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International Journal of Gynaecology... Mar 2024Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is... (Review)
Review
Postpartum femoral neuropathy has a reported incidence of less than 1% and its total recovery time extends up to 6 months to a year. A multidisciplinary approach is vital to rule out permanent disability and to assure a correct diagnosis and earlier rehabilitation. We report a case of a 37-year-old puerperal woman with a history of intrapartum epidural analgesia, who presented post-labor unilateral lower-limb motor weakness and sensory loss, with functional compromise on independent gait. A multidisciplinary team consisting of an anesthesiologist, a physiatrist, a neurologist, and an obstetrician was then established. In the initial physiatry and neurology assessment, the patient reported pain (numerical rating scale 7/10) over the inguinal ligament, lower limb hypoesthesia, and muscle weakness. Femoral neuropathy was suspected. Magnetic resonance imaging ruled out potential complications related to the anesthetic procedure. The patient was then enrolled in a supervised rehabilitation program and, 3 weeks later, electrodiagnostic studies confirmed the initial suspicion. Two months later, the patient had regained lower-limb active range of motion and no pain nor paresthesia was reported. Our case report describes how an early multimodal rehabilitation program within a multidisciplinary framework allows for sooner neuromotor function improvement and activities of daily living independence.
Topics: Pregnancy; Female; Humans; Adult; Femoral Neuropathy; Activities of Daily Living; Postpartum Period; Magnetic Resonance Imaging; Neurological Rehabilitation
PubMed: 37537869
DOI: 10.1002/ijgo.15025 -
Spinal Cord Series and Cases Jun 2024Women of childbearing age make up around 5-10% of individuals with spinal cord injury (SCI) and may face unique medical and functional complications during pregnancy,...
INTRODUCTION
Women of childbearing age make up around 5-10% of individuals with spinal cord injury (SCI) and may face unique medical and functional complications during pregnancy, including prolonged hospitalization and increased risk of early rehospitalization due to falls.
CASE PRESENTATION
Here, we discuss a case of a young ambulatory woman with a lumbar motor incomplete spinal cord injury who underwent successful delivery via cesarean section and the role of the physiatrist in the management of the patient's antepartum, intrapartum, and postpartum complications. The patient faced significant antepartum challenges secondary to her neurogenic bladder and pelvic floor weakness, resulting in increased use of her manual wheelchair. The physiatry team assisted with the co-development of a multidisciplinary bladder plan for increased urinary frequency and urinary tract infection prevention with the patient's obstetrics physician (OB). In addition, the physiatry team assisted with the procurement of a new wheelchair suited for the patient's pregnancy and childcare needs in anticipation of decreased mobility during this time. Regarding intrapartum challenges, the physiatry team worked with the patient and her OB to develop a safe birth plan considering the method of delivery, epidural usage, and the need for pelvic floor therapy before and after childbirth.
DISCUSSION
The patient had a successful cesarean section delivery, with return to independent mobility soon after childbirth. In summary, this case demonstrates that there is a need for a multidisciplinary approach to patients with SCI during pregnancy and that the role of physiatry is critical to optimizing medical and functional outcomes.
Topics: Humans; Female; Pregnancy; Spinal Cord Injuries; Pregnancy Complications; Adult; Cesarean Section; Lumbar Vertebrae; Physical and Rehabilitation Medicine; Urinary Bladder, Neurogenic; Delivery, Obstetric
PubMed: 38834538
DOI: 10.1038/s41394-024-00652-3 -
Physical condition and perceived fatigue in post-covid patients: An observational descriptive study.Sao Paulo Medical Journal = Revista... 2024Patients with severe coronavirus disease 2019 (COVID-19) often require hospital admission and experience sequelae such as chronic fatigue or low muscle mass. (Observational Study)
Observational Study
BACKGROUND
Patients with severe coronavirus disease 2019 (COVID-19) often require hospital admission and experience sequelae such as chronic fatigue or low muscle mass.
OBJECTIVE
To analyze the functional capacity of a cohort of patients with severe acute respiratory syndrome coronavirus 2 who required hospitalization.
DESIGN AND SETTING
An observational descriptive study was conducted on post-COVID-19 patients referred to the Rehabilitation Department of Gregorio Marañón Hospital (Madrid, SPAIN).
METHODS
Cardiorespiratory fitness, muscle strength, body composition, and perception of fatigue and dyspnea were analyzed. Furthermore, the existing correlations between clinical variables and physical conditions were analyzed.
RESULTS
Forty-two patients who required hospital admission (80 ± 22.45 days) or intensive care unit (ICU) admission (58 ± 10.52 days) were analyzed. They presented with decreased strength, respiratory capacity, and moderate-to-severe perceived fatigue. Additionally, an inverse correlation was found between right-handgrip strength and days in the ICU, as well as the 6-minute walk test for women. Similarly, strength and fitness were negatively associated with perceived fatigue.
