PM&R最新文献

Background: Children with cerebral palsy and other disabilities face barriers in obtaining equitable medical care. Although many factors contribute to these disparities, physicians' lack of knowledge and comfort when caring for patients with cerebral palsy have been reported to play a role. We propose that this gap in understanding may reflect a deficit in disability education during medical school.

Objective: To (1) obtain insight into medical students' knowledge regarding cerebral palsy at two medical schools in the United States; and (2) determine whether viewing a brief educational video increases short-term knowledge regarding cerebral palsy.

Methods: All medical students attending Wayne State University School of Medicine and Central Michigan University College of Medicine in November-December 2023 were invited to participate in the study. Respondents completed a three-step survey, in which they answered nine multiple-choice knowledge-based questions about cerebral palsy, viewed a 10-minute educational video, and responded to the same nine knowledge-based questions after viewing the video.

Results: A total of 221 surveys were received (response rate: 14%). For the submitted surveys in which paired data were available, the percentage of correct responses at baseline (prevideo), averaged for the nine knowledge-based questions, was 45 ± 15% and increased to 67 ± 11% after viewing the educational video (p < .01).

Conclusions: Our results reveal that medical students' knowledge of cerebral palsy is limited and that a brief, focused educational session may have a short-term beneficial effect in mitigating this gap in knowledge.

Background: Lower limb motor dysfunction is a common sequela of stroke. Further research is needed to identify effective rehabilitation methods to improve motor function.

Objective: To investigate the therapeutic effects of transcranial direct current stimulation (tDCS) and isokinetic strength training (IST), both individually and in combination, on two primary outcomes: lower limb motor function and lower limb muscle strength in individuals with chronic stroke. Additionally, it also explored the effects on balance, gait, and muscle tone as secondary outcomes.

Design: Randomized controlled trial.

Setting: Inpatient department of university hospital.

Participants: A total of 56 individuals with chronic stroke (aged 35 to 77 years) were selected and randomly divided into four groups: control group (n = 14), tDCS group (n = 14), IST group (n = 13), and combined group (n = 15).

Intervention: Two intervention techniques were employed: (1) 20 minutes of 2 mA tDCS, and (2) 20 minutes of IST. In addition, all participants received 80 minutes of standard rehabilitation therapy.

Outcome measures: The primary outcomes were peak torque (PT) of knee flexion and extension and the Fugl-Meyer Assessment of Lower Extremity (FMA-LE) score. The secondary outcomes included the Berg Balance Scale, the 10-meter Walk Test, and the Modified Ashworth Scale scores. Data were collected at baseline and 4 weeks after the treatment.

Results: After 4 weeks of treatment, the tDCS group showed a significant increase in knee extension PT and FMA-LE scores compared to baseline data by 3.59 (p = .009) and 2.07 (p = .009) respectively. In the IST group, knee flexion, extension PT, and FMA-LE scores were significantly higher than baseline data by 5.67 (p = .001), 7.18 (p < .001), and 3.00 (p = .007), respectively. The combined group showed significant increases in knee flexion, extension PT, and FMA-LE scores compared to baseline data by 10.13 (p < .001), 13.04 (p < .001), and 5.27 (p < .001). The combined group showed significantly superior treatment effects compared to the control group, tDCS group, and IST group.

Conclusion: Both tDCS and IST were effective in improving lower limb muscle strength and motor function in individuals with chronic stroke, but the combination of these two techniques was more effective.

Background: Despite targeted national quality improvement initiatives, opioid prescription and use patterns after lower limb amputation are not well studied.

Objective: To determine risk factors associated with extended opioid use and rates of high-risk opioid prescribing after lower limb amputation.

Design and setting: A retrospective population-based study was performed by querying a 20% national sample of Medicare claims of patients undergoing lower limb amputation from 2009 to 2018. Patients were excluded if they did not discharge home or had subsequent surgery 180 days after discharge. Extended opioid use was defined as one opioid prescription filled within 90 days after discharge and another within 90-180 days. Chronic opioid users were defined as having a 180-day supply over the preoperative surgical period and at least one opioid prescription within 60 days of surgery. High-risk opioid prescribing included overlapping opioid prescriptions, overlapping benzodiazepine-opioid prescriptions, high daily doses >100 oral morphine milligram equivalents, multiple prescribers, and new long-acting opioid use within 90 days postoperatively. Multilevel mixed-effects logistic regression and the Cochran-Armitage Trend Test was used.

Main outcome: New persistent and prolonged opioid use following lower extremity amputation.

