PM&R最新文献

Background: Trigger finger is a common cause of hand pain. Though multiple techniques for percutaneous A1 pulley release have been described in the literature, there is a continued need for safe and effective techniques using inexpensive, familiar, and commonly found instruments. This study evaluated outcomes of percutaneous A1 pulley release performed using a novel technique with a modified 20-gauge spinal needle and ultrasound guidance, with follow-up outcomes at least 6 months after the procedure.

Objective: To evaluate the efficacy and safety of a novel percutaneous A1-pulley release technique in individuals with trigger finger.

Design: Retrospective observational study.

Setting: Private practice outpatient orthopedics clinic.

Participants: Forty digits from 30 unique patients with trigger finger who underwent percutaneous A1 pulley release.

Interventions: Percutaneous ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle.

Main outcome measures: The primary outcome measure was cessation of triggering. Secondary measures examined intraoperative and postoperative pain, postprocedural duration of activity limiting pain, and time to perform the procedure.

Results: Immediate cessation of triggering was achieved in all 40 digits following the procedure, with no recurrence reported at any time at an average follow-up of 11 months (range 6-32). Patients reported returning to normal activity in 2.75 days. Only one minor complication was reported, tenosynovitis, which resolved with a corticosteroid injection.

Conclusions: Percutaneous, ultrasound-guided A1 pulley release performed with a modified 20-gauge spinal needle can be safely performed with good outcomes and a rapid return to normal activity.

Background: There is little research regarding the self-perceived preparedness of residents to enter independent practice after training. Given the vast breadth of physical medicine & rehabilitation (PM&R) and the increasingly complex and wide-ranging responsibilities and roles of physiatrists, this study is necessary to evaluate residents' perspectives of how programs are preparing them in the face of the changing practice environment.

Objective: To identify how graduating PM&R residents perceived their training to prepare them for future practice. The researchers assessed perceived preparedness in six domains: (1) evaluation and management of conditions, (2) settings and responsibilities of practice, (3) familiarity with administrative processes, (4) physiatric-specific prescriptions, (5) performing procedures, and (6) interpretation of diagnostic studies.

Design: Survey.

Setting: Virtual.

Participants: Graduating PM&R residents in their final year of training in the United States were invited to complete the survey. Of 415 graduating residents, 54 accessed the survey, and 40 (9.6%) fully completed questions relating to preparation by residency.

Interventions: Not applicable.

Main outcome measure: Self-perceived preparedness for practice among graduating residents across 70 subdomains of practice.

Results: Mean preparedness was highest in the domain of physiatric prescription (3.45/5), and preparedness for administrative processes was significantly lower than all other domains (mean 2.25/5, p < .001). Across subdomains, the highest preparedness was in performing electromyography (4.48/5). Medical skills rated less than 2.50/5 included interpreting urodynamics (1.93/5), performing osteopathic manipulative therapy (1.57/5), and performing unguided peripheral nerve injections (2.25/5).

Conclusions: Ultimately, residency programs should increase administrative training and identify internal strengths and weaknesses by polling their residents.

Background: Despite quadriceps weakness in individuals after quadriceps tendon anterior cruciate ligament reconstruction (QT-ACLR), and its association with knee joint mechanics, no studies have addressed gait mechanics in both partial-thickness (PT-Q) and full-thickness (FT-Q) options for QT-ACLR.

Objective: To assess gait mechanics across a QT-ACLR cohort. We hypothesized that QT-ACLR would show changes in knee joint mechanics compared to control participants (CON) and nonoperated limbs. Additionally, we hypothesized that FT-Q operated limbs would show greater changes compared to PT-Q and CON.

Design: Retrospective cohort study.

Setting: University-affiliated sports medicine institute.

Participants: Sixteen patients who underwent QT-ACLR (7 FT-Q: Age (years) = 28.6 ± 7.3, post-op (months) = 23.5 ± 10.7, 9 PT-Q: Age = 25.2 ± 4.3, post-op = 24.4 ± 11.7) were recruited and compared to 11 CON (age = 23.4 ± 4.8).

Intervention: Participants underwent gait testing with force plate integrated motion capture.

Main outcome measures: Mixed repeated-measures analyses of covariance, adjusted for gait speed, were used to determine significant main effects or interactions in peak knee flexion angle, sagittal knee range of motion, peak internal knee extension moment (KEM), and peak internal knee flexion moment.

