PM&R最新文献

Background: Calcific rotator cuff (RTC) tendinopathy is a self-limited, atraumatic cause of shoulder pain. Ultrasound-guided percutaneous needling and aspiration (USPNA) can be used when other nonoperative treatments fail.

Objective: To determine if there is an association between morphology of RTC calcifications on imaging and the ability to aspirate calcifications.

Design: Case series.

Setting: Tertiary orthopedic institution.

Patients: A total of 272 patients who underwent USPNA for symptomatic calcific RTC tendinopathy and had available imaging and clinical data.

Interventions: Imaging was categorized using Gärtner-Heyer (x-ray), Farin-Jaroma (ultrasound), and Chiou (ultrasound) morphological classifications.

Main outcome measures: Percentages of successful and unsuccessful aspirations were calculated.

Results: There were 292 USPNA cases; 170 (58.2%) aspirations were successful. Inter-rater reliability was almost-perfect for Farin-Jaroma and Chiou classifications (kappa: 0.92-1.00; p < .001) and fair-to-moderate for Gärtner-Heyer classifications (kappa: 0.38-0.74; p < .001). When applying the Gärtner-Heyer classification, 92/134 (68.7%) type I, 65/117 (55.6%) type II, and 10/35 (28.6%) type III calcifications were successfully aspirated (p < .001). Six calcifications could not be classified. No statistical difference was appreciated when using Farin-Jaroma (p = .939) or Chiou (p = .524) classifications. The mean calcification size for successful aspirations was significantly larger than that for unsuccessful aspirations (16.7 ± 6.4 mm vs. 13.4 ± 7.5 mm; p < .001), although there was no difference in ability to aspirate single versus multiple calcifications. The regression analysis showed an association between increasing calcification size and greater odds of aspiration success (10% increase; p < .001). Compared with type I Gärtner-Heyer classifications, type II and type III were associated with decreased odds of aspiration success (64% and 91% decreases, respectively; p ≤ .003).

Conclusions: Gärtner-Heyer classification was associated with the ability to successfully aspirate calcifications; type I calcifications were most frequently aspirated. Larger calcifications were also more frequently aspirated successfully. These factors may improve patient selection for USPNA. Further studies are needed to explore whether imaging classifications of RTC calcifications are correlated with patient-reported outcomes following USPNA.

Background: Survivors of head and neck cancer (HNC) are commonly affected by multiple complex and interrelated long-term and late effects that can adversely affect their function and quality of life.

Objective: To define the prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life in survivors of HNC.

Design: Retrospective cohort analysis.

Setting: Outpatient cancer rehabilitation clinic at a physical medicine and rehabilitation hospital that includes a freestanding inpatient rehabilitation unit along with an outpatient clinic.

Participants: One hundred thirty survivors of HNC who sought specialized cancer rehabilitation services to address complex functional impairments.

Interventions: Not applicable.

Main outcome measures: Prevalence of neuromuscular, musculoskeletal, visceral, oncologic, and other late effects affecting function and quality of life in survivors of HNC.

Results: The majority underwent surgery (53.8%), chemotherapy (22.3%), and radiation therapy (93.8%) as part of their treatment. Neuromuscular complications such as myelopathy (45.4%), radiculoplexopathy (58.5%), mononeuropathy (84.6%), and myopathy (57.7%) were prevalent. Musculoskeletal impairments included dysphagia (92.3%), dysarthria (60.8%), trismus (40.8%), cervical dystonia (47.7%), and shoulder dysfunction (27.7%). Visceral disorders encompassed lymphedema (86.2%), hypothyroidism (26.2%), and baroreceptor failure (19.2%). Additionally, oncologic complications, including recurrence (18.5%), metastasis (5.4%), and secondary malignancies (8.5%) were observed. Pain (74.6%) and fatigue (31.5%) were reported as major function-limiting impairments. Most survivors (96.9%) were referred to therapy including physical therapy (85.4%), occupational therapy (13.1%), speech-language pathology (84.6%), and lymphedema therapy (72.3%). Most (85.4%) required two or more therapy disciplines.

Conclusion: Survivors of HNC accessing cancer rehabilitation services commonly present with diverse, complex, and interrelated neuromuscular, musculoskeletal, visceral, and oncologic late effects that can severely affect function and quality of life. Comprehensive rehabilitation should include evaluation and management of these complex and interrelated late effects by a rehabilitation team that includes cancer rehabilitation physicians, physical therapists, occupational therapists, lymphedema therapists, and speech-language pathologists, among others.

