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Journal of Rural Medicine : JRM Jan 2023: Dysphagia rehabilitation is an important area in geriatric nutrition due to the commonality of sarcopenic dysphagia in older adults. However, there have been no...
Association between board-certified physiatrist involvement and functional outcomes in sarcopenic dysphagia patients: a retrospective cohort study of the Japanese Sarcopenic Dysphagia Database.
: Dysphagia rehabilitation is an important area in geriatric nutrition due to the commonality of sarcopenic dysphagia in older adults. However, there have been no reports on the efficacy of treatment by board-certified physiatrists (BCP) in patients with sarcopenic dysphagia. This study therefore aimed to investigate whether intervention by board-certified physiatrists affects the functional prognosis of patients with sarcopenic dysphagia. Of 467 patients enrolled in the Japanese Sarcopenic Dysphagia database between November 2019 and March 2021, 433 met the study eligibility criteria. The patients were divided into two groups based on whether or not they received intervention by a BCP. The clinical characteristics and outcomes of the two groups were compared. Statistical analyses were performed by inverse probability weighting (IPW). BCPs were involved in the management of 57.0% of patients with sarcopenic dysphagia. These patients had a significantly higher increase in the Barthel index both before and after IPW correction than those not managed by a BCP (=0.001 and =0.016, respectively). However, sarcopenic dysphagia significantly improved in the non-BCP group before IPW correction (<0.001), although there was no significant difference after IPW correction (=0.301). BCP management was significantly associated with higher activities of daily living (ADL), but not with an improvement in sarcopenic dysphagia. To provide and manage effective rehabilitation, it is necessary to familiarize patients with the management and training of sarcopenic dysphagia rehabilitation for BCP in order to cope in regions with few rehabilitation units.
PubMed: 36700126
DOI: 10.2185/jrm.2022-026 -
American Journal of Physical Medicine &... Feb 2023Environmental scans determine trends in an organization's or field's internal and external environment. The results can help shape goals, inform strategic decision...
Environmental scans determine trends in an organization's or field's internal and external environment. The results can help shape goals, inform strategic decision making, and direct future actions. The Association of Academic Physiatrists convened a strategic planning group in 2020, composed of physiatrists representing a diversity of professional roles, career stages, race and ethnicity, gender, disability status, and geographic areas of practice. This strategic planning group performed an environmental scan to assess the forces, trends, challenges, and opportunities affecting both the Association of Academic Physiatrists and the entire field of academic physiatry (also known as physical medicine and rehabilitation, physical and rehabilitation medicine, and rehabilitation medicine). This article presents aspects of the environmental scan thought to be most pertinent to the field of academic physiatry organized within the following five themes: (1) Macro/Societal Trends, (2) Technological Advancements, (3) Diversity and Global Outreach, (4) Economy, and (5) Education/Learning Environment. The challenges and opportunities presented here can provide a roadmap for the field to thrive within the complex and evolving healthcare systems in the United States and globally.
Topics: Humans; United States; Physical and Rehabilitation Medicine; Medicine; Education, Medical, Graduate; Internship and Residency; Delivery of Health Care
PubMed: 36634238
DOI: 10.1097/PHM.0000000000002127 -
The Journal of Spinal Cord Medicine Jul 2024Following spinal cord injury (SCI), early spasms are associated with decreased functional recovery. It has also been hypothesized that early spasticity might sign...
CONTEXT
Following spinal cord injury (SCI), early spasms are associated with decreased functional recovery. It has also been hypothesized that early spasticity might sign underlying maladaptive neuroplasticity, which could translate in worse neurological outcomes.
OBJECTIVE
In this context, this paper aims to evaluate if early-onset spasms are also associated with neurological outcomes after SCI.
METHODS
A retrospective review of 196 cases from a prospective SCI database was conducted. The presence of early spasms during the acute hospitalization was assessed by a single physiatrist. The characteristics and long-term neurological outcomes of individuals with and without early spasms were first compared. Multivariate regression analyses were then performed to determine the relationship between early spasms and neurological outcomes.
