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Current Physical Medicine and... 2022The aim of this paper is to explore current trends and advancements that lead to improved practitioner knowledge and patient care resulting in better outcomes. It is... (Review)
Review
PURPOSE OF REVIEW
The aim of this paper is to explore current trends and advancements that lead to improved practitioner knowledge and patient care resulting in better outcomes. It is common for the physiatrist to lead the team of interprofessional practitioners in the care of individuals with upper limb absence. The focus of the care is to understand and access prosthetic options, but there are often other health factors and relevant issues to consider.
RECENT FINDINGS
Some of the latest updates offer solutions to pain management, prosthetic control, access to relevant evidence, and outcomes-related data. An interesting finding was the influence of telehealth service delivery on multiple issues faced by this population. These issues include lack of information, pain management, monitoring skin breakdown and peripheral vascular disease, prosthetic training, and access to peers and specialized practitioners.
SUMMARY
The diverse technology advancements in surgical techniques, materials, outcome measures, and data management, as well as telehealth, work together to assist the collaborative interprofessional team to provide contemporary and comprehensive care to this unique population.
PubMed: 35342660
DOI: 10.1007/s40141-022-00342-x -
Health Economics Review Dec 2022Since the enactment of the long-term care insurance (LTCI) act in 2000, the number of LTCI users has increased annually. However, evidence regarding what is being... (Review)
Review
PURPOSE
Since the enactment of the long-term care insurance (LTCI) act in 2000, the number of LTCI users has increased annually. However, evidence regarding what is being carried out as rehabilitation treatment under LTCI is lacking. In this study, a scoping review was performed to bridge this knowledge gap.
METHODS
Articles related to rehabilitation in connection with LTCI published between April 2000 and November 2020 were searched for in PubMed, CINAHL, CENTRAL (Cochrane Central Register of Controlled Trials), Ichushi Web Ver.5, and CiNii and randomized controlled trials (RCTs) of rehabilitation provided under LTCI were examined.
RESULTS
Of the 15,572 publications identified, 15 RCTs, including rehabilitation treatment by physiatrists and therapists, met the eligibility criteria of our review and were included. The rehabilitation trials in the 15 RCTs varied and included balance training, exercise therapy, cognitive tasks, and activities such as singing and dancing. The results allowed us to focus on three categories: fall prevention, dementia, and theory and tools interventions related to occupational therapy practice.
CONCLUSION
The focal points of attention in the rehabilitation treatment of LTCI were identified. However, the physical function, quality of life, and activities of daily living (ADL) of those who "need support" vary from person to person. Therefore, the consolidation of evidence on rehabilitation treatment of LTCI must be continued.
PubMed: 36450881
DOI: 10.1186/s13561-022-00407-6 -
Frontiers in Neurology 2021Pompe disease, also denoted as acid maltase or acid α-glucosidase deficiency or glycogen storage disease type II, is a rare, autosomal recessive lysosomal storage... (Review)
Review
Pompe disease, also denoted as acid maltase or acid α-glucosidase deficiency or glycogen storage disease type II, is a rare, autosomal recessive lysosomal storage disorder. Several reports have previously described Pompe disease in Iran and considering increased awareness of related subspecialties and physicians, the disease's diagnosis is growing. This guideline's main objective was to develop a national guideline for Pompe disease based on national and international evidence adapting with national necessities. A group of expert clinicians with particular interests and experience in diagnosing and managing Pompe disease participated in developing this guideline. This group included adult neurologists, pediatric neurologists, pulmonologists, endocrinologists, cardiologists, pathologists, and physiatrists. After developing search terms, four authors performed an extensive literature review, including Embase, PubMed, and Google Scholar, from 1932 to current publications before the main meeting. Before the main consensus session, each panel member prepared an initial draft according to pertinent data in diagnosis and management and was presented in the panel discussion. Primary algorithms for the diagnosis and management of patients were prepared in the panel discussion. The prepared consensus was finalized after agreement and concordance between the panel members. Herein, we attempted to develop a consensus based on Iran's local requirements. The authors hope that disseminating these consensuses will help healthcare professionals in Iran achieve the diagnosis, suitable treatment, and better follow-up of patients with infantile-onset Pompe disease and late-onset Pompe disease.