Results: When measured an average of 2 years after surgery, no main effect for limb or limb by depth interaction were detected. A significant effect by group was observed for peak KEM (p = .03, η² = .27) and peak knee flexion angle (p = .04, η² = .24) in the loading response phase. FT-Q (p = .02) and PT-Q (p = .03) showed lower KEM compared to the CON group in both limbs. The FT-Q group showed lower peak knee flexion angle compared to the CON group (p = .01).

Conclusions: Knee joint symmetry may be recovered 2 years following QT-ACLR, but lower KEM compared to CON for both graft options and lower peak knee flexion angle than CON for the FT-Q group may indicate a need for further investigation in QT-ACLR.

Background: Catheter-associated urinary tract infection (CAUTI) prevention is a major target for hospital quality metrics because it is linked to increased morbidity, mortality, and health care costs. Health care systems use strict protocols surrounding catheterization and maintenance, which often disregard the clinical needs of special populations (eg, spinal cord injury [SCI]). However, for populations that rely on chronic instrumentation of the bladder, asymptomatic (ie, nonpathogenic) bacterial colonization in the bladder is common but not linked to adverse outcomes. Additionally, alterations in neurologic and sensory function after SCI make it difficult for clinicians to discern asymptomatic bacteriuria from acute urinary tract infection requiring antibiotics. Institutional policies for screening urine during SCI annual exams often lead to detection of bacteriuria but create a clinical decision-making challenge when determining whether antibiotic treatment is appropriate.

Objective: To conduct preimplementation SCI-focused adaptations to the evidence-based practice (EBP) "Kicking CAUTI"-to develop a guide for SCI providers surrounding testing and treatment of CAUTI.

Methods: Four 1-hour focus groups were conducted with SCI clinicians (prescribers and nursing staff) to assess insights on needed modifications to adapt Kicking CAUTI for SCI. The Framework for Reporting Adaptations and Modifications to Evidence-based Implementation Strategies (FRAME-IS) was used to plan and report adaptations in this work and the integrated Promoting Action on Research Implementation in Health Services (i-PARIHS) framework to guide adaptation of the EBP for the SCI population. Content and thematic analysis guided our process.

Results: The clinical algorithm was simplified, a urinary symptom assessment added, and provider- and patient-facing educational materials were developed to support implementation efforts to create the Test Smart Treat Smart Intervention.

Conclusions: Traditional CAUTI protocols do not adequately address the needs of those with SCI and modifications are needed. Provider feedback provides valuable insights when adapting population appropriate interventions.

Background: Prior research found that Black veterans with upper limb amputation (ULA) reported greater disability and need for assistance compared to White veterans. The extent to which racial disparities in outcomes exist outside of the Department of Veterans Affairs has not been explored.

Objective: To examine racial disparities in physical function and prosthesis satisfaction among individuals with ULA and assess the potential moderating role of veteran status.

Design: Cross-sectional survey.

Setting: Community-dwelling participants.

Participants: U.S. veterans and civilians with ULA.

Interventions: Not applicable.

Main outcome measures: Physical function measures included Patient-Reported Outcomes Measurement Information System-Upper Extremity Amputation-specific (PROMIS-UE AMP), and Upper Extremity Functional Scale for Prosthesis Users (UEFS-P) for one-handed and two-handed tasks. Prosthesis satisfaction measures included the modified Client Satisfaction with Device (CSD) Comfort, Appearance, and Utility scales, the CSD-8, and the Trinity Amputation and Prosthesis Experience Satisfaction (TAPES) scale.

Results: Of 713 participants, 79% were male, with mean age of 61.3 years. The racial composition was 83.6% White, 9.1% Black, and 7.3% other, with 75.4% identifying as veterans. Multivariable linear regression found that Black participants (compared to White) had lower PROMIS 13-UE AMP (β: -5.1, 95% CI: -7.7 to -2.5) and UEFS-P Two-Handed Task Scale (β: -4.0, 95% CI: -7.3 to -2.1) scores. Satisfaction scores were lower for Black participants as measured by modified CSD Comfort (β: -3.9, 95% CI: -7.2 to -0.6), Appearance (β: -4.4, 95% CI: -7.5 to -1.2), Utility (β: -3.9, 95% CI: -7.2 to -0.6), and CSD-8 (β: -3.9, 95% CI: -7.2 to -0.6) scales. Veteran status moderated the impact of Black race on the UEFS-P Two-Handed Task Scale and the TAPES.