CONCLUSIONS
Post-COVID-19 patients showed low muscle function and low levels of physical fitness associated with high perceived fatigue.
Topics: Female; Humans; Body Composition; Cardiorespiratory Fitness; COVID-19; Disease Progression; Hand Strength; Male
PubMed: 38477734
DOI: 10.1590/1516-3180.2023.0167.R1.04122023 -
American Journal of Physical Medicine &... Aug 2023The aim of this study was to examine the effect of adding weight shift training to a weight loss program on the risk of falling, fear of falling, overall stability,... (Randomized Controlled Trial)
Randomized Controlled Trial
OBJECTIVE
The aim of this study was to examine the effect of adding weight shift training to a weight loss program on the risk of falling, fear of falling, overall stability, anteroposterior stability, mediolateral stability, and isometric knee torque in young obese women.
DESIGN
A single-blinded, randomized controlled study was performed. Sixty women, 18 to 46 yrs old, were randomly assigned either to the study or the control group. The participants in the study group were given weight-shifting training plus a weight reduction program; the control group received only a weight-reduction program. The interventions were performed for 12 wks. At baseline and after 12 wks of training, the risk of falling, fear of falling, overall stability, anteroposterior stability, mediolateral stability, and isometric knee torque were all examined.
RESULTS
There were statistically significant differences in risk of falling, fear of falling, isometric knee torque, and overall, anteroposterior, and mediolateral stability indices, in favor of the study group, after 3 mos of training ( P < 0.001).
CONCLUSIONS
Weight shift training combined with weight reduction was more beneficial than weight reduction alone in decreasing the risk of falling and fear of falling and improving isometric knee torque and overall, anteroposterior, and mediolateral stability indices. It could be used for treating balance problems and weakness around the knee joint in obese women.
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) Determine the impact of weight shift training on risk of falling and postural stability in obese women; (2) Identify the effect of weight shift training on fear of falling in adult women with obesity; and (3) Verify the additive effect of weight shift training to weight reduction program vs. weight reduction program alone on muscle strength in young obese women.
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; Female; Prospective Studies; Fear; Lower Extremity; Weight Loss
PubMed: 36882303
DOI: 10.1097/PHM.0000000000002224 -
PM & R : the Journal of Injury,... Dec 2023Feedback and evaluation are important in the professional development of academic physiatrists. Yet, physical medicine and rehabilitation (PM&R) learners giving academic...
BACKGROUND
Feedback and evaluation are important in the professional development of academic physiatrists. Yet, physical medicine and rehabilitation (PM&R) learners giving academic presentations receive limited narrative feedback through generic evaluation forms.
OBJECTIVE
To assess whether customizable evaluation forms that integrate a presenter's specific questions would be associated with an increase in quantity and quality of narrative feedback received from the audience.
DESIGN
Separate samples pre-post intervention study.
SETTING
A large academic PM&R department's grand rounds.
PARTICIPANTS
PM&R faculty and trainees attending grand rounds (10-50 attendees with one presenter per session). The study included 20 presentations pre intervention (across 1 year) and 38 presentations post intervention (across about 3 years).
INTERVENTION
A customizable evaluation form that integrates a presenter's own questions into a tailored evaluation form comprising both standardized and presenter-built questions.
MAIN OUTCOME MEASURE(S)
Narrative feedback quantity was defined as the mean percentage and number of evaluation forms per presentation with at least one comment. Narrative feedback quality included three metrics: mean percentage and number of evaluation forms per presentation with comments that (1) contained ≥8 words, (2) referenced something specific, and (3) offered an actionable suggestion.
RESULTS
Compared to preintervention, presentations in the postintervention period had a greater mean percentage of evaluation forms containing at least one comment (pre = 33.4%, post =74.7%, p < .001), a comment that contained ≥8 words (pre = 20.2%, post = 44.2%, p < .001), a comment that referenced something specific (pre = 19.6%, post = 55.1%, p < .001), and a comment that offered an actionable suggestion (pre = 10.2%, post = 22.2%, p < .001).
CONCLUSIONS
Use of a customizable evaluation form in PM&R grand rounds that integrates a presenter's own questions was associated with a greater mean percentage of evaluation forms containing comments as well as comments meeting quality metrics related to length, specificity, and actionability.
