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Physical Medicine and Rehabilitation... Aug 2024The focus of this article is on the acute management of traumatic brain injury. The article focuses on the classification of traumatic brain injury, general acute... (Review)
Review
The focus of this article is on the acute management of traumatic brain injury. The article focuses on the classification of traumatic brain injury, general acute management of traumatic brain injury, the role of the physiatrist on this team, and lastly, behavioral and family considerations in the acute care setting. The article includes a focus on physiologic systems, strategies for the management of various aspects of brain injury, and consideration of factors associated with the continuum of care. Overall, the article reviews this critical period of brain injury recovery and provides a primer for the physiatrist.
Topics: Humans; Brain Injuries, Traumatic
PubMed: 38945645
DOI: 10.1016/j.pmr.2024.02.002 -
American Journal of Physical Medicine &... Jun 2024Sacroiliac joint (SIJ) mediated back pain has proven therapeutic benefit from fluoroscopically guided SIJ corticosteroid injections. We examined corticosteroid dose and...
OBJECTIVE
Sacroiliac joint (SIJ) mediated back pain has proven therapeutic benefit from fluoroscopically guided SIJ corticosteroid injections. We examined corticosteroid dose and pain relief following fluoroscopically guided SIJ injections to better understand their relationship.
DESIGN
Retrospective observational cohort analysis of electronic health record data on 661 patients who received unilateral fluoroscopically guided SIJ intraarticular corticosteroid injection with 40 mg versus 80 mg of methylprednisolone from 2012 and 2019. Patients were injected by fellowship trained proceduralists after diagnosis by board certified physiatrists in an academic physiatry practice. Absolute change in pain scores (post-procedure and first follow up) was modeled using linear regression of methylprednisolone dosage (40 mg vs. 80 mg) controlling for age, sex, BMI, baseline pain scores, and follow-up time.
RESULTS
Linear regression indicated that dosage of methylprednisolone, age and BMI were not statistically significantly associated with change in pain scores. Sex approached significance (p = 0.0501) indicating that females may have a lower degree of pain resolution than males.
CONCLUSIONS
Practitioners should consider corticosteroid dose when performing these beneficial procedures. This could reduce cost and potential side effects associated with larger doses, while still providing therapeutic benefit. This pilot study can guide future research and dosing guidelines for fluoroscopic spine injections.
PubMed: 38917434
DOI: 10.1097/PHM.0000000000002558 -
Cureus May 2024Cancer is often accompanied by bone metastasis, which may lead to skeletal-related events (SREs), such as pain, hypercalcemia, pathological fractures, spinal cord...
Cancer is often accompanied by bone metastasis, which may lead to skeletal-related events (SREs), such as pain, hypercalcemia, pathological fractures, spinal cord compression, orthopedic surgical intervention, and palliative radiation directed at the bone. Herein, we report the case of a 75-year-old female patient diagnosed with diffuse large B-cell lymphoma (DLBCL) with bone metastasis and a pathological fracture of the right iliac bone. The management strategy and follow-up were determined by a multidisciplinary cancer board comprising physicians, physiatrists, orthopedic surgeons, radiologists, and rehabilitation therapists. A conservative approach was chosen, incorporating a bone-modifying agent and weight-bearing restrictions for the right leg, along with rehabilitation therapy and post-discharge support. A multidisciplinary rehabilitation approach for two months enabled the patient to walk independently upon discharge. She maintains her activities of daily living (ADL) for over six months after discharge without any skeletal issues. This case highlights the effectiveness of a multidisciplinary approach in managing bone metastasis or involvement in patients with lymphoma.
PubMed: 38903364
DOI: 10.7759/cureus.60713 -
Medical Science Educator Jun 2024Persons with disabilities (PWD) often require special accommodations and more comprehensive healthcare yet frequently have encounters with physicians who are unprepared...
UNLABELLED
Persons with disabilities (PWD) often require special accommodations and more comprehensive healthcare yet frequently have encounters with physicians who are unprepared to provide tailored and complete care. A multipronged disability awareness curriculum for second-year medical students was implemented, including content on disability etiquette, patient-centered and interprofessional learning sessions for individuals with physical disabilities and intellectual and developmental disabilities, and a debriefing session with physiatrists. The objective of this study was to utilize a mixed methods approach to evaluate the disability awareness curriculum in undergraduate medical education (UME). Assessment was conducted using course evaluations, pre- and post-surveys including the Attitudes and Perspectives Towards Persons with Disabilities (APPD) scale and Multidimensional Attitudes Scale Toward Persons with Disabilities (MAS), and student focus groups. The mean scores from both the APPD (2.11 ± 0.43 pre-score vs. 1.7 ± 0.39 post-score) and MAS (2.45 ± 0.43 pre-score vs. 2.25 ± 0.55 post-score) indicate the curriculum improved medical students' attitudes toward PWD ( < 0.05), with lower numbers representing more favorable attitudes. After completing the curriculum, medical students' attitudes were comparable to those of doctor of physical therapy (DPT) students. Qualitative analysis from focus groups highlighted four major themes: education, comfort level, impact on future practice, and disability differences. This curriculum has potential as a valuable framework for delivering effective disability education to medical students to prepare future physicians to serve PWD and their unique needs. It meets core competencies, provides an opportunity to learn in interprofessional environments, and integrates PWD into the educational process.
SUPPLEMENTARY INFORMATION
The online version contains supplementary material available at 10.1007/s40670-024-02004-0.
