PM&R最新文献

Background: A national database is used to evaluate pediatric burn survivor outcomes, but the generalizability to the United States pediatric burn injury population is unclear, as only 60% of enrollees are U.S. residents. An increased understanding of population similarities and differences between residents of the United States and residents of Mexico treated in the United States within this database will help determine its ability to extrapolate.

Objective: Assess the generalizability of a national burn database to the U.S. pediatric burn injury population.

Design: This retrospective cohort study analyzed pediatric enrollees in a burn database. Data were stratified into children who were residents of the United States or Mexico at time of injury and grouped by age into <5 years, 5-10 years, and >10 years.

Setting: Not applicable.

Participants: A total of 2043 children enrolled in the database from 1998 to 2020.

Interventions: Not applicable.

Main outcomes measured: Determination of similarities and differences between gender, injury etiology, total body surface area injured, length of stay, and place of injury between the two groups.

Results: Both groups showed an increased incidence of burn injury among males as they aged. In U.S. residents, the most frequent etiology in patients <5 years was scald (292 [53.6%]), followed by fire/flame (157 [28.8%]). In residents of Mexico, fire/flame burns were more frequent in all ages and electric burns were more common among children >5 years. In both groups, outdoor injuries became more common as children aged. Children from Mexico had larger burns and longer lengths of hospital stay than children from the United States across all ages.

Conclusion: Differences between U.S. and Mexico groups were likely attributable to children with more severe burns being transferred to the United States for care, whereas those with low-severity burns were treated locally. This suggests that children from Mexico in the database were not representative of the pediatric burn injury population of the United States or Mexico more broadly and caution should be used before generalizations are made using this database.

Background: Poststroke osteoporosis, particularly of the hip, and an increased risk of fractures due to accidental falls are well known in people with stroke. Only a few of the current stroke guidelines recommend bone mineral density (BMD) measurements during follow-up in this population and measurements are often performed unilaterally.

Objectives: To compare femoral hip BMD between fallers and nonfallers among patients with stroke, while also assessing differences in balance, mobility, fear of falling, and exploring discrepancies between paretic and nonparetic sides within each group.

Design: Cross-sectional.

Setting: Inpatient stroke rehabilitation unit of a tertiary university hospital.

Patients: Patients with unilateral hemiplegia hospitalized as a result of stroke.

Interventions: Not applicable.

Main outcome measures: The primary outcome was the femoral neck BMD measurement. Dual-energy x-ray absorptiometry was used to measure BMD. Secondary outcomes included Berg balance scale (BBS), timed up-and-go test (TUGT), functional ambulation classification (FAC), and falls efficacy scale-international (FES-I).

Results: A total of 44 patients were enrolled. Twenty-two participants (50%) reported falling. There were no statistically significant differences in BMD (p = .504, p = .197, p = .667, respectively) and T-scores (p = .457, p = .194, p = .693, respectively) of paretic, nonparetic femoral neck, and lumbar spine between nonfallers and fallers. The BBS (p = .033, 95% confidence interval [CI] 0.17-19.05) was significantly lower in the fallers. The FES-I was statistically significantly higher in the fallers (p = .001, 95% CI -22.40 to -6.50). The BMD and T-scores of femoral neck between the paretic and the nonparetic limbs did not differ significantly in the nonfallers (n = 22) (p = .908, 95% CI -0.03-0.03; p = .886, 95% CI -0.27-0.24) but did differ in the fallers (n = 22) (p = .007, 95% CI -0.06 to -0.01; p = .006, 95% CI -0.51 to -0.09).

Conclusions: This study emphasizes that hip BMD may differ on paretic and nonparetic sides, especially in patients with stroke and a history of falls and balance problems. Fall-related self-efficacy and balance may be determinants of falls in these patients.

Background: Youth concussion is common but there is a paucity of information on symptoms students report to school personnel and a gap in understanding what accommodations schools can provide.

Objective: To examine symptoms and provision of temporary accommodations in schools for students reporting concussion symptoms.

Design: Secondary data analysis of a trial implementing an evidence-based student-centered return to learn (RTL) program.

Setting: Thirteen public high schools during the 2021-2022 academic year.

Participants: Sixty-two students diagnosed with concussion who reported symptoms to school personnel.

Interventions: The school-based RTL program, which consists of up to four weekly check-ins with an RTL champion who evaluates symptoms and recommends symptom-tailored accommodations.

Main outcome measures: Symptom profile, accommodation type, and accommodation duration.

Results: A total of 46 (74.2%) students received accommodation for ≤2 weeks and 16 (25.8%) students received accommodation for 3 (21.0%) or 4 (4.8%) weeks. Sixty-two students experienced an average of 11.2 unique symptoms during week 1. Compared to students whose symptoms resolved within the first 2 weeks, students who received accommodation for 3 or 4 weeks reported higher initial total symptom severity score (p = .02), and higher initial average severity per symptom (p = .01) at week 1. Physical symptoms were most common and received corresponding accommodations most often (75/90 reports: 83.3% of occurrences). In total, 674 (nearly 11 accommodations per student) weekly accommodations were offered.

Conclusions: Students with concussion report a large number and type of symptoms that necessitate symptom-tailored academic accommodations. High school implementation of an evidence-based RTL program may aid in identifying and addressing many RTL needs after concussion, including potential identification of students with concussion who will require longer-term support.

The medical specialty of physical medicine and rehabilitation (PM&R) focuses on quality of life, function, ability, and interdisciplinary care. PM&R clerkships are uniquely qualified to teach medical students about rehabilitation and the spectrum of postacute care, medical knowledge, and medical decision making related to health care affecting people with disabilities, health care disparities affecting people with disabilities, and the communication and teamwork strategies to provide a patient-centered approach to optimize function and outcomes. PM&R clerkships can be used to fulfill stakeholder and governing body requirements, such as medical knowledge, rehabilitation, critical judgment, health disparities, ethics, communication, teamwork, and patient-centered medical care, in order to maintain accreditation and provide a high-quality education This review provides both a rationale for a medical student clerkship in PM&R and an effective example of such an experience that has been implemented during medical school training.

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: 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.