-
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 -
Cureus Oct 2023Background Patients staying in acute rehabilitation often use large amounts of opioids during their stay. There are a number of reasons for this increased opioid...
Background Patients staying in acute rehabilitation often use large amounts of opioids during their stay. There are a number of reasons for this increased opioid exposure, including but not limited to daily exercises with physical and occupational therapists, increased demand on a healing body, and use of previously atrophying musculature. Some physiatrists have noticed that patients who concurrently are prescribed medications such as Robaxin seem to require fewer opioids during their stay in acute rehabilitation. This study aimed to determine the association between non-opioid analgesic use and total opioid load, as measured using morphine milligram equivalents (MMEs), during inpatient rehabilitation for traumatic brain injury. Methodology A retrospective study of individuals with a diagnosis of traumatic brain injury admitted to an acute inpatient rehabilitation program was performed. Non-opioid medications that were reviewed in the study included acetaminophen, amitriptyline, baclofen, diclofenac, gabapentin, ibuprofen, lidocaine, methocarbamol, nortriptyline, and pregabalin. Five of the most-used non-opioid medications (acetaminophen, diclofenac, gabapentin, lidocaine, and methocarbamol) were statistically analyzed using regression and analysis of variance to evaluate for any significant variables. Results Results showed that the average daily dose of acetaminophen has a significant effect on the average daily MME and that the average daily dose of gabapentin and methocarbamol each have a significant effect on the change of daily MME usage from admission to discharge from acute rehab (ΔMME). Results also showed that the mere presence of methocarbamol (regardless of daily or total dosage) had a significant effect on the ΔMME. Conclusions Based on these findings, physicians may want to consider prescribing acetaminophen, gabapentin, or methocarbamol for patients admitted for inpatient rehabilitation following traumatic brain injury who require high amounts of opioids.
PubMed: 37954704
DOI: 10.7759/cureus.46872 -
Children (Basel, Switzerland) Sep 2023The COVID-19 pandemic has caused unprecedented challenges in the care of children with cerebral palsy (CP) and other neuromuscular complex chronic conditions (NCCCs)....
The COVID-19 pandemic has caused unprecedented challenges in the care of children with cerebral palsy (CP) and other neuromuscular complex chronic conditions (NCCCs). The purpose of this study is to explore the direct impact of the COVID-19 pandemic on healthcare delivery. From May to August 2020, medical professionals caring for CP and NCCC patients across multiple countries and disciplines completed a self-administered cross-sectional survey comparing practices before and during the COVID-19 pandemic. Of the 79 healthcare workers from eight countries who participated-predominantly pediatric orthopedic surgeons (32%), pediatricians (30%), and pediatric physiatrists (23%)-most of them felt that caring for NCCC patients during the pandemic presented unique difficulties, and they reported a significant decrease in the in-person NCCC clinic volume ( < 0.001), multidisciplinary appointments ( < 0.001), surgical cases ( = 0.008), and botulinum toxin/phenol injections. Most providers affirmed that institutional guidelines for perioperative emergent/urgent and elective procedures, workplace settings, and technology were modified to accommodate the ongoing public health crisis. The usage of telemedicine significantly increased for NCCC patient visits ( < 0.001). During the COVID-19 pandemic, many children with NCCCs lost access to routine, multidisciplinary care. Telemedicine became an integral part of communication and management. In the setting of the COVID-19 pandemic and with the threat of future healthcare disruptions, these data lay the foundation for trending the evolution of healthcare delivery and accelerating best practice guidelines for children with CP and NCCCs.
PubMed: 37761516
DOI: 10.3390/children10091555 -
BMC Public Health Jan 2024Low back pain (LBP) is a prevalent musculoskeletal disorder with a wide range of etiologies, ranging from self-limiting conditions to life-threatening diseases. Various...
INTRODUCTION
Low back pain (LBP) is a prevalent musculoskeletal disorder with a wide range of etiologies, ranging from self-limiting conditions to life-threatening diseases. Various modalities are available for the diagnosis and management of patients with LBP. However, many of these health services, known as low-value care (LVC), are unnecessary and impose undue financial costs on patients and health systems. The present study aimed to explore the perceptions of service providers regarding the facilitators and barriers to reducing LVC in the management of LBP in Iran.