RESULTS
30.1% ( = 59) of patients presented early spasms. These patients had several distinguishing characteristics including higher odds of tetraplegia (vs. paraplegia) and more severe injuries. At the bivariate level, patients with early spasms had higher odds of improving at least 1 AIS grade between baseline and follow-up. However, this was not significant at the multivariate level.
CONCLUSIONS
Early spasms are not significantly associated with poorer neurological outcomes, contrasting with the unwritten consensus that early spasticity translates maladaptive neuroplasticity.
Topics: Humans; Spinal Cord Injuries; Female; Male; Adult; Middle Aged; Recovery of Function; Spasm; Retrospective Studies
PubMed: 36622323
DOI: 10.1080/10790268.2022.2150068 -
PloS One 2023Understand the continuity and changes in headache not-otherwise-specified (NOS), migraine, and post-traumatic headache (PTH) diagnoses after the transition from ICD-9-CM...
OBJECTIVES
Understand the continuity and changes in headache not-otherwise-specified (NOS), migraine, and post-traumatic headache (PTH) diagnoses after the transition from ICD-9-CM to ICD-10-CM in the Veterans Health Administration (VHA).
BACKGROUND
Headache is one of the most commonly diagnosed chronic conditions managed within primary and specialty care clinics. The VHA transitioned from ICD-9-CM to ICD-10-CM on October-1-2015. The effect transitioning on coding of specific headache diagnoses is unknown. Accuracy of headache diagnosis is important since different headache types respond to different treatments.
METHODS
We mapped headache diagnoses from ICD-9-CM (FY 2014/2015) onto ICD-10-CM (FY 2016/2017) and computed coding proportions two years before/after the transition in VHA. We used queries to determine the change in transition pathways. We report the odds of ICD-10-CM coding associated with ICD-9-CM controlling for provider type, and patient age, sex, and race/ethnicity.
RESULTS
Only 37%, 58% and 34% of patients with ICD-9-CM coding of NOS, migraine, and PTH respectively had an ICD-10-CM headache diagnosis. Of those with an ICD-10-CM diagnosis, 73-79% had a single headache diagnosis. The odds ratios for receiving the same code in both ICD-9-CM and ICD-10-CM after adjustment for ICD-9-CM and ICD-10-CM headache comorbidities and sociodemographic factors were high (range 6-26) and statistically significant. Specifically, 75% of patients with headache NOS had received one headache diagnoses (Adjusted headache NOS-ICD-9-CM OR for headache NOS-ICD-10-CM = 6.1, 95% CI 5.89-6.32. 79% of migraineurs had one headache diagnoses, mostly migraine (Adjusted migraine-ICD-9-CM OR for migraine-ICD-10-CM = 26.43, 95% CI 25.51-27.38). The same held true for PTH (Adjusted PTH-ICD-9-CM OR for PTH-ICD-10-CM = 22.92, 95% CI: 18.97-27.68). These strong associations remained after adjustment for specialist care in ICD-10-CM follow-up period.
DISCUSSION
The majority of people with ICD-9-CM headache diagnoses did not have an ICD-10-CM headache diagnosis. However, a given diagnosis in ICD-9-CM by a primary care provider (PCP) was significantly predictive of its assignment in ICD-10-CM as was seeing either a neurologist or physiatrist (compared to a generalist) for an ICD-10-CM headache diagnosis.
CONCLUSION
When a veteran had a specific diagnosis in ICD-9-CM, the odds of being coded with the same diagnosis in ICD-10-CM were significantly higher. Specialist visit during the ICD-10-CM period was independently associated with all three ICD-10-CM headaches.