PubMed: 34621239
DOI: 10.3389/fneur.2021.739931 -
Future Science OA Oct 2021Knee osteoarthritis is a common disabling disorder, with no curative treatment. This study aims to assess autologous conditioned serum effectiveness in its treatment. (Review)
Review
AIM
Knee osteoarthritis is a common disabling disorder, with no curative treatment. This study aims to assess autologous conditioned serum effectiveness in its treatment.
MATERIALS & METHODS
Following a systematic search (2000-2020) on major databases and screening and filtering processes, eight articles were included in the final analyses. The pooled effect of visual analog scale (VAS) and the Western Ontario and McMaster Universities (WOMAC) variables was evaluated before and after the intervention.
RESULTS
The combined standardized mean difference for the global WOMAC score was -2.44 and the combined weighted mean difference was -22.92. The combined standardized mean difference for the VAS score was -3.77 and the combined weighted mean difference was -32.37 (p < 0.000).
CONCLUSION
This meta-analysis reported that the autologous conditioned serum can reduce pain and improve function (VAS and WOMAC outcome measures) in patients with knee osteoarthritis.
PubMed: 34737891
DOI: 10.2144/fsoa-2021-0069 -
Musculoskeletal Surgery Dec 2022The exact nature of sex and gender differences in knee osteoarthritis (OA) among patient candidates for total knee arthroplasty (TKA) remains unclear and requires better...
PURPOSE
The exact nature of sex and gender differences in knee osteoarthritis (OA) among patient candidates for total knee arthroplasty (TKA) remains unclear and requires better elucidation to guide clinical practice. The purpose of this investigation was to survey physician practices and perceptions about the influence of sex and gender on knee OA presentation, care, and outcomes after TKA.
METHODS
The survey questions were elaborated by a multidisciplinary scientific board composed of 1 pain specialist, 4 orthopedic specialists, 2 physiatrists, and 1 expert in gender medicine. The survey included 5 demographic questions and 20 topic questions. Eligible physician respondents were those who treat patients during all phases of care (pain specialists, orthopedic specialists, and physiatrists). All survey responses were anonymized and handled via remote dispersed geographic participation.
RESULTS
Fifty-six physicians (71% male) accepted the invitation to complete the survey. In general, healthcare professionals expressed that women presented worse symptomology, higher pain intensity, and lower pain tolerance and necessitated a different pharmacological approach compared to men. Pain and orthopedic specialists were more likely to indicate sex and gender differences in knee OA than physiatrists. Physicians expressed that the absence of sex and gender-specific instruments and indications is an important limitation on available studies.
CONCLUSIONS
Healthcare professionals perceive multiple sex and gender-related differences in patients with knee OA, especially in the pre- and perioperative phases of TKA. Sex and gender bias sensitivity training for physicians can potentially improve the objectivity of care for knee OA among TKA candidates.
Topics: Female; Humans; Male; Osteoarthritis, Knee; Sexism; Arthroplasty, Replacement, Knee; Pain Measurement; Pain
PubMed: 34363604
DOI: 10.1007/s12306-021-00725-8 -
Journal of Clinical Medicine Mar 2023To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and... (Review)
Review
To review the available data on non-surgical management for neurogenic lower urinary tract dysfunction (NLUTD) in patients with chronic spinal cord injury (SCI) and provide the most updated knowledge for readers. We categorized the bladder management approaches into storage and voiding dysfunction separately; both are minimally invasive, safe, and efficacious procedures. The main goals for NLUTD management are to achieve urinary continence; improve quality of life; prevent urinary tract infections and, last but not least, preserve upper urinary tract function. Annual renal sonography workups and regular video urodynamics examinations are crucial for early detection and further urological management. Despite the extensive data on NLUTD, there are still relatively few novel publications and there is a lack of high-quality evidence. There is a paucity of new minimally invasive and prolonged efficacy treatments for NLUTD, and a partnership between urologists, nephrologists and physiatrists is required to promote and ensure the health of SCI patients in the future.
PubMed: 36902808
DOI: 10.3390/jcm12052021 -
Materia Socio-medica Mar 2022Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment of this chronic pain syndrome and results are often not clear. Tricyclic...