METHODS
This qualitative descriptive study interviewed a total of 20 participants, including neurosurgeons, physiatrists, orthopedists, and physiotherapists, who were selected through purposive and snowball sampling strategies. The collected data were analyzed using the thematic content analysis approach.
RESULTS
Thirty-nine sub-themes, with 183 citations, were identified as barriers, and 31 sub-themes, with 120 citations, were defined as facilitators. Facilitators and barriers to reducing LVC for LBP, according to the interviewees, were categorized into five themes, including: (1) individual provider characteristics; (2) individual patient characteristics; (3) social context; (4) organizational context; and (5) economic and political context. The ten most commonly cited barriers included unrealistic tariffs, provider-induced demand, patient distrust, insufficient time allocation, a lack of insurance coverage, a lack of a comprehensive referral system, a lack of teamwork, cultural challenges, a lack of awareness, and defensive medicine. Barriers such as adherence to clinical guidelines, improving the referral system, improving the cultural status of patients, and facilitators such as strengthening teamwork, developing an appropriate provider-patient relationship, improving the cultural status of the public, motivating the patients, considering an individualized approach, establishing a desirable payment mechanism, and raising the medical tariffs were most repeatedly stated by participants.
CONCLUSION
This study has pointed out a great number of barriers and facilitators that shape the provision of LVC in the management of LBP in Iran. Therefore, it is essential for relevant stakeholders to consider these findings in order to de-implement LVC interventions in the process of LBP management.
Topics: Humans; Low Back Pain; Iran; Low-Value Care; Qualitative Research; Health Services Accessibility
PubMed: 38233835
DOI: 10.1186/s12889-023-17597-1 -
Reumatismo Mar 2024Melorheostosis is a rare, non-hereditary, benign bone disease characterized by abnormal bone growth. Generally, melorheostosis develops during childhood or adolescence... (Review)
Review
OBJECTIVE
Melorheostosis is a rare, non-hereditary, benign bone disease characterized by abnormal bone growth. Generally, melorheostosis develops during childhood or adolescence and progresses gradually over time. This disease represents a true challenge to the physician because of its variability due to location, extension of the affected bone, and involvement of associated soft tissue. Pain management, physical therapy, and surgery may be recommended, depending on the individual case. This review aims to get an overview of the latest evidence relating to epidemiology, clinical and radiographic characteristics, diagnosis, and possible therapeutic strategies for melorheostosis and describe our experience through a clinical case.
METHODS
We designed a comprehensive literature search on melorheostosis in MEDLINE (via Pubmed) up to April 2023 and reviewed reports published in international journals.
RESULTS
The purpose is to highlight the importance of a multidisciplinary approach in the management of a rare disease such as melorheostosis. We discuss the role of different physicians, including genetists, rheumatologists, physiatrists, physical therapists, and orthopedic surgeons, in providing accurate diagnoses and effective treatments. We conducted a comprehensive review of the literature on the treatment of melorheostosis to support these findings. In addition, the article presents a case study of a patient suffering from melorheostosis, focusing on difficulties in reaching a correct diagnosis and attempts towards conservative and surgical interventions. The patient underwent hip arthroplasty, and the final result was an improvement in function and a reduction in pain.
CONCLUSIONS
Managing melorheostosis can be challenging, and there is no standardized treatment for this condition at the moment.
Topics: Adolescent; Humans; Melorheostosis; Pain; Pain Management; Treatment Outcome; Rare Diseases
PubMed: 38523583
DOI: 10.4081/reumatismo.2024.1621 -
Frontiers in Neurology 2023Survivors of traumatic brain injury are at increased risk for firearm-related injuries, including suicide.
BACKGROUND
Survivors of traumatic brain injury are at increased risk for firearm-related injuries, including suicide.
