PM&R最新文献

Background: Differences in female athlete triad risk factors between runners from Japan and the United States have not been explored.

Objective: To compare the prevalence of Triad risk factors and Triad components between female Japanese and American distance runners.

Design: Observational, cross-sectional.

Setting: Two universities; one in the United States and one in Japan.

Participants: A total of 77 female runners: 36 Japanese middle- and long-distance runners, and 41 American distance runners.

Interventions: Not applicable.

Main outcome measures: Triad components were energy deficiency, menstrual disturbances, and poor bone health. Triad risk factors were, respectively for each component: body mass index, serum total triiodothyronine, and history of diagnosed eating disorders; delayed menarche, history of menstrual irregularity, and current oligoamenorrhea; and bone mineral density and history of stress fractures. Prevalence was compared with chi-square and Fisher's exact tests. Group differences were assessed with t-tests and Mann-Whitney U tests. Data are mean difference (95% confidence interval [CI]).

Results: Japanese runners had lower body weight (-4.15 [95% CI, -7.03.to -1.27] kg, p = .005) and percentage of body fat (-5.2 [95% CI, -6.9 to -3.5] %, p < .001) than American runners, with no differences in body mass index, serum total triiodothyronine, age of menarche, or menstrual cycle length (p > .05). Japanese runners had significantly lower bone mineral density at the lumbar spine (-0.195 [95% CI, -0.246 to -0.143] g/cm², p < .001), total hip (-0.115 [95% CI, -0.165 to -0.064] g/cm², p < .001), and femoral neck (-0.214 [95% CI, -0.260 to -0.167] g/cm², p < .001), but higher total hip Z-scores than the American runners (0.5 [95% CI, 0.1 to 1.0], p = .022). The prevalence of energy deficiency (56% vs. 32%, p = .035), history of stress fractures (50% vs. 17%, p = .003), and of runners experiencing all three Triad components (42% vs. 16%, p = .014) was higher in Japanese than American runners. No other differences in prevalence were observed.

Conclusions: Japanese female runners may be at a higher Triad risk than American peers, given their higher prevalence of energy deficiency risk factors, history of stress fractures, and of athletes experiencing all Triad components.

Background: Fatty infiltration and muscle atrophy strongly influence clinical outcomes in patients with rotator cuff tears. Emerging quantitative techniques integrated with brightness-mode ultrasound and shear wave elastography (SWE) have been used to evaluate soft tissue morphology and mechanical properties.

Objective: To evaluate integrative B-mode ultrasound and SWE as a potential tool to quantify rotator cuff muscle quality.

Methods: Twenty participants (a total of 32 shoulders) with and without rotator cuff tears were included in this study. Shear wave speed (SWS) was measured in SWE-mode and cross-sectional area (CSA) was measured in B-mode with a linear transducer. Muscle strength was measured using a hand-held dynamometer. Psychometric properties were calculated for SWS and CSA under both passive and active conditions.

Results: The SE of measurement and minimum detectable difference for the SWS of supraspinatus in shoulders with rotator cuff tears were 0.195 and 0.541 m/s, respectively. The SE of measurement and minimum detectable difference for the CSA of supraspinatus in shoulders with rotator cuff tears were 0.265 and 0.733 cm², respectively. Correlation analysis between passive mean SWS and CSA revealed a strong correlation (r = 0.652, p = .003) for the supraspinatus.

Conclusion: These findings demonstrate a strong positive correlation between SWS and CSA of the supraspinatus in participants with rotator cuff tears but not the infraspinatus or in asymptomatic participants. Assessment of SWS and CSA under passive conditions yields superior psychometric properties compared to active conditions. However, the lack of association between SWS and strength limits the clinical utility of SWE to quantify rotator cuff muscle quality.

Background: Pain is a common experience in the phantom limb, residual limb, and other parts of the body following amputation. However, formal pain surveys typically do not differentiate between these different pain subtypes, leading to a lack of relevant data to clinically diagnose patients' pain and provide targeted treatment.

Objective: To characterize the phantom limb, residual limb, and bodily pain experiences and quality of life of patients with major lower limb amputation and compare these to self-evaluations of overall pain at time the survey, during the past month during rest, light daily activity, and maximal exertion to investigate prosthesis-related pains.

Design: Cross-sectional within-participant study.

Setting: Institutional secondary care.

Patients: Eighty three adults with unilateral transfemoral or transtibial amputation with socket prostheses or bone-anchored limbs.

Interventions: Not applicable.

Main outcome measures: Overall, phantom limb, residual limb, and bodily pain evaluated at time of survey, averaged over past month, and during rest, light activity, and maximal activity.