Topics: Humans; Teaching Rounds; Feedback; Medicine; Physical and Rehabilitation Medicine
PubMed: 37366308
DOI: 10.1002/pmrj.12989 -
American Journal of Physical Medicine &... Aug 2023Stigmatizing language can negatively influence providers' attitudes and care toward patients, but this has not been studied among physiatrists. An online survey was... (Randomized Controlled Trial)
Randomized Controlled Trial
Stigmatizing language can negatively influence providers' attitudes and care toward patients, but this has not been studied among physiatrists. An online survey was created to assess whether stigmatizing language can impact physical medicine and rehabilitation trainees' attitudes toward patients. We hypothesized stigmatizing language would negatively impact trainees' attitudes. Participants were randomized to a stigmatizing or neutral language vignette describing the same hypothetical spinal cord injury patient. Questions were asked about attitudes and assumptions toward the patient, pain management based on the vignette, and general views regarding individuals with disabilities. Between August 2021 and January 2022, 75 US physical medicine and rehabilitation residency trainees participated. Thirty-seven (49.3%) identified as women; 52 (69.3%) were White, and half (50.6%) received the stigmatized vignette. Participants exposed to stigmatizing language scored 4.8 points lower ( P < 0.01) on the provider attitude toward patient scale compared with those exposed to neutral language. There were no significant differences in the disability attitude scores between the two groups ( P = 0.81). These findings may indicate that stigmatizing language in the medical record may negatively affect physical medicine and rehabilitation trainees' attitudes toward patients. Further exploration is needed to identify the best way to educate trainees and reduce the propagation of bias in the medical record.
Topics: Humans; Female; Attitude; Medicine; Surveys and Questionnaires; Physical and Rehabilitation Medicine; Medical Records; Attitude of Health Personnel
PubMed: 36757856
DOI: 10.1097/PHM.0000000000002186 -
Rehabilitacion 2024To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical...
INTRODUCTION
To assess whether, in patients with distal radius fracture feedback-guided exercises performed on a tablet touchscreen reduce healthcare usage and improve clinical recovery, more than the conventional home exercise program prescribed on paper.
MATERIAL AND METHODS
A multicentre, parallel, two-group, pragmatic, controlled trial with assessor blinding and intention-to-treat analysis. Forty-six patients with distal radius fracture were recruited in Andalusian Public Health System. Participants in the experimental and control groups received the same in-patient physiotherapy sessions. Experimental group received a home exercise program using the ReHand tablet application and control group received an evidence-based home exercise program on paper. The primary outcome was the number of physiotherapy sessions tallied from hospitals data management system. Secondary outcomes included: the face-to-face rehabilitation consultations with a physiatrist, and clinical outcomes such as functional ability, grip strength, dexterity, pain intensity and range of motion.
RESULTS
The experimental group required fewer physiotherapy sessions (MD: -16.94; 95%CI: -32.5 to -1.38) and rehabilitation consultations (MD: -1.7; 95%CI: -3.39 to -0.02) compared to the control group.
CONCLUSIONS
In patients with distal radius fracture, prescribing feedback-guided exercises performed on a tablet touchscreen provided by ReHand reduced number of physiotherapy sessions and rehabilitation consultations.
Topics: Humans; Wrist Fractures; Telerehabilitation; Exercise Therapy; Physical Therapy Modalities; Hand Strength
PubMed: 37890425
DOI: 10.1016/j.rh.2023.100818 -
Clinical Imaging Oct 2023Evaluate physicians who treat musculoskeletal (MSK) disorders in their knowledge of image-guided MSK interventions, and identify areas that could benefit from education.
PURPOSE
Evaluate physicians who treat musculoskeletal (MSK) disorders in their knowledge of image-guided MSK interventions, and identify areas that could benefit from education.
MATERIALS AND METHODS
A 17-question survey was distributed to orthopaedic surgeons, physiatrists, and rheumatologists in the 14-hospital health system. It inquired about demographics, practice environment, awareness of interventional radiology (IR) and MSK radiology (MSKR) training, referral patterns, and knowledge of image-guided MSK interventions.
RESULTS
In total, 59 of 303 physicians completed the survey (41% orthopaedists, 35% physiatrists, and 24% rheumatologists). Most (93%) were attendings and 41% were female. A minority of survey respondents (17%) recognized the designation of IR as a distinct specialty of medicine per the American Board of Medical Specialties, in contrast to MSKR, which is not designated as a distinct specialty. When queried about IR procedures not under investigation, 24% selected genicular artery embolization and 31% selected embolization for adhesive capsulitis. Barriers to referral were as follows: 21% of specialists performed the procedure, 17% listed electronic medical record challenges, 14% reported scheduling difficulty, 13% reported no barriers, 11% reported difficulty consulting, 11% referred to another specialty, 10% did not have enough knowledge of image guided procedures, and 3% reported the procedure is not performed by IR or MSKR.