Topics: Humans; International Classification of Diseases; Veterans Health; Headache; Migraine Disorders; Comorbidity; Post-Traumatic Headache; Veterans
PubMed: 36598881
DOI: 10.1371/journal.pone.0279163 -
Genes Nov 2022Kyphoscoliotic Ehlers-Danlos syndrome and 17p13.3 microduplication share multiple clinical features such as muscle hypotonia, cleft palate, and growth impairment. This...
Kyphoscoliotic Ehlers-Danlos syndrome and 17p13.3 microduplication share multiple clinical features such as muscle hypotonia, cleft palate, and growth impairment. This paper describes a patient who was first diagnosed with the duplication and a decade later also with -kEDS. The latter was initially overlooked due to the pathogenic significance attributed to the duplication and to the fact that, at the time of the first diagnosis, this specific form of kEDS had yet to be discovered. The patient's progressive kyphoscoliosis and severe joint laxity were the clinical features that prompted the patient's physiatrist to reassess the genetic work-up. This extreme latency caused inaccurate management in the patient's follow-up program, which ultimately may have resulted in preventable clinical complications. This report underlines the importance of remaining up-to-date with patient status, reviewing old cases, and relying on specialist advice to reach a correct diagnosis.
Topics: Humans; Mutation; Ehlers-Danlos Syndrome; Muscle Hypotonia; Peptidylprolyl Isomerase
PubMed: 36553464
DOI: 10.3390/genes13122197 -
Journal of Medical Ultrasound 2022The aim of the study was to evaluate the feasibility of convolutional neural network (CNN)-based deep learning (DL) algorithms to dichotomize shoulder ultrasound (US)...
BACKGROUND
The aim of the study was to evaluate the feasibility of convolutional neural network (CNN)-based deep learning (DL) algorithms to dichotomize shoulder ultrasound (US) images with or without supraspinatus calcific tendinopathy (SSCT).
METHODS
This was a retrospective study pertaining to US examinations that had been performed by 18 physiatrists with 3-20 years of experience. 133,619 US images from 7836 consecutive patients who had undergone shoulder US examinations between January 2017 and June 2019 were collected. Only images with longitudinal or transverse views of supraspinatus tendons (SSTs) were included. During the labeling process, two physiatrists with 6-and 10-year experience in musculoskeletal US independently classified the images as with or without SSCT. DenseNet-121, a pre-trained model in CNN, was used to develop a computer-aided system to identify US images of SSTs with and without calcifications. Testing accuracy, sensitivity, and specificity calculated from the confusion matrix was used to evaluate the models.
RESULTS
A total of 2462 images were used for developing the DL algorithm. The longitudinal-transverse model developed with a CNN-based DL algorithm was better for the diagnosis of SSCT when compared with the longitudinal and transverse models (accuracy: 91.32%, sensitivity: 87.89%, and specificity: 94.74%).
CONCLUSION
The developed DL model as a computer-aided system can assist physicians in diagnosing SSCT during the US examination.
PubMed: 36484040
DOI: 10.4103/jmu.jmu_182_21 -
Turkish Journal of Physical Medicine... Sep 2022The aim of this study was to translate, cross-culturally adapt the patient-based Constant-Murley Score (p-CMS), assess its validity, reliability, and compare it with the...
OBJECTIVES
The aim of this study was to translate, cross-culturally adapt the patient-based Constant-Murley Score (p-CMS), assess its validity, reliability, and compare it with the clinician-based CMS (c-CMS).
PATIENTS AND METHODS
This cross-sectional study included a total of 51 shoulders of 46 patients (22 males, 24 females; mean age: 49±10 years; range, 29 to 70 years) with shoulder pain between December 2015 and July 2016. After translation of p-CMS, each participant was asked to complete the final Turkish version of the p-CMS. The c-CMS was assessed by a physiatrist who was blinded to the p-CMS. Retest of the p-CMS was performed in patients (n=15) who did not receive any treatment between two visits (Days 3 to 5).