AIMS
To determine current practices of Brain Injury Medicine (BIM) physicians and their rehabilitation teams in assessing patients' access to firearms and in providing firearm safety education, and the impact of having received training on this topic on physicians' likelihood of inquiring about patients' access to firearms.
METHODS
14-item web-based cross-sectional survey of 86 U.S. physiatrists board-certified in BIM.
RESULTS
81% of respondents indicated they believe BIM physicians should counsel their patients on firearm safety but only 12.9% reported always doing so. Fifteen percent reported always inquiring about their patients' access to firearms. 88.2% indicated having never received formal training on firearm injury prevention counseling. Physicians who received such training had 7.5 times higher odds of reporting at least sometimes inquiring about patients' access to firearms than those who were not trained [95% confidence interval (1.94, 28.64)]. They also had 5.7 times higher odds for reporting being at least moderately comfortable providing patients firearm safety counseling [95% CI: (1.39, 23.22)].
CONCLUSION
While most BIM specialists who responded to this survey believe they should counsel patients on firearm safety, few always or usually do so. Moreover, most do not routinely inquire about their patients' access to firearms. The provision of firearm injury prevention training to BIM physicians was strongly associated with an increased likelihood they will inquire about their patients' access to guns and with an improved comfort level in providing counseling on this subject matter.
PubMed: 37693749
DOI: 10.3389/fneur.2023.1237095 -
Journal of Yeungnam Medical Science Apr 2024Physiatrists are facing with survivors from disasters in both the acute and chronic phases of muscle and nerve injuries. Similar to many other clinical conditions,...
BACKGROUND
Physiatrists are facing with survivors from disasters in both the acute and chronic phases of muscle and nerve injuries. Similar to many other clinical conditions, neuromusculoskeletal ultrasound can play a key role in the management of such cases (with various muscle/nerve injuries) as well. Accordingly, in this article, a recent single-center experience after the Turkey-Syria earthquake will be rendered.
METHODS
Ultrasound examinations were performed for various nerve/muscle lesions in 52 earthquake victims referred from different cities. Demographic features, type of injuries, and applied treatment procedures as well as detailed ultrasonographic findings are illustrated.
RESULTS
Of the 52 patients, 19 had incomplete peripheral nerve lesions of the brachial plexus (n=4), lumbosacral plexus (n=1), and upper and lower limbs (n=14).
CONCLUSION
The ultrasonographic approach during disaster relief is paramount as regards subacute and chronic phases of rehabilitation. Considering technological advances (e.g., portable machines), the use of on-site ultrasound examination in the (very) early phases of disaster response also needs to be on the agenda of medical personnel.
PubMed: 38576339
DOI: 10.12701/jyms.2024.00087 -
Indian Pediatrics Jan 2024Neurodevelopmental disorders, as per DSM-V, are described as a group of conditions with onset in the development period of childhood. There is a need to distinguish the...
Consensus Statement of the IAP - Neurodevelopmental Chapter On Neurodevelopmental Disorders Habilitation Process: Strategic Plan for Prevention, Early Detection and Early Intervention.
JUSTIFICATION
Neurodevelopmental disorders, as per DSM-V, are described as a group of conditions with onset in the development period of childhood. There is a need to distinguish the process of habilitation and rehabilitation, especially in a developing country like India, and define the roles of all stakeholders to reduce the burden of neurodevelopmental disorders.
PROCESS
Subject experts and members of Indian Academy of Pediatrics (IAP) Chapter of Neurodevelopmental Pediatrics, who reviewed the literature on the topic, developed key questions and prepared the first draft on guidelines. The guidelines were then discussed by the whole group through online meetings, and the contentious issues were discussed until a general consensus was arrived at. Following this, the final guidelines were drafted by the writing group and approved by all contributors.
OBJECTIVES
These guidelines aim to provide practical clinical guidelines for pediatricians on the prevention, early diagnosis and management of neurodevelopmental disorders (NDDs) in the Indian settings. It also defines the roles of developmental pediatricians and development nurse counselor.