Background: Brain-computer interface combined with virtual reality (BCI-VR) can reduce the difficulty of motor imagery execution and improve training performance. Few studies have focused on the effects of BCI-VR on attention, executive function, and lower-limb function in stroke.

Objective: To evaluate feasibility and preliminary efficacy of BCI-VR pedaling training on the attention, executive function, and lower-extremity function in people after stroke. It will also provide data support for future research, especially sample size calculations.

Design: A single group before-after trial design was used. All participants had a stable level of function over a 2-week period to ensure that their functional recovery was all attributable to BCI-VR training.

Setting: The study was conducted in a specialized rehabilitation hospital.

Participants: Twelve participants with stroke, a certain level of motor imagery ability, capable of walking 10 meters continuously.

Interventions: All participants received a 4-week BCI-VR pedaling training program, 5 days per week, 30 minutes each session.

Outcome measures: Primary outcomes are feasibility and safety. Secondary outcomes were lower-extremity mobility, attention, and executive functions.

Results: Twelve patients were recruited from inpatient rehabilitation and nine completed the study (six males/three females; 56.6 ± 11.6 years). Recruitment and retention rates were 34% and 75%, respectively. Excellent adherence rate (97.7%) was obtained. No adverse events or equipment issues were reported. Following the intervention, significant improvements were found in the lower-extremity strength, balance, walking stability, attention, and general cognitive function (p < .05). A significant correlation was found between improved Berg balance scale change values and symbol digit modalities test change values (p < .05, r = 0.677).

Conclusions: BCI-VR pedaling training provides a depth of feasibility and safety data, methodological detail, and preliminary results. This could provide a useful basis for future studies of BCI-VR pedaling training for stroke rehabilitation.

Clinicaltrials: gov registration number: ChiCTR2300071522 (http://www.chictr.org.cn).

Background: Survivors of stroke commonly report sleep disturbances. Studies of sleep disturbances after stroke are mostly performed in the acute phase. An increased knowledge of sleep disturbances and its determinants a longer time after stroke is needed to improve treatment and rehabilitation.

Objective: To assess survivors of stroke more than 1 year after stroke onset and (1) investigate self-reported sleep disturbances and (2) explore the association between self-reported sleep disturbances, gender, age, time since stroke, other stroke characteristics, and sociodemographic data.

Design: Cross-sectional survey.

Setting: Community setting.

Participants: Participants (n = 160) in the Life After Stroke In Northern Sweden Study (LASINS) (46% women, mean age 73 years, mean time since stroke 35 months).

Interventions: Not applicable.

Main outcome measurements: Pittsburgh Sleep Quality Index (PSQI), stroke characteristics (time since stroke, first time stroke, type of stroke, location of stroke, stroke treatment and comorbidities) and sociodemographic data (gender, age, marital status, vocational situation, need for home help, and use of mobility devices).

Results: A total of 84 participants (53%) rated 6 points or more on the PSQI (mean 6.5 points, SD: ±4.2, min-max 0-18), indicating sleep disturbances. Gender (p = .002) and use of mobility devices (p = .036) explained 9.5% of the variance in PSQI.

Conclusion: Survivors of stroke report sleep disturbances even several years after stroke onset. Women and those using mobility devices, indicating less recovery after stroke, report sleep disturbances to a higher degree, regardless of chronological age, time since stroke onset, other stroke characteristics, comorbidities, and sociodemographic data. Further studies with a longitudinal design are needed to gain a comprehensive understanding of how stroke-related factors and other reasons account for poststroke sleep disturbances in order to improve treatment and rehabilitation.

Background: Despite the growth of physical medicine and rehabilitation (PM&R) in recent years, the same cannot be said for its workforce conditions. Although various issues regarding the reality of the physiatry workforce have been reported, no studies were found that have evaluated it in Peru.

Objective: To assess characteristics, proficiency profile, and specialty perceptions of Peruvian physiatrists.

Design: Cross-sectional survey, designed and validated by the Peruvian Society of PM&R.

Setting: Online anonymous and voluntary questionnaire.

Participants: One hundred five Peruvian physiatrists.

Interventions: During August 2023, after approval from the ethics committee, a Google Forms questionnaire was shared with the participants via WhatsApp, providing information about study details. Responses were monitored through direct communication with each participant.

Main outcome measures: Twenty-four questions covering sociodemographic data, training-related characteristics, work-related characteristics, proficiency perceptions, and specialty perceptions.