Results: The study included 5191 patients (nonchronic opioid users = 3759, chronic opioid users = 1432). Among the nonchronic opioid users, 873 (23.2%) had new persistent opioid use after surgery. In these patients, age < 55 years (odds ratio [OR], 1.41, p = .04), concurrent gabapentinoid fills (OR, 1.92, p < .001), and sedative/anxiolytic fills (OR, 1.75, p < .001) were associated with new persistent use. Of the chronic opioid users, 1306 (91.2%) had prolonged opioid use after surgery. Rates of high-risk prescribing did not change significantly during the study period, and 82.3% of chronic opioid users were exposed to high-risk prescribing.

Conclusions: Extended opioid use is common following lower extremity amputation. Moreover, high-risk prescribing practices remain common and have not changed over time.

Background: Prior research shows that persons with disabilities (PWD) frequently receive inadequate health care and that physicians are uncomfortable caring for patients with disabilities, both of which may be attributed to the lack of disability education in medical training. Little is known about what adequate training would include or what PWD wish physicians knew about their experiences.

Objective: To inform the design of a preclinical elective course for medical students by learning from PWD what they believe is most important for physicians to know when providing their care.

Design: Semistructured interviews.

Setting: PWD in the greater Pittsburgh region.

Participants: We recruited individuals aged 18 years and older with disabilities, as well as parents of children with disabilities. Purposive, expert sampling and snowball recruitment took place through medical clinics familiar to the study, social media, and naturally occurring social networks. Of the 94 individuals who expressed interest, 15 were selected to participate.

Methods: Fifteen one-to-one interviews were conducted using a semistructured interview guide, and key themes were identified using thematic analysis.

Results: Study participants described many things they wanted physicians to understand prior to providing their care. They explained the preparation and collaboration necessary to adequately accommodate disability-related needs and the significant impact that failing to do so has on their health and well-being. They also offered examples of good care and practical suggestions for improving care.

Conclusion: Participants highlighted critical gaps in the health care system, underscoring the need for medical education that includes providing care to PWD and a better understanding of disability-related needs. Although the purpose of the study was to inform a preclinical elective course for medical students, this alone is insufficient to train a competent workforce. Further curriculum work is needed to ensure students receive a broad education on disabilities, including both clinical and preclinical instruction.

Background: Clinicians often rely on significant results to inform clinical decisions, with the p value being a common tool to identify statistically significant data. Using trend statements to describe nonstatistically significant results can lead readers to draw misleading conclusions.

Objective: To investigate the frequency and context of trend statements in relation to non-significant findings in platelet-rich plasma (PRP) literature.

Methods: Original research articles examining the use of PRP to treat osteoarthritis or tendinopathy, published between January 2014 and December 2024, were searched on PubMed. Instances where nonstatistically significant results were labeled as a "trend" or included "trend-related statements" were examined to evaluate their use and context within the articles.

Results: A total of 418 articles were analyzed. Trend statements were found in 65 articles (15.6%) to describe nonsignificant data. Among these, 43 articles (66.2%) reported an associated p value, and 22 (33.8%) did not. Forty-seven (72.3%) of the trend statements made were supportive of PRP. Additionally, 40 articles (61.5%) used trend statements for multiple findings, whereas 25 (38.5%) referred to a single finding. The presence or absence of a p value significantly predicted whether a trend statement was made (p < .05). There was no statistically significant difference in average journal impact factors between articles that did or did not contain trend statements, as both groups had an average impact factor of 2.3.

Conclusion: Trend statements are frequently used to characterize nonstatistically significant findings in the PRP literature, which may lead readers to draw incorrect statistical conclusions. Many trend statements were employed to describe multiple findings, often without an associated p value or with a p > .2.

Background: Hamstring injuries are among the most frequent and recurrent musculoskeletal issues in professional women's football. Range of motion (ROM) limitations and neuromuscular fatigue are potentially modifiable risk factors targeted by preventive therapies OBJECTIVE: To compare the immediate and short-term effects of three intervention protocols-manual therapy, active neuromuscular exercises, and a combined approach-on hip and knee ROM in elite female football players during the competitive season METHODS: Sixty-six players were randomly allocated to one of three groups (n = 22 per group): passive therapy (Group A), active therapy (Group B), and combined intervention (passive and active therapy) (Group C). Hip and knee ROM were measured at baseline (Pre), immediately after a single intervention session (Post), and at 1-week follow-up (FU) and a 24-item questionnaire was completed for each player. Data were analyzed using repeated-measures analysis of variance (ANOVA) and post hoc tests with Bonferroni correction RESULTS: All groups showed significant within-group improvements over time in multiple ROM variables (p < .001). Between-group analyses at FU revealed significantly greater gains in passive left hip flexion for Groups B (p = .006) and C (p = .034) compared to Group A. Right hip external rotation also showed significant differences at FU (Group B > A, p < .001; Group B > C, p = .011). Mixed-model ANOVA indicated significant time × group interaction effects for passive left hip flexion (p = .014), right hip external rotation (p = .010), and left hip external rotation (p = .041), favoring the combined intervention CONCLUSION: Combined therapy produced superior short-term gains in specific ROM measures compared to isolated interventions. These findings suggest that integrated neuromuscular strategies may enhance flexibility outcomes relevant to hamstring injury prevention.