STATEMENT
There is a need for nationwide studies with representative sampling on epidemiology of babies with early NDD in the first 1000 days in India. Specific learning disability (SLD) has been documented as the most common NDD after 6 years in India, and special efforts should be made to establish the epidemiology of infants and toddlers at risk for SLD, where ever measures are available. Preconception counseling as part of focusing on first 1000 days; Promoting efforts to organize systematic training programs in Newborn Resuscitation Program (NRP); Lactation management; Developmental follow-up and Early stimulation for SNCU/ NICU graduates; Risk stratification of NICU graduates, Newborn Screening; Counseling parents; Screening for developmental delay by trained professionals using simple validated Indian screening tools at 4, 8, 12, 18 and 24 months; Holistic assessment of 10 NDDs at child developmental clinics (CDCs) / district early intervention centre (DEICs) by multidisciplinary team members; Confirmation of diagnosis by developmental pediatrician/developmental neurologist/child psychiatrist using clinical/diagnostic tools; Providing parent guided low intensity multimodal therapies before 3 years age as a center-based or home-based or community-based rehabilitation; Developmental pediatrician to seek guidance of pediatric neurologist, geneticist, child psychiatrist, physiatrist, and other specialists, when necessary; and Need to promote ongoing academic programs in clinical child development for capacity building of community based therapies, are the chief recommendations.
Topics: Child; Humans; Infant; Infant, Newborn; Academies and Institutes; Early Diagnosis; India; Neurodevelopmental Disorders
PubMed: 38183246
DOI: No ID Found -
Annals of Biomedical Engineering Mar 2024Artificial intelligence (AI) has been driving the continuous development of the Physical Medicine and Rehabilitation (PM&R) fields. The latest release of ChatGPT/GPT-4...
Artificial intelligence (AI) has been driving the continuous development of the Physical Medicine and Rehabilitation (PM&R) fields. The latest release of ChatGPT/GPT-4 has shown us that AI can potentially transform the healthcare industry. In this study, we propose various ways in which ChatGPT/GPT-4 can display its talents in the field of PM&R in future. ChatGPT/GPT-4 is an essential tool for Physiatrists in the new era.
Topics: Artificial Intelligence; Physical and Rehabilitation Medicine; Physical Examination
PubMed: 37500980
DOI: 10.1007/s10439-023-03314-x -
Archives of Physical Medicine and... Nov 2023To analyze the changes over time in the strain on the inferior iliofemoral (IIF) ligament when a constant high-force long-axis distraction mobilization (LADM) was...
OBJECTIVE
To analyze the changes over time in the strain on the inferior iliofemoral (IIF) ligament when a constant high-force long-axis distraction mobilization (LADM) was applied over 5 minutes.
DESIGN
A cross-sectional laboratory cadaveric study.
SETTING
Anatomy laboratory.
PARTICIPANTS
Thirteen hip joints from 9 fresh-frozen cadavers (mean age, 75.6±7.8 years; N=13).
INTERVENTIONS
High-force LADM in open-packed position was sustained for a period of 5 minutes.
MAIN OUTCOME MEASURE(S)
Strain on IFF ligament was measured over time with a microminiature differential variable reluctance transducer. Strain measurements were taken at every 15 seconds for the first 3 minutes and every 30 seconds for the next 2 minutes.
RESULTS
Major changes in strain occurred in the first minute of high-force LADM application. The greatest increase in strain on the IFF ligament occurred at the first 15 seconds (7.3±7.2%). At 30 seconds, the increase in strain was 10.1±9.6%, the half of the total increase at the end of the 5-minute high-force LADM (20.2±8.5%). Significant changes in strain measures were shown to occur at 45 seconds of high-force LADM (F=18.11; P<.001).
CONCLUSIONS
When a 5-minute high-force LADM was applied, the major changes in the strain on IIF ligament occurred in the first minute of the mobilization. A high-force LADM mobilization should be sustained at least 45 seconds to produce a significant change in the strain of capsular-ligament tissue.
Topics: Humans; Aged; Aged, 80 and over; Cross-Sectional Studies; Hip Joint; Ligaments; Cadaver; Biomechanical Phenomena
PubMed: 37040862
DOI: 10.1016/j.apmr.2023.03.022