Conclusions: Black individuals with ULA had worse physical function and prosthesis satisfaction than White individuals. Although veteran status moderated these disparities, the reasons for these disparities remain unclear. Further research is essential to understand the causes of these disparities.

Background: Gradual-onset Achilles tendon injuries (GoATIs) in runners are common. Data show that chronic diseases are associated with GoATI.

Objective: To determine risk factors associated with a history of GoATIs among long-distance runners (21.1 and 56 km) entering a mass community-based running event.

Methods: Online pre-race medical screening questionnaire data from 76,654 consenting Two Ocean Marathon race entrants (71.8% entrants) were collected prospectively over 4 years (2012-2015); this cross-sectional study is a retrospective analysis of these data. A total of 617 entrants (0.8%) reported a GoATI in the last 12 months; 60,635 entrants reported no history of any running injury (controls). Categories of factors associated with GoATI were explored (univariate and multiple regression analyses): demographics (age group, sex, race, distance), training/racing history, and history of allergy, history of chronic disease, and Composite Chronic Disease Score. Prevalence and prevalence ratios (PRs; 95% CI) are reported.

Results: Factors associated with a higher prevalence of a history of GoATI (univariate analysis vs. controls) were older age (>31 years) (p < .001), male sex (PR = 1.76; p < .001), and longer race distance (56 km vs. 21.1 km) (PR = 2.06; p < .001). Independent factors associated with a history of GoATI (multiple regression) were increased years of recreational running (PR = 1.17 for every 5-year increase, p < .001), higher Composite Chronic Disease Score (PR = 2.07 for every 2-unit increase, p < .001), and allergy history (PR = 1.98 p < .001).

Conclusion: Novel independent factors associated with a history of GoATI in distance runners were increased years of recreational running, chronic disease history, and allergy history. Runners at risk for GoATI could be targeted for injury prevention interventions. Future studies should focus on establishing a causal relationship.

The prevalence of asymptomatic shoulder pathology has been shown to be high on both ultrasound and magnetic resonance imaging (MRI). The most common shoulder pathologies identified in asymptomatic, non-athlete individuals include rotator cuff pathology, acromioclavicular (AC) joint pathology, labral tears, subacromial bursitis, and calcific tendinitis. The data in the current literature suggest that asymptomatic rotator cuff tears are diagnosed on ultrasound and MRI at high rates, suggesting that rotator cuff tears may be considered an age-related, normal, degenerative change. However, there are data to suggest that the presence of an asymptomatic rotator cuff tear on imaging may predispose a patient to shoulder pain in the future, although the data remain inconclusive. AC joint arthritic changes are also common in older individuals on advanced imaging. Recent studies have reported that labral tears are common in asymptomatic shoulders, although at less frequent rates than in athletes, but more research is required on this topic. In addition, the presence of subacromial bursitis on imaging has not been found to accurately differentiate between symptomatic and asymptomatic shoulders. Finally, calcific tendinitis has been diagnosed asymptomatically, with most individuals remaining asymptomatic. Individuals who did develop pain developed severe pain, although the risk factors for developing symptomatic calcific tendinitis are unclear. In summary, given the high prevalence of shoulder pathology diagnosed on imaging, it is important to not over diagnose or complete an unnecessary workup for an asymptomatic person who is otherwise healthy.

Background: This report explores and summarizes perspectives from end users on unmet needs in achieving optimal and effective phantom pain management through a human-centered design approach.

Objective: To examine current strategies, pharmacological, nonpharmacological, surgical procedures, virtual reality, and mirror therapy, and the evidence supporting them, in the management of phantom limb pain.

Design: This study reviewed and analyzed transcripts acquired in nonresearch contexts from the Veterans Affairs Translational Education and Mentoring Center's commercialization training program and from a Veteran Engagement Panel. Key themes were extracted using quasi-qualitative analysis of one-on-one interviews.

Results: Clinicians and patients report that early patient intervention and education will yield improved management of phantom limb pain, which aligns with the growing recognition of the impact of patient-centered care on overall treatment outcomes. Mirror therapy is viewed as an effective and low-risk therapy, though compliance and buy-in may be barriers to clinical practice. Patient engagement can contribute to better treatment adherence and outcomes.

Conclusion: The study highlights implementation barriers, importance of end-user input, and the role of the Veteran Engagement Panel in providing feedback to pain researchers. The findings help explain unaddressed challenges and areas requiring further research to direct phantom pain management.