p= 0.001, respectively). The average Google Trends (GT) score for all terms was 40 between January 1, 2013, and December 31, 2017, and the average GT score for all terms was 48 between January 1, 2018, and December 31, 2022 (p= 0.001). Conclusion The present study stated that public interest in osteoarthritis and minimally invasive treatments for osteoarthritis has increased significantly in the last five years. Study outcomes demonstrated that public attention to 'joint pain,' 'joint treatment,' 'joint cartilage damage,' 'narrowing of the joint,' 'osteoarthritis,' 'intra-articular injection,' 'intra-articular PRP,' and 'joint pain supplements' has also significantly increased in the last five years.
PubMed: 37965413
DOI: 10.7759/cureus.47021 -
The American Journal of Occupational... Mar 2024Reablement is a person-centered and goal-oriented rehabilitative intervention to optimize people's chances to live independently. (Randomized Controlled Trial)
Randomized Controlled Trial
IMPORTANCE
Reablement is a person-centered and goal-oriented rehabilitative intervention to optimize people's chances to live independently.
OBJECTIVE
To investigate the effects of a reablement intervention on performance of instrumental activities of daily living (IADLs) in three aspects (i.e., actual performance, ability, and self-perceived difficulty) for patients with stroke.
DESIGN
A single-blinded, randomized crossover study.
SETTING
Participants' home and community.
PARTICIPANTS
Twenty-seven patients with stroke.
INTERVENTIONS
Each participant received two interventions (IADL reablement and health education). Each intervention was administered for 6 wk. All participants were randomly assigned to one intervention and then received the other intervention after a 4-wk washout period.
OUTCOMES AND MEASURES
Outcomes of actual performance and self-perceived difficulty were derived from the Frenchay Activities Index (FAI) and the difficulty dimension of the Participation Measure-3 Domains, 4 Dimensions (PM-3D4D), respectively. Outcomes of ability were measured with the Lawton Instrumental Activities of Daily Living Scale (LIADL) and the Canadian Occupational Performance Measure Performance score (COPM Performance).
RESULTS
No statistically significant differences were found in the three aspects between the IADL reablement and health education (ps = .148-.570). Compared with the health education, the IADL reablement showed better improvements on the FAI, LIADL, COPM Performance, and difficulty dimension of the PM-3D4D with trivial to small effect sizes (ds = 0.17-0.45).
CONCLUSIONS AND RELEVANCE
Our results reveal that the IADL reablement has the potential to increase the frequency of IADL administration, enhancing the capability to perform IADLs and reducing the self-perceived difficulty of carrying out IADLs. Plain-Language Summary: The results of this study showed positive outcomes for a reablement intervention that focuses on goal-oriented instrumental activities of daily living for patients with stroke. An IADL reablement intervention may be useful for improving the ability to carry out IADL tasks at home and in the community.
Topics: Humans; Activities of Daily Living; Cross-Over Studies; Canada; Stroke
PubMed: 38305817
DOI: 10.5014/ajot.2024.050288 -
American Journal of Physical Medicine &... Apr 2024This review aimed to compare the effectiveness of resistance exercise with that of other exercises in functional improvement and pain control in patients with... (Meta-Analysis)
Meta-Analysis
OBJECTIVE
This review aimed to compare the effectiveness of resistance exercise with that of other exercises in functional improvement and pain control in patients with fibromyalgia.
DESIGN
PubMed, Embase, Scopus, and Cochrane databases were searched for studies published from their inception until March 2023. The following medical search heading terms were used: "resistance OR strength OR strengthening" AND "fibromyalgia." The analysis was performed using the statistical package Review Manager, version 5.4.1.
RESULTS
This study reviewed 11 randomized controlled trials involving 530 patients. In comparison with no intervention, resistance exercise reduced the Fibromyalgia Impact Questionnaire total score, pain score, tender points, and depression and improved physical function. Compared with flexibility exercise, resistance exercise reduced the Fibromyalgia Impact Questionnaire total score. Compared with aerobic exercise, resistance exercise shows similar effects on pain control, reduction of tender points, and improvement of physical function.
CONCLUSIONS
Compared with other exercises, resistance exercise demonstrated a more favorable effect on the Fibromyalgia Impact Questionnaire total score, and the effects on pain control, tender points, physical function, and depression were comparable. Thus, resistance exercise exhibits comparable or superior effects when compared with other interventions and more precise research is needed to confirm this conclusion.
TO CLAIM CME CREDITS
Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.