Results: Current and recalled residual limb pain intensity correlated with other pain subtypes for individuals with transfemoral socket prostheses (p ≤ .023), but not transfemoral bone-anchored limbs (p ≥ .064). Residual limb pain consistently correlated with current and recalled overall pain (p ≤ .037). More intense activity was correlated with higher pain intensity for individuals with transfemoral socket prostheses (p < .001), but phantom limb and bodily pains did not increase between rest and walking for individuals with transfemoral bone-anchored limbs (p ≥ .063).

Conclusions: Phantom limb, residual limb, and bodily pains contribute differently to the self-evaluation of overall pain, impact on quality of life, and challenge completing daily activities. Pain subtypes also differed between activity levels for individuals using socket prostheses but less so for those with bone-anchored limbs. Thus, pain subtypes should be evaluated simultaneously to provide a comprehensive assessment of patients' experiences with pain.

Background: Chronic sacroiliac joint (SIJ) pain is highly debilitating. Minimally invasive SIJ fusion has become a commonly performed surgical treatment for SIJ pain, with level I evidence showing clinically significant improvements in pain, function, and quality of life and a low adverse event rate. Primarily performed by surgeons, this procedure is increasingly being performed by interventional pain management (IPM) physicians.

Purpose: To evaluate the safety and effectiveness of lateral SIJ fusion performed by IPM physicians, compared with prior studies of similar devices.

Study design: Prospective, multicenter, single-arm clinical trial conducted at 15 U.S. sites.

Patient sample: A total of 112 patients with a diagnosis of SIJ pain, who met study eligibility criteria, underwent lateral SIJ fusion.

Outcome measures: SIJ pain (numerical rating scale [NRS]), Oswestry Disability Index (ODI), quality of life (Patient-Reported Outcomes Measurement Information System [PROMIS]-29), patient satisfaction, and device/procedure-related adverse events.

Methods: Medical and surgical history and patient-reported outcomes were assessed at baseline and follow-up at 1, 3, 6, 12, and 24 months postoperatively. Primary endpoint is change in SIJ pain from baseline to 6 months; statistical evaluation used a noninferiority approach with a 1-point noninferiority margin compared to prior studies of a similar device. Secondary endpoints included ODI, NRS, PROMIS-29, device/procedure-related adverse events, and evidence of fusion via computed tomography scan at 2 years. Twelve- and 24-month follow-up data collection is ongoing.

Results: Mean (SD) participant age was 64 (14) years and 68% female. No serious or device-related adverse events occurred. At 6 months, mean SIJ pain decreased 5.2 points (95% confidence interval [CI] 4.7-5.7), meeting the study's primary noninferiority endpoint (p < .001 for noninferiority, p < .001 for change from baseline). A majority (91%) had a ≥2-point improvement in SIJ pain. ODI improved by 25.8 points (95% CI 22.2-29.4, p < .001 vs. baseline).

Conclusion: Interim trial results support the safety and effectiveness of lateral SIJ fusion performed by IPM physicians. Clinically significant improvements in pain and disability are commensurate with results from surgeon-performed randomized trials and published literature. Results should be reproduced in randomized trials.

Background and objective: Previous work from this dataset found 45% prescribing frequency of any medications (35.1%, 33.5%, and 56.8% at institutions 1, 2, and 3 respectively), without significant difference between in-person and telemedicine. The current study examines medication prescription patterns in greater depth by type of medications.

Design: Multicenter retrospective study.

Setting: Three academic medical centers in the United States.

Participants: Patients with cancer or history of cancer.

Interventions: Cancer rehabilitation physiatry outpatient visits.

Main outcome measures: Frequency of medication types prescribed.

Results: A total of 1234 unique patients underwent 3006 visits (institutions 1, 2, and 3 with 614, 1638, and 754 visits, respectively). Most frequently prescribed medication types (percentage of total encounters followed by 95% confidence interval) included opioids (14.5%; 8.1%-21.1%), membrane stabilizers (11.3.%; 5.2%-17.3%), topical agents (8.7%; 2.7%-14.7%), antidepressants (8.3%; 5%-11.8%), muscle relaxants (5%; 1.8%-8.2%), analgesics (nonsteroidal anti-inflammatory agents or acetaminophen) (3.7%; 3.4%-4.1%), and injected agents (5%;1.7%-8.3%). Less frequent categories included bowel medications (2.4%; 0.9%-3.9%), benzodiazepines (2.6%; 0.7%-4.5%), antiemetics (1.8%; 0.3%-3.3%), antibiotics (0.7%; 0.4%-1.0%), sleep aids (1%; 0.5%-1.5%), antipsychotics (1%; 0.1-1.2%), oral corticosteroids (0.5%; 0.3%-0.7%), and cognitive medications (0.6%; 0.2%-1%). Other medications were prescribed in 9.2% (3.5%-14.9%) of encounters. Interinstitutional differences were seen for all medication categories (p < .001), except for nonopioid analgesics (p = .640), antibiotics (p = .4), and corticosteroids (p = .337).

