PM&R最新文献

Background: Prosthetists and other rehabilitation specialists often need to identify which aspects of mobility should be prioritized in order to make meaningful changes in a patient's health outcomes. By comparing a patient's responses on the Prosthetic Limb Users Survey of Mobility (PLUS-M) to predicted responses, clinicians can identify areas for improvement and provide more targeted rehabilitation.

Objective: To generate PLUS-M T-score maps based on patient presentation (ie, etiology and amputation level) to provide guidance on the next steps in a patient's rehabilitation care.

Design: A frequency response method was used to generate PLUS-M T-score maps. The maps predicted the most probable response to each item on the PLUS-M based on the T-score. The maps were then tested using a separate test dataset. Accuracy was evaluated by comparing differences and Spearman correlation coefficients between predicted and actual scores.

Setting: Clinical orthotics and prosthetics care.

Participants: Maps were generated based on a training dataset from a large sample (N = 28,719) of patients with lower limb amputation. A separate test dataset (N = 26,535) was used to test the model. Individuals were included in the training and test datasets if they were adults with unilateral above-knee or below-knee amputation.

Interventions: Not applicable.

Main outcome measure(s): PLUS-M 12-item short form (v1.2).

Results: PLUS-M T-score maps were generated for two amputation levels (above and below knee) and two etiologies (dysvascular and nondysvascular), in addition to one for all patients. PLUS-M T-score maps predicted patient scores with high accuracy (difference scores >91.5% and Spearman correlation coefficients >0.801).

Conclusions: Clinicians can use the developed PLUS-M T-score maps to better understand patients' mobility. This insight can help clinicians improve care by identifying key rehabilitation goals for their patients.

Background: Cauda equina syndrome is a surgical emergency often caused by lumbar disc herniation. Spinal manipulative therapy is commonly used for lumbar spine disorders, but case reports have raised concerns it may precipitate cauda equina syndrome. One cohort study suggested no increased risk, although it did not focus on patients with lumbar spine disorders pertinent to cauda equina syndrome, such as disc herniation, stenosis, or radiculopathy/sciatica.

Objective: To address this evidence gap, we tested the null hypothesis that there is no increased risk of cauda equina syndrome following spinal manipulative therapy among adults with these lumbar spine disorders compared to matched controls receiving physical therapist-led therapeutic exercise (PTE).

Methods: Using a retrospective cohort design, we queried a U.S. research network (TriNetX) including patients aged ≥18 years with a lumbar spine disorder and excluding those with preexisting cauda equina syndrome, incontinence, serious spinal pathology, and recent spine surgery/injection. Data spanned 2005-2025. Patients were divided into cohorts: (1) spinal manipulative therapy administered by a chiropractor or (2) PTE without spinal manipulative therapy. Propensity score matching controlled for confounding variables. Outcomes included the risk ratio of cauda equina syndrome (primary), and bladder catheterization and bowel incontinence as additional cauda equina syndrome markers (secondary).

Results: After matching, there were 34,376 patients in each cohort. Comparing the spinal manipulative therapy cohort to PTE cohort, the incidence and risk of cauda equina syndrome did not significantly differ (risk ratio=0.88 [95% CI, 0.43-1.79]; p = .715). The risk of bladder catheterization (risk ratio = 0.50 [95% CI, 0.39- 0.64]; p < .001) and fecal incontinence (risk ratio = 0.50 [0.37, 0.68]; p < .001) was significantly lower in the spinal manipulative therapy cohort.

Conclusion: Among adults with lumbar disc herniation, stenosis, and/or radiculopathy, we did not identify an association between spinal manipulative therapy and an increased risk of cauda equina syndrome.

Background: Concomitant traumatic brain injury (TBI) and traumatic spinal cord injury (TSCI) have been understudied despite their occurrence in approximately 40%-60% of TSCI cases and approximately 4%-13% of TBI cases.

Objective: To compare outcomes between concurrent TBI and TSCI (TBI + TSCI) to isolated TBI and TSCI.

Design: Observational longitudinal study.

Setting: Merative MarketScan Research Database (2000-2022).

Participants: Data for individuals 18 years or older who were hospitalized for TBI or TSCI were extracted and separated into three groups: 200,018 TBI; 17,045 TSCI; and 5486 TBI + TSCI.

Interventions: Not applicable.

Main outcome measures: Demographics, comorbidities, index hospitalization length of stay, index payments, index complications, discharge disposition, 12-month rehabilitation use, 12-month complications, health care use (emergency department visits, outpatient services, hospitalizations, medications), 12-month post-discharge payments, and total payments.