CME OBJECTIVES
Upon completion of this article, the reader should be able to: (1) Appraise the effectiveness and role of resistance exercise as a treatment option for patients with fibromyalgia; (2) Differentiate the comparative effectiveness of resistance exercise in relation to other forms of exercise for patients with fibromyalgia; and (3) Identify demographic factors commonly associated with fibromyalgia.
LEVEL
Advanced.
ACCREDITATION
The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.
Topics: Humans; Fibromyalgia; Resistance Training; Randomized Controlled Trials as Topic; Exercise; Pain
PubMed: 37535560
DOI: 10.1097/PHM.0000000000002318 -
Topics in Spinal Cord Injury... 2024The World Health Organization (WHO) recommends that infants be breastfed exclusively for the first 6 months of age. However, there are few resources available on the...
The World Health Organization (WHO) recommends that infants be breastfed exclusively for the first 6 months of age. However, there are few resources available on the effects a spinal cord injury (SCI) can have for breastfeeding mothers. It is difficult to find information to address the unique challenges women with SCI experience when planning or trying to breastfeed. Our international team, including women with SCI, health care providers, and SCI researchers, aims to address the information gap through the creation of this consumer guide. The purpose of this consumer guide is to share the most common issues women with SCI experience during breastfeeding and provide information, practical suggestions, recommendations, and key resources in lay language. General information about breastfeeding is available on the internet, in books, or from friends and health care providers. We do not intend to repeat nor replace general breastfeeding information or medical advice. Breastfeeding for mothers with SCI is complex and requires a team of health care providers with complementary expertise. Such a team may include family physician, obstetrician, physiatrist, neurologist, occupational and physical therapist, lactation consultant, midwife, and psychologist. We hope this consumer guide can serve as a quick reference guide for mothers with SCI planning of trying to breastfeed. This guide will also be helpful to health care providers as an educational tool.
Topics: Humans; Breast Feeding; Spinal Cord Injuries; Female; Mothers; Infant, Newborn; Infant
PubMed: 38799608
DOI: 10.46292/sci23-00080 -
Diagnostics (Basel, Switzerland) Jul 2023Metastasis to bone is a common occurrence among epithelial tumors, with a high incidence rate in the Western world. As a result, bone lesions are a significant burden on...
Magnetic Resonance Imaging Evaluation of Bone Metastases Treated with Radiotherapy in Palliative Intent: A Multicenter Prospective Study on Clinical and Instrumental Evaluation Assessment Concordance (MARTE Study).
Metastasis to bone is a common occurrence among epithelial tumors, with a high incidence rate in the Western world. As a result, bone lesions are a significant burden on the healthcare system, with a high morbidity index. These injuries are often symptomatic and can lead to functional limitations, which in turn cause reduced mobility in patients. Additionally, they can lead to secondary complications such as pathological fractures, spinal cord compression, hypercalcemia, or bone marrow suppression. The treatment of bone metastases requires collaboration between multiple healthcare professionals, including oncologists, orthopedists, neurosurgeons, physiatrists, and radiotherapists. The primary objective of this study is to evaluate the correlation between two methods used to assess local control. Specifically, the study aims to determine if a reduction in the volume of bone lesions corresponds to better symptomatic control in the clinical management of patients, and vice versa. To achieve this objective, the study evaluates morphological criteria by comparing pre- and post-radiotherapy treatment imaging using MRI and RECIST 1.1 criteria. MRI without contrast is the preferred diagnostic imaging method, due to its excellent tolerance by patients, the absence of exposure to ionizing radiation, and the avoidance of paramagnetic contrast media side effects. This imaging modality allows for accurate assessment of bone lesions. One of the secondary objectives of this study is to identify potentially useful parameters that can distinguish patients into two classes: "good" and "poor" responders to treatment, as reported by previous studies in the literature. These parameters can be evaluated from the imaging examinations by analyzing morphological changes and radiomic features on different sequences, such as T1, STIR (short tau inversion recovery), and DWI-MRI (diffusion-weighted).
PubMed: 37510078
DOI: 10.3390/diagnostics13142334 -
Children (Basel, Switzerland) Oct 2023The purpose of this study is to better understand the way caregivers of patients with Rett syndrome perceive the quality of the health care services they receive and...
BACKGROUND
The purpose of this study is to better understand the way caregivers of patients with Rett syndrome perceive the quality of the health care services they receive and identify its main shortcomings.
METHODS
A survey was distributed to all caregivers who are part of AIRETT (the Italian Association of Relatives of Patients with RS). The survey gathered information on the management of relatives of patients with Rett syndrome.