Conclusion: Treating pain appears to be a predominant but not sole focus of medication prescription in this population. Results illuminate prescribing trends seen in actual practice and may serve to inform individual cancer rehabilitation physiatrist practice, as well as to provide insight into possible directions for future research, such as focusing on frequently prescribed medications in controlled trials, and further examination of "other" medications, which were prescribed at a higher frequency than anticipated. Limitations include that factors underlying the observations could not be determined, including overall acuity; cancer type, stage, or phase; probable impact of differences in dispensation of refills depending on medication type; variability in clinically intended purposes of medications for specific cases; and possible regulatory or institution-specific contexts.

Introduction: COVID-19 can result in persistent symptoms and functional impairment that significantly impact daily functioning, highlighting the need for targeted rehabilitation. However, there is a lack of data on what proportion of long COVID patients need rehabilitation and which types are required.

Objective: To estimate the rehabilitation needs of patients with long COVID.

Design: Retrospective, cross-sectional analysis of clinical data.

Setting: Post-COVID recovery clinic in British Columbia, Canada.

Participants: Individuals with long COVID, defined as having symptoms persisting beyond 3 months post infection, with the first clinic visit occurring within 6 months post infection.

Intervention: Not applicable.

Main outcome measures: We created thresholds based on objective tests and patient-reported outcomes to determine rehabilitation needs.

Results: Data from 3709 patients who visited the clinic between March 2020 and May 2023 were available for analysis; 33% met the study eligibility criteria (n = 1237). Patients were primarily women (65%) and white (57%), with a mean age of 49 ± 14 years. Two thirds had required hospitalization. The average time from infection to clinic visit was 136 ± 34 days. At 3-6 months post infection, the most common COVID-19 symptoms were fatigue, dyspnea, muscle weakness, and muscle/joint aches. Most patients exceeded the rehabilitation threshold for dyspnea (83%), fatigue (78%), frailty (74%), and posttraumatic stress disorder (58%). Quality of life was impaired for 80%. Neuropsychological symptoms like anxiety (42%) and depression (36%) were also prevalent. Reductions in 6-minute walk distance (≥25%) and sit-to-stand performance (≥50%) occurred in 26% and 55% of patients, respectively. The majority of participants (98%) exceeded at least one test threshold for rehabilitation, and most (85%) were eligible for more than one type. The most required types of rehabilitation were pulmonary rehabilitation (83%), mental health support (78%), and neurorehabilitation (70%).

Conclusion: The need for rehabilitation services among individuals experiencing long COVID in British Columbia is substantial. Use of predefined thresholds that incorporate measures of both symptom burden and functional impairment can effectively support the identification of high-need patients and their overall rehabilitation needs. Combined with clinicians' expertise, this approach can facilitate timely, evidence-based referrals to specialized care for those who need it.

Background: Telehealth provides remote clinical care for patients using communications technology. The increased use of telehealth during the COVID-19 pandemic compels us to better understand telehealth's costs, value, and limitations.

Objective: To describe barriers to access and costs of care for telehealth patients among an outpatient musculoskeletal cohort. This study also evaluates patients' perceptions of telehealth as a means of care delivery during the COVID-19 pandemic.

Design: Cross-sectional study.

Setting: Tertiary academic institution.

Patients: Adult patients attending telehealth visits in an academic physiatry department.

Interventions: N/A MAIN OUTCOME MEASURES: Telehealth-related barriers, costs, and perceptions were assessed using a one-time survey.

Results: A total of 262 patients (mean age: 59.6 ± 15.5 years, median: 62 [interquartile range, 49-72]) completed the survey from November 23, 2020 to February 14, 2021 (completion rate: 28.3%; 262/926). Comfort levels with technology averaged 8.5 ± 2.0 out of 10 (median: 9 [interquartile range, 8-10]), and all but one patient had existing access to the electronic device used for their telehealth visit. Most patients (89.7%) had previously received in-person care for the same issue. Concern about the pandemic was the top reason for receiving telehealth care. For almost all patients, the only costs related to telehealth were direct costs of care. In contrast, patients reported they would have spent an average of $25.14 (median: $10 [interquartile range, $0-$40]) on travel if their visit had been in person. Of the 141 patients who were employed or students, 25.5% reported taking time away from work or school to attend the telehealth visit, whereas 85.1% reported they would have needed to take time away from work or school if the visit had been in-person. Satisfaction with telehealth visits averaged 9.1 out of 10 (median: 10 [interquartile range, 9-10]), and 71.6% of patients reported a better impression of telehealth compared to 1 year ago.

Conclusions: Our findings illustrate that telehealth is a low-cost form of health care delivery that has high satisfaction for the patient. This is particularly beneficial in the musculoskeletal patient population who may face additional physical barriers to accessing care in person.