RESULTS
A total of 51 shoulders (n=5 bilateral shoulder pain) were tested. Strength, subjective, objective, and total scores were significantly different between the p-CMS and c-CMS (p<0.001). Pain scores of the c-CMS and p-CMS revealed similar results with 95% limits of agreement of -3.81 and 4.81. Weighted kappa statistics demonstrated that the levels of agreement ranged between 0.343 and 0.698 in subjective and between 0.379 and 0.515 in objective components. For test-retest reliability of the p-CMS, intraclass correlation coefficient values ranged between 0.838 and 0.995.
CONCLUSION
The Turkish version of the p-CMS has internal consistency and test-retest reliability to evaluate shoulder function in Turkish patients with shoulder pathologies. Considering the differences in test protocols and scoring methods of c-CMS and p-CMS, their interchangeable use is not supported.
PubMed: 36475100
DOI: 10.5606/tftrd.2022.8520 -
Acta Ortopedica Brasileira 2022The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of... (Review)
Review
OBJECTIVE
The Brazilian Consensus on Hip Viscosupplementation aims to generate a referential and consensual source from the theoretical knowledge and clinical experience of specialists in the field.
METHODS
A multidisciplinary panel was formed with 15 specialists (sports medicine, orthopedists, physiatrists and rheumatologists), based on clinical and academic experience in the use of viscosupplementation of the hip. 12 statements were prepared, discussed and voted. Each panelist gave a value between 0 and 10 on a Likert scale, specifying their level of agreement with the statement.
RESULTS
The panel reached a consensus on several aspects of viscosupplementation of the hip, with emphasis on the following statements: best indication is for mild to moderate hip arthrosis; it may be indicated in severe osteoarthritis; results may vary according to the characteristics of the viscosupplement used; Viscosupplementation should not be performed as an isolated procedure, but in conjunction with other rehabilitation and pharmacological measures; best injection technique should be based on anatomical references coupled with imaging guidance; it is a cost-effective procedure.
CONCLUSION
Viscosupplementation is a safe and effective therapy for hip osteoarthritis, even in severe cases. Guided injection is recommended.
PubMed: 36451782
DOI: 10.1590/1413-785220223005e250414 -
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 -
Journal of Rural Medicine : JRM Oct 2022This study assessed the regional disparities and the associated factors in the implementation of cardiac rehabilitation in Japan. Regional disparities were...
This study assessed the regional disparities and the associated factors in the implementation of cardiac rehabilitation in Japan. Regional disparities were investigated by comparing the number of cardiac rehabilitation units in each of 47 prefectures in Japan based on the National Database of Health Insurance Claims Open Data published by the Ministry of Health, Labour, and Welfare. The relationships between the numbers of inpatient and outpatient cardiac rehabilitation units and the numbers of registered instructors of cardiac rehabilitation, board-certified physiatrists, and board-certified cardiologists were examined. The region with the highest and lowest numbers of inpatient units showed 11,620.5 and 1,650.2 population-adjusted cardiac rehabilitation units adjusted per 100,000 population, respectively, corresponding to a 7.0-fold difference. Meanwhile, 4,865.3 and 238.6 units were present in the regions with the highest and lowest numbers of outpatient units, respectively, corresponding to a 20.4-fold regional disparity. Our analysis showed that the population-adjusted number of inpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.647, <0.001) and board-certified cardiologists (r=0.445, =0.002) but only marginally associated with the population-adjusted number of board-certified physiatrists (r=0.329, =0.024). Moreover, the population-adjusted number of outpatient cardiac rehabilitation units was significantly associated with the population-adjusted numbers of registered instructors of cardiac rehabilitation (r=0.406, =0.005) and board-certified cardiologists (r=0.450, =0.002) but not with the population-adjusted number of board-certified physiatrists (r=0.078, =0.603). Large regional disparities were observed during the implementation of cardiac rehabilitation. Increased numbers of cardiac rehabilitation instructors and cardiac rehabilitation practices are expected to eliminate these regional differences in cardiac rehabilitation practices.
PubMed: 36397803
DOI: 10.2185/jrm.2022-015