Results: Patients with TBI + TSCI were overall younger than those with isolated TBI or TSCI. Patients with TBI + TSCI had more commercial insurance coverage but less Medicare and Medicaid coverage compared to isolated injuries. Individuals with TBI + TSCI had the greatest index payments and were the least likely to be discharged home. At 12 months post-discharge, 73% of individuals with concurrent injuries had at least one complication, higher than the complication rates of isolated TBI or TSCI. However, the TBI + TSCI group had lower prescription medication refills than the groups with isolated injuries. Individuals with TBI + TSCI used fewer rehabilitation services and had lower 12-month post-discharge payments than those with isolated TSCI but used more rehabilitation services and had higher payments than those with isolated TBI. Total payments were greatest in TBI + TSCI cases.

Conclusion: Overall, patients with co-occurring TBI + TSCI had higher complication rates and payments compared to TBI alone and TSCI alone. Gaining deeper insights into the complexities, health care requirements, and economic impact of concurrent TBI + TSCI can facilitate the development of tailored and effective treatment management strategies.

Background: Brain injury medicine (BIM) is a medical subspecialty addressing the prevention, diagnosis, and treatment of individuals with brain injury. BIM fellowships have been accredited by the Accreditation Council for Graduate Medical Education (ACGME) since 2014.

Objective: To identify practice patterns of physiatrists who have completed an ACGME-accredited BIM fellowship and assess the training satisfaction and potential opportunities for enhancement of BIM fellowship training.

Design: Online cross-sectional survey.

Setting: A national cross-sectional survey of BIM physiatrists was designed in conjunction with the American Board of Physical Medicine and Rehabilitation.

Participants: Physiatrists who had graduated from an ACGME-accredited BIM fellowship between 2014 and 2023.

Interventions: Not applicable.

Main outcome measure(s): Demographic information, current practice patterns, and levels of satisfaction (very unsatisfied to very satisfied) with fellowship training in areas of core competency.

Results: The survey was completed by 61 BIM fellowship graduates. Fifty-one percent of respondents identified as male, and 46% reported practicing in the Northeast. Seventy-seven percent of respondents held teaching roles at a medical school, and 82% were in a clinical leadership role. Eighty-seven percent reported performing botulinum toxin injections in their current practice. Overall, respondents reported a high degree of satisfaction with fellowship training.

Conclusions: Survey respondents work predominantly in the Northeast, in both inpatient and outpatient environments, and are more likely to work in academic medical centers. Survey respondents commonly held clinical and academic leadership roles. Phenol/alcohol neurolysis, respiratory complications, pain management, and special brain injury populations were identified as potential areas for further fellowship development.

By the end of residency, physical medicine and rehabilitation (PM&R) residents are expected to align patient values with treatments using goals of care (GOC) discussions. Like other procedural skills, GOC communication skills are best learned through simulation training and deliberate practice and feedback rather than lectures. However, educational resources to effectively impart these skills are often lacking. How can educators design effective GOC communication curricula with limited time and resources? This article presents two teaching techniques grounded in adult learning theory that educators can apply to increase teaching effectiveness. Additionally, a 2-hour GOC curriculum for PM&R residents is outlined, its feasibility and acceptability are discussed, and preliminary efficacy data are shared.

Background: Artificial intelligence has begun to replace human power in many areas today.

Objective: To assess the performance of Chat Generative Pretrained Transformer (ChatGPT) on examinations administered to physical medicine and rehabilitation (PM&R) residents.

Design: Cross-sectional study.

Setting: Tertiary-care training and research hospital, department of physical medicine and rehabilitation.

Participants: ChatGPT-4o and PM&R residents.

Intervention: ChatGPT was presented with questions from the annual nationwide in-training exams administered to PM&R residents at different postgraduate years. The exam is a national requirement for the majority of PM&R residents in Turkey and is administered annually.

Main outcome measures: The responses to these multiple-choice questions were evaluated as correct or incorrect, and ChatGPT's performance was then compared to that of the residents of each postgraduate year (PGY) term. The time taken by ChatGPT to answer each question was also recorded. Additionally, its learning ability was assessed by reasking the questions it initially answered incorrectly, this time providing the correct answers to evaluate improvement.

Results: ChatGPT received a score of 88 out of 100 points in the PGY1 exam, 84 points in the PGY2 exam, 78 points in the PGY3 exam, and 80 points in the PGY4 exam. When compared with the performance distribution of residents, ChatGPT ranked in the 40th-50th percentile for PGY1, 70th-80th percentile for PGY2, 30th-40th percentile for PGY3, and 40th-50th percentile for PGY4. It has been demonstrated that ChatGPT has achieved a learning rate of 65%.

Conclusion: Despite the potential of ChatGPT to surpass PM&R physicians in terms of learning capabilities and extensive knowledge network, several functional limitations remain. In its current form, it is not capable of replacing a physician, especially in the field of PM&R, where clinical examination and patient interaction play a critical role.