CONCLUSIONS
Survey data reveal a knowledge gap among surveyed physicians regarding IR as a specialty as well as areas of IR research in MSK disorders. Findings suggest areas where referring physicians can be educated and identify barriers to referral.
Topics: Female; Humans; Male; Musculoskeletal Diseases; Orthopedic Surgeons; Physiatrists; Physicians; Radiology, Interventional; Rheumatologists; United States
PubMed: 37473557
DOI: 10.1016/j.clinimag.2023.06.017 -
Spinal Cord Oct 2023A retrospective longitudinal cohort time-series analysis study.
STUDY DESIGN
A retrospective longitudinal cohort time-series analysis study.
OBJECTIVES
To examine healthcare utilization and delivery during the COVID-19 pandemic in individuals with spinal cord injury/dysfunction (SCI/D).
SETTING
Health administrative database in Ontario, Canada.
METHODS
In 5754 individuals with SCI/D diagnosed from 2004-2014 and living in the community, healthcare utilization (physician visits, primary care visits, specialist visits, urologist visits, physiatrist visits, emergency department (ED) visits, and hospital admissions) and delivery (total, in-person, virtual) were determined at the (1) pre-pandemic period (March 2015 to February 2020), (2) initial pandemic onset period (March 2020-May 2020), and (3) pandemic period (June 2020 to March 2022). Autoregressive integrated moving average (ARIMA) modelling was conducted to determine the impact of the pandemic on monthly healthcare utilization and delivery.
RESULTS
The initial pandemic onset period had a significant reduction of 24% in physicians (p = 0.0081), 35% in specialists (p < 0.0001), and 30% in urologist (p < 0.0001) visits, compared to pre-pandemic levels, with a partial recovery as the pandemic progressed. In April 2020, compared to the pre-pandemic period, a significant increase (p < 0.0001) in virtual visits for physicians, specialists, urologists, and primary care was found. The initial pandemic onset period had a 58% decrease in hospital admissions (p = 0.0011), compared to the pre-pandemic period.
CONCLUSION
Healthcare utilization dropped in the initial pandemic onset period as physicians, specialists, and urologists, as well as hospitalization visits decreased significantly (p < 0.05) versus pre-pandemic levels. Virtual visit increases compensated for in-person visit decreases as the pandemic progressed to allow for total visits to partially recover.
Topics: Humans; Pandemics; Retrospective Studies; COVID-19; Spinal Cord Injuries; Patient Acceptance of Health Care; Ontario; Emergency Service, Hospital
PubMed: 37660208
DOI: 10.1038/s41393-023-00930-1 -
Hand (New York, N.Y.) Aug 2023There is increased interest in ultrasound (US) for the diagnosis of cubital tunnel syndrome (CuTS). We hypothesize that ulnar nerve cross-sectional area (CSA) correlates...
BACKGROUND
There is increased interest in ultrasound (US) for the diagnosis of cubital tunnel syndrome (CuTS). We hypothesize that ulnar nerve cross-sectional area (CSA) correlates with disease severity and electrodiagnostic studies (EDX).
METHODS
ARetrospective review was performed at a tertiary medical center. One hundred seventeen patients (166 ulnar nerves) were evaluated. Maximum CSA at 3 points around the elbow (proximal, groove, and distal) and EDX results (American Board of Electrodiagnostic Medicine-certified physiatrist's interpretations) were collected.
RESULTS
US was positive (CSA > 0.1 cm) in 95/117 cases (81.20%) versus 84/117 (71.79%) positive for EDX. CuTS patients treated surgically had significantly greater (0.13 cm, standard deviation [SD] 0.038) preoperative CSA than non-operative patients (0.10 cm, SD 0.033) ( = .003). CSA increased as EDX increased in severity; mild (0.116 cm, SD 0.031), moderate (0.121 cm, SD 0.035), and severe (0.163 cm, SD 0.047) with a significant difference between the mild and severe groups ( = .001) and between the moderate and severe groups ( = .01). Significant differences were seen between patients with positive US and EDX studies compared to those with negative US and EDX in the average physical function scores (57.26, SD 8.57 versus 43.18, SD 7.70; < .001); average sleep scores (50.14, SD 9.53 versus 56.62, SD 7.31; = .02); average physical function scores (43.04, SD 8.68 versus 57.08, SD 6.34; < .001) and average depression scores (49.10, SD 10.88 versus 45.043, SD 7.06; = .02).
CONCLUSIONS
US is a reliable tool for diagnosis and surgical decision-making for CuTS.
TYPE OF STUDY/LEVEL OF EVIDENCE
Diagnostic/III.
PubMed: 37533402
DOI: 10.1177/15589447231187081