PubMed: 38887426
DOI: 10.1007/s40670-024-02004-0 -
American Journal of Physical Medicine &... Jun 2024Siloed and episodic care delivery is often not equitable, high-quality, or sustainable. Transitioning from separate care settings, with potentially divergent care...
Siloed and episodic care delivery is often not equitable, high-quality, or sustainable. Transitioning from separate care settings, with potentially divergent care models, to an integrated care model is not always straightforward. Some experiences in expanding collaborative care between physiatrists and other healthcare providers for a variety of patient populations and care settings within a university physical medicine and rehabilitation (PM&R) division are shared as a means to inspire the uptake of care integration initiatives more broadly within the specialty. After an initial survey of care integration across multiple clinical sites, the university division: highlighted successful integrated care models; discussed integrated care models at every divisional retreat; reached out to clinicians in other specialties to collaboratively explore expansion; developed a "one-pager" on what physiatrists do; and invited collaborative specialists from integrated clinics to PM&R national and/or international meetings. Since 2019, divisional activity in integrated care has grown and evolved substantially. Future work will focus on: further expansion of integrated clinical care; scholarly evaluation of integrated care models; expansion of academic activity resulting from integration; and advocacy to healthcare providers, hospital administrators, and health system funders about the potential value of care integration in improving rehabilitation outcomes.
PubMed: 38865682
DOI: 10.1097/PHM.0000000000002576 -
American Journal of Physical Medicine &... Jun 2024Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that...
BACKGROUND
Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout.
OBJECTIVE
To identify changes that resulted in improvement of occupational well-being of physiatrists over a 6- to 9-month period.
DESIGN
We employed two quantitative surveys spaced 6 to 9 months apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey timepoints. These physiatrists were subsequently recruited to participate in a qualitative study using semi-structured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment.Setting: Online surveys and interviews.Participants: Physiatrists in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Membership Masterfile.Main Outcome Measure: Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.
RESULTS
One hundred twelve physiatrists responded to the baseline and follow-up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes from the qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work-life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work-life harmony also included making trade-offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges.
CONCLUSION
Our findings illustrate that, in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment.
PubMed: 38838100
DOI: 10.1097/PHM.0000000000002555 -
PM & R : the Journal of Injury,... Jun 2024Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that...
BACKGROUND
Physiatry is a specialty with high rates of burnout. Although organizational strategies to combat burnout are key, it is also important to understand strategies that individual physiatrists can use to address burnout.
OBJECTIVE
To identify changes that resulted in improvement of occupational well-being of physiatrists over a 6- to 9-month period.
DESIGN
We employed two quantitative surveys spaced 6 to 9 months apart to identify physiatrists who experienced meaningful improvement in occupational burnout and/or professional fulfillment between the two survey timepoints. These physiatrists were subsequently recruited to participate in a qualitative study using semi-structured interviews to identify changes that respondents felt contributed to improvements in burnout and professional fulfillment.
SETTING
Online surveys and interviews.
PARTICIPANTS
Physiatrists in the American Academy of Physical Medicine and Rehabilitation (AAPM&R) Membership Masterfile.
MAIN OUTCOME MEASURE
Burnout and professional fulfillment were assessed using the Stanford Professional Fulfillment Index.
RESULTS
One hundred twelve physiatrists responded to the baseline and follow-up surveys. Of these, 35 were eligible for interviews based on improvements in the Stanford Professional Fulfillment Index, and 23 (64%) agreed to participate. Themes from the qualitative interviews highlighted the importance of personal lifestyle choices, approaches to improve professional satisfaction, and strategies to foster work-life harmony. Personal lifestyle strategies included investing in wellness and mental health. Efforts to improve professional satisfaction included decreasing work intensity, prioritizing meaningful aspects of work, and building relationships with colleagues. Fostering work-life harmony also included making trade-offs in both domains, setting boundaries at work, setting expectations at home, and overcoming personal challenges.
CONCLUSION
Our findings illustrate that, in addition to organizational strategies demonstrated to be effective, there are actions that individual physiatrists can take to recover from burnout and foster professional fulfillment.
PubMed: 38837667
DOI: 10.1002/pmrj.13189 -
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 -
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 -
Topics in Spinal Cord Injury... 2024The World Health Organization (WHO) recommends that children be breastfed exclusively for the first 6 months of age. This recommendation may prove challenging for women...
The World Health Organization (WHO) recommends that children be breastfed exclusively for the first 6 months of age. This recommendation may prove challenging for women with spinal cord injury (SCI) who face unique challenges and barriers to breastfeeding due to the impact of SCI on mobility and physiology. Tailored provision of care from health care professionals (HCPs) is important in helping women navigate these potential barriers. Yet, HCPs often lack the confidence and SCI-specific knowledge to meet the needs of mothers with SCI. An international panel of clinicians, researchers, consultants, and women with lived experience was formed to create an accessible resource that can address this gap. A comprehensive survey on breastfeeding complications, challenges, resources, and quality of life of mothers with SCI was conducted, along with an environmental scan to evaluate existing postpartum guidelines and assess their relevance and usability as recommendations for breastfeeding after SCI. Building on this work, this article provides evidence-based recommendations for HCPs, including but not limited to general practitioners, obstetricians, pediatricians, physiatrists, lactation consultants, nurses, midwives, occupational therapists, and physiotherapists who work with prospective and current mothers with SCI.
Topics: Humans; Spinal Cord Injuries; Breast Feeding; Female; Autonomic Dysreflexia; Practice Guidelines as Topic; Mothers; Quality of Life; Adult
PubMed: 38799607
DOI: 10.46292/sci23-00079