Objective: To evaluate the effects of incobotulinumtoxinA (incoBoNT-A) in children and adolescents with spastic cerebral palsy (CP).

Literature survey: CP is a leading cause of childhood disability, with spasticity present in >90% of cases. BoNT-A is widely used to manage spasticity, improving function and quality of life. IncoBoNT-A, a highly purified BoNT-A formulation, offers reduced immunogenicity and greater stability across storage conditions. Although previous reviews have evaluated BoNT-A in CP, none have focused specifically on incoBoNT-A.

Methodology: For this systematic review, we searched databases and trial registries through February 2025 for randomized controlled trials (RCTs) comparing incoBoNT-A with placebo, other BoNT-A formulations, or different doses in patients ≤18 years with spastic CP. Meta-analyses used random- or fixed-effects models; evidence certainty was rated with Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach.

Synthesis: We included four RCTs. IncoBoNT-A showed very uncertain effects compared to onabotulinumtoxinA (onaBoNT-A) on spasticity, gait, and adverse events. Higher doses of incoBoNT-A (≥6 units/kg) showed minimal improvement in spasticity (mean difference: -0.19, 95% confidence interval [CI]: -0.36 to -0.01; moderate certainty) compared to lower doses (≤4 units/kg), with no meaningful differences in motor function, global impression of change, or adverse events. Certainty ranged from moderate to very low.

Conclusions: The available evidence is insufficient to determine whether incoBoNT-A offers any advantages or disadvantages compared to onaBoNT-A in children with spastic CP, given the very low certainty of the data. Similarly, using a higher dose of incoBoNT-A is unlikely to yield a meaningful clinical benefit compared to a lower dose. Further high-quality trials are needed to reduce uncertainty and guide clinical decision-making.

Objective: Infrapatellar fat pad (IFP) conditions represent a significant cause of anterior knee pain, yet evidence-based recommendations for their diagnosis and treatment remain fragmented and underexplored. Despite their clinical relevance, no comprehensive synthesis currently exists of the diagnostic and therapeutic approaches used in these conditions. This review aimed to synthesize existing data on clinical and imaging diagnostics, as well as conservative and surgical treatments for IFP conditions.

Literature survey: A comprehensive literature search was conducted in PubMed, Physiotherapy Evidence Database (PEDro), ProQuest, Scopus, and SPORTDiscus databases from their inception to January 2024.

Methodology: Peer-reviewed studies in English focusing on the diagnosis or treatment of IFP conditions in patients with anterior knee pain were identified and screened independently by two reviewers. Diagnostic and treatments methods for IFP conditions, including clinical manifestations and evidence levels, were synthesized. The occurrence rates of each diagnostic and treatment method were identified and their correlation illustrated with evidence levels using a bubble plot.

Synthesis: This systematic mapping review analyzed 137 studies from 1272 identified articles, aiming to clarify current diagnostic practices and treatment modalities. IFP conditions were most commonly associated with anterior knee pain (52%), typically aggravated by physical activity. Clinical assessments predominantly relied on evaluations of range of motion and pain (25.5% and 24.2%), and magnetic resonance imaging emerged as the diagnostic gold standard, reported in 40.6% of studies. Radiography, ultrasound, and histopathology also played a role in selected cases. The most frequently reported IFP conditions included masses (55.7%) and impingement syndromes (21.6%), followed by scars or postoperative changes (7.2%) and synovial abnormalities (3%). Conservative treatments were reported in approximately one-third of the studies, with medications used in 37% and active modalities in 33.3% of cases. However, surgical interventions, particularly mass resections, were the most frequently reported therapeutic option, reported in 38.4% of the literature.

Conclusions: Diagnosing IFP conditions with magnetic resonance imaging is standard, supported by clinical exams. Conservative approaches are prioritized for mild cases, with surgery considered if needed. Limited metrological validation and lack of standardized protocols limit generalizability. Future research should focus on diagnostic accuracy and treatment optimization.