Results: Most surveyed physiatrists were females (80%) and completed residency between 2017 and 2022 (46.7%). Only 2.8% had pursued a subspecialty fellowship; 41.9% were involved in teaching and easily found employment after residency. Most worked in the public sector (82.9%) and had a permanent employment status under the 728 regime (33.3%). Most reported having much proficiency (Level 3) in all competency domains. Mastery in ultrasound (US) (10.2%) and electrodiagnostic medicine (EDX) (4.1%) was reported mainly by those completing residency between 2017 and 2022. Only 2.9% reported ability to conduct scientific research. Overall satisfaction with the specialty was high (75.2%).

Conclusions: The survey found that most of surveyed Peruvian physiatrists worked in the public sector, had permanent employment status, considered themselves highly proficient in all evaluated domains, reported low mastery in US and EDX, and were very satisfied with the specialty. Given the lack of literature, these findings provide valuable insights for policymakers and educators, highlighting key areas for improving conditions for the physiatry workforce.

Objective: To determine the effect of conservative interventions on kinesiophobia, a fear-avoidance belief regarding exercise, in individuals who have had a lateral ankle sprain.

Literature survey: Systematic computerized literature search was performed using PubMed, CINAHL, Web of Sciences, and Cochrane Library databases. Randomized controlled trials investigating the effects of conservative interventions on kinesiophobia in individuals with a history of lateral ankle sprain, including chronic ankle instability, compared to those of control, sham, or different conservative interventions were included. They were written in English and published prior to December 2023.

Methodology: Two independent reviewers screened the studies using specific eligibility criteria. Study characteristics, patients, intervention and comparator, and outcome were extracted. Outcomes were defined as kinesiophobia observed using a questionnaire (eg, Tampa Scale for Kinesiophobia-11) or other means. The risk of bias was assessed using the Revised Cochrane risk of bias tool for randomized trials.

Synthesis: Five randomized controlled trials were included. These studies examined the effects of transcranial direct current stimulation, joint mobilization, balance and strength training, visual biofeedback during multimodal training, and low-friction patches attached to the outside of shoes, respectively. Limited evidence from single studies showed that the visual biofeedback during walking and low-friction patches attached on the outside of shoes were significantly more effective than the control and other treatments for kinesiophobia in individuals with a history of a lateral ankle sprain. Because the intervention and control groups differed between studies, data synthesis through meta-analysis was not performed.

Conclusions: Visual biofeedback during walking and low-friction patches attached on the outside of shoes may improve kinesiophobia in patients with a history of lateral ankle sprains. An approach to sensory-perceptual impairment in individuals with a history of lateral ankle sprains may be more effective in improving kinesiophobia. These conservative interventions may have an effect on kinesiophobia, but the evidence is limited.

Background: Nonarthritic hip-related pain can cause chronic pain and disability. Movement pattern training is an effective nonoperative treatment when delivered via formal physical therapy, but some patients have limited access to physical therapy. Discussion of movement pattern training during a patient's initial visit to a medical provider could be a valuable addition to first-line management of hip pain. However, the general acceptability of movement pattern related activity modification is not yet known.

Objective: To understand the real-world willingness of patients with nonarthritic hip-related pain to implement movement pattern modifications. A secondary goal was to explore adherence to movement pattern related activity modification after a single instructional session.

Design: Prospective cohort study.

Setting: Outpatient clinics of two U.S. tertiary care academic medical centers.

Participants: Eighty-eight 15-40-year-old patients who were diagnosed by a musculoskeletal clinician with nonarthritic hip-related pain and advised to pursue nonoperative management.

Interventions: Participants received a single instructional session of movement pattern training principles, in addition to usual nonoperative care.

Main outcome measures: The primary outcome was the proportion of participants who reported implementing one or more movement pattern related activity modifications during the 12-week follow-up period. The secondary outcome was participants' self-reported proportion of time that movement pattern related activity modifications were implemented.

Results: Eighty-eight participants enrolled (mean 27 [SD 8] years old, 81% (n = 71) female). By 12-week follow-up, 100% of the 80 retained participants implemented one or more movement pattern related activity modifications. Participants incorporated movement pattern modifications a median of 73% (interquartile range 50%-85%) of the time.

Conclusions: Participants with nonarthritic hip-related pain demonstrated high willingness to engage in movement pattern related activity modification, even after a single instructional session. Instruction in movement pattern training principles during an initial medical visit for nonarthritic hip-related pain may be a valuable, well-received addition to traditional first-line management.