RESULTS
The data refers to 52 patients, all females, with a median age of 15 years at the time of the survey. Concerning RS specificity, our data confirm the high complexity of this chronic, multifaceted condition, mainly characterized by the presence of epilepsy, apnea, severe scoliosis, and gastrointestinal symptoms. The specialists more frequently involved in the care of patients were general practitioners or family pediatricians (98%) and neurologists (92%), and more rarely physiatrists (71%). Only 15% of patients were followed by a pulmonologist, despite the fact that respiratory problems were frequent (apneas were present in 81% of patients, and 2% had a tracheostomy). Although 63.5% of patients presented with gastrointestinal symptoms and 2% had a gastrostomy, only 33% were followed by a gastroenterologist. Moreover, although orthopedic issues were present in 78.8% of patients, including severe scoliosis in 22% of them, only 25% were followed by an orthopedist. Furthermore, despite the fact that RS patients are fragile, about one quarter of them were not vaccinated. As far as organizational issues are concerned, several specialized centers are located in various regions throughout the country. As a consequence, the high mobility rate from one center to another resulted in non-homogeneous assistance.
CONCLUSIONS
The study shows that caregivers of RS patients take over most obligations and burdens by increasing their perceived level of stress. For the majority of patients, the most frequent complications were not followed by the reference subspecialist, with the only exception of epilepsy. Moreover, improving vaccination strategies for these patients is necessary.
PubMed: 37892376
DOI: 10.3390/children10101713 -
Cureus Nov 2023Upper limb spasticity can be responsible for several complications (e.g., pain, spasms, contractures, deformity, decreased or lost motor control), which can have a...
INTRODUCTION
Upper limb spasticity can be responsible for several complications (e.g., pain, spasms, contractures, deformity, decreased or lost motor control), which can have a negative impact on functional independence and the quality of life of patients. Chemodenervation with botulinum toxin type A (BoNT-A) is a first-line treatment of focal spasticity in the upper limb (UL). However, shoulder muscles were not included in the classical pivotal BoNT-A studies, leaving a knowledge gap regarding the application of intra-muscular BoNT-A in the spasticity management of this anatomical area compared with the arm and forearm.
MATERIALS AND METHODS
We conducted a descriptive cross-sectional nationwide online survey of the current Portuguese clinical practices for BoNT-A injections treating shoulder spasticity. Data were collected regarding the patient's spasticity cause, shoulder muscles treated, BoNT-A doses, guidance methods used, primary goal domains, treatment effectiveness, adverse effects, and recommendation of adjuvant therapy.
RESULTS
A total of 33 physical medicine and rehabilitation physicians were surveyed. Most of the surveyed doctors (90.91%; n = 30) identified post-stroke spasticity as the major condition for the use of BoNT-A injections in their clinical practice. The most frequently injected muscles for patterns that included shoulder adduction and internal rotation were the pectoralis major (100%; n = 33), subscapularis (93.94%; n = 31), latissimus dorsi (54.55%; n = 18), and teres major (24.24%; n = 8). In patterns including shoulder extension, the posterior deltoid (75.76%; n = 25), the long head of the triceps brachii (66.67%; n = 22), and the latissimus dorsi (48.48%; n = 16) were the most frequently targeted muscles. The primary goals of treatments were improvements in passive function (96.97%; n = 32), pain (84.85%; n = 28), active function (45.45%; n = 15), and range of motion (39.39%; n = 13). The overall impression of therapeutic efficacy was "good" (60.61%; n = 20), and adverse drug reactions were considered "very rare" (84.85%; n = 28) and "mild" (93.94%; n = 31). Ultrasound was used "always" and "most times" in 66.67% (n = 22) of cases. The maximum BoNT-A doses per muscle were lower than those in previously reported studies. Conventional kinesiotherapy was "always" recommended as adjuvant therapy after BoNT-A by 66.67% (n = 22) of physiatrists.
CONCLUSIONS
This study provides the first nationwide Portuguese description of "real-life" clinical practices concerning the use of BoNT-A for shoulder spasticity. The selection of goal domains aligned with international results, and the targeted muscles were relatively similar. The use of ultrasound was high, and the maximum BoNT-A doses per muscle were lower than those in other reported clinical practices. The providers reviewed indicated high safety satisfaction with using BoNT-A for shoulder spasticity. Further development of clinical guidelines to standardize practices may be useful.
PubMed: 38073907
DOI: 10.7759/cureus.48493