BACKGROUND
Postherpetic neuralgia (PHN) is a frequent complication of herpes zoster (HZ). Treatment of this chronic pain syndrome and results are often not clear. Tricyclic antidepressants, gabapentinoids and potent opioids are first-line treatments and are highly effective, but their use is limited due to adverse effects that may occur in elderly patients with significant medical comorbidities or interaction due to multiple drug use. There are no head-to-head comparisons of non medical treatments. Dry needling appears comparable to conventional physical therapy for treating PHN.
OBJECTIVE
Our aim is to determine the incidence of PHN in our population and to compare the treatments in patients with postherpetic neuralgia.
METHODS
A search for HZ and PHN was conducted in a general practice research database, comprising 2 general practices (dermatologist and physiatrist) and representing 5600 people. We analyzed a retrospective 37 case with PNH of 170 herpes zoster patient admmited to the dermatology and physical therapy and rehabilitation outpatient clinic between October 2018 and October 2020. Dry needling and physical therapy methods applied in addition to medical treatment in PHN treatment were compared.
RESULTS
In patients with postherpetic neuralgia, both dry needling therapy group and physical therapy group LANSS scores decreased significantly in the first week and in the third week compared to baseline. Dry needling therapy group has also similar results in VAS scores in the first and third week. But in physical therapy group, the VAS score did not show a significant decrease in the first week compared to the baseline, but it decreased significantly in the third week.
CONCLUSION
PHN is a complex, difficult to treat and severe neuropathic pain that affects patients' daily function and quality of life. Various agents and methods are available to relieve the symptoms of PHN. This study shows as both physical therapy and dry needling therapy are effective treatment for postherpetic nevralgia..
PubMed: 35801062
DOI: 10.5455/msm.2022.33.55-59 -
SAGE Open Medical Case Reports 2021Cancer rehabilitation can be preventive, restorative, supportive, and palliative. The rehabilitation goals change as the cancer pathway alters. Following any treatment...
INTRODUCTION
Cancer rehabilitation can be preventive, restorative, supportive, and palliative. The rehabilitation goals change as the cancer pathway alters. Following any treatment for head and neck cancer, a physiatrist plays an essential role in preventing various complications and helping patients to mitigate impairments and restore function, optimizing their quality of life.
CASE DESCRIPTION
This is a case study of a 56-year-old man with squamous cell cancer of the tongue managed with glossectomy, chemotherapy, and radiotherapy. He also has a remote history of acute myeloid leukemia involving the central nervous system, presenting with seizure and infective endocarditis. He underwent a sternotomy and an aortic valve replacement. His postoperative course was complicated by sternal infection, bradycardia with agonal breathing, and a weak pulse, for which the patient underwent cardiopulmonary resuscitation and achieved return of spontaneous circulation and was intubated and managed with antibiotics. He had a tracheostomy and underwent aggressive pulmonary toileting and suctioning in acute care. As the patient stabilized, he was transferred to in-patient rehabilitation.
INTERVENTIONS
While the patient was in the in-patient rehabilitation unit, cancer rehabilitation issues were addressed, including swallowing, pulmonary rehabilitation, management of upper-extremity deep venous thrombosis and infection, bowel and bladder issues, skin care, and evaluation of mental status. The patient's cancer prognosis and future were discussed in collaboration with his oncologist. He was discharged with a palliative care plan.
CONCLUSION
This report illustrates the significance of physical medicine and rehabilitation in management of cancer patients, as most cancer patients experience some deconditioning that results in physical challenges. As the prognosis for most types of cancers improves, it becomes more important to ensure that all cancer patients regain maximum function in the broadest sense to maximize their independence.
PubMed: 34262771
DOI: 10.1177/2050313X211025450 -
Cureus Aug 2022Objective We aim to assess the awareness and evaluation pattern among physiatrists regarding cancer rehabilitation and associated barriers to access. Design The present...
Objective We aim to assess the awareness and evaluation pattern among physiatrists regarding cancer rehabilitation and associated barriers to access. Design The present study is a cross-sectional study in the Physical Medicine and Rehabilitation (PMR) Association Annual Meeting in Puerto Rico that used a 10-item questionnaire to summarize physiatrists' clinical patterns with their persons diagnosed with cancer (PDWCs). Results Thirty-eight (66.7%) participants answered they received minimal to no education about cancer rehabilitation benefits. Cancer patients represented 10% or less of the weekly patient load for 47 (82.5%) physiatrists surveyed. The most common type of cancer encountered was breast cancer for the management of adverse effects. Twenty-nine (50.9%) physiatrists answered that a multifactorial barrier was the cause for limited services within this population group. All participants agreed that rehabilitation is at least sometimes beneficial for cancer patients, and 54 (94.7%) believed these services are needed. Conclusion Although rehabilitation specialists learn about the benefits of rehabilitation for PDWCs, there continues to be a limited number of PDWCs evaluated, mainly due to poor access, lack of information about cancer rehabilitation, and economic difficulties. Further efforts should be made to emphasize the importance of integrating rehabilitation techniques in the care of PDWCs.
PubMed: 36196316
DOI: 10.7759/cureus.28622 -
European Journal of Physical and... Dec 2023Hip displacement (HD) and dislocation in severe Cerebral Palsy (CP) (GMFCS III, IV, V) are important causes of worsening disability and quality of life. Prevention must... (Review)
Review
Prevention of hip dislocation in severe cerebral palsy (GMFCS III-IV-V): an interdisciplinary and multi-professional Care Pathway for clinical best practice implementation.
BACKGROUND
Hip displacement (HD) and dislocation in severe Cerebral Palsy (CP) (GMFCS III, IV, V) are important causes of worsening disability and quality of life. Prevention must be started from the first months of life through screening programs and early treatments, both conservative and surgical. Evidence from Clinical Practice Guidelines also suggests the development of Care Pathways for good clinical practice. At the beginning of 2020 an interdisciplinary, multi-professional working group, composed of 26 members (including Physiatrists, Physiotherapist, Neuro-psychomotor Therapists and Orthopedists representing the respective Italian Scientific Societies) with the involvement of the FightTheStroke Foundation families' association, was set up.
AIM
The aim of the multi-professional panel was the production of evidence-based recommendations for the Care Pathway "Prevention of Hip Displacement in children and adolescents with severe CP" for best clinical practice implementation in our national context.
DESIGN
Clinical Care Pathway (Clinical Practice Guideline).
SETTING
Inpatient and outpatient.
POPULATION
Children with severe CP (GMFCS III-IV-V).
METHODS
The recommendations of this Care Pathway were developed using the American Academy for Cerebral Palsy and Developmental Medicine (AACPDM) guidelines for Care Pathways development and the Grading of Recommendations Assessment Development and Evaluation (GRADE ADOLOPMENT) working group for adoption or adaption or de novo development of recommendations from high-quality guidelines. In 2020 a multidisciplinary working group (WG) developed four research questions on the prevention of HD on the following topics: screening, botulinum toxin treatment, postural management and preventive soft tissue surgery. A comprehensive review of the biomedical literature was performed on each question. Guidelines, Systematic Reviews and Primary studies were retrieved through a top-down approach. References were screened according to inclusion criteria and quality was assessed by means of specific tools. A list of recommendations was then produced divided by intervention (screening programs, postural management, botulinum toxin, preventive surgery). In a series of meetings, the panel graduated recommendations using the GRADE evidence to decision frameworks.
RESULTS
Fifteen recommendations were developed: seven on screening programs, four on postural management strategies, one on botulinum toxin, and three on preventive surgery. Evidence quality was variable (from very low to moderate) and only a few strong recommendations were made.
CONCLUSIONS
In severe CP at high risk of hip dislocation, it is strongly recommended to start early hip surveillance programs. In our national context, there is a need to implement Screening programs and dedicated Network teams. We also strongly recommend a comprehensive approach shared with the families and goal-oriented by integrating the different therapeutic interventions, both conservative and not, within Screening programs.
CLINICAL REHABILITATION IMPACT
Implementing a comprehensive multi-professional approach for the prevention of hip dislocation in severe CP.
Topics: Child; Adolescent; Humans; Hip Dislocation; Critical Pathways; Cerebral Palsy; Quality of Life; Botulinum Toxins
PubMed: 37796120
DOI: 10.23736/S1973-9087.23.07978-9