PM&R最新文献

This scoping review aims to better characterize finger growth plate injuries in adolescent sport climbers and to create a diagnostic and management algorithm for adolescent climbers after a finger growth plate injury. PubMed, EMBASE, and ScienceDirect databases were queried to identify articles from database inception to July 2024 for inclusion. The following search terms were used: (epiphys* OR physis OR physeal OR metaphys* OR "growth plate*") AND (climb*). Studies that examined adolescent sport climbers with a diagnosis of finger growth plate injury were included. Demographic and clinical information, injury characteristics, imaging and treatment modalities, and outcome data were extracted and pooled from all included studies. Eleven studies were included. In total, 149 physeal stress injuries occurred in 98 adolescent climbers with a mean age of 14 years and range of 10 to 18 years. A total of 146 injuries (98%) occurred at the proximal interphalangeal joint. Of these injuries, 74% were fractures, of which 97% occurred at the epiphysis. Baseline radiograph was the most used imaging modality for initial diagnosis of fracture. Treatment ranged from complete rest (21%) to surgical intervention (8%). Overall, return to sport time ranged from 2 weeks to 6 months, and 91% were able to return to climbing. Epiphyseal fractures are the most common growth plate injury reported in adolescent climbers. Identification of these injuries with clinical history and timely diagnostic imaging is critical to return to sport.

Objective: To evaluate the reliability of physical examination tests used for assessing hip flexor flexibility, including the Modified Thomas Test (MTT), Thomas Test, Reactive Hip Flexor Test, Swing Test, and Falcon Test.

Literature survey: A systematic search was conducted across multiple databases (PubMed, CINAHL, SPORTDiscus, Scopus, Web of Science, and Rehabilitation & Sports Medicine Source) up to March 2024.

Methodology: Studies were included if they reported intra- or interrater reliability outcomes for clinical tests assessing hip flexor flexibility, using recognized statistical measures such as the intraclass correlation coefficient (ICC), SEM, minimal detectable change, or Bland-Altman plots. The methodological quality of included studies was assessed using the Quality Appraisal of Reliability Studies checklist. Meta-analyses were performed using random-effects models to calculate pooled ICC values for intra- and interrater reliability, with subgroup analyses based on the type of flexibility test.

Synthesis: The meta-analysis included 27 studies, comprising 1056 participants. The overall pooled intrarater ICC was 0.90 (95% CI, 0.85-0.95) in 888 participants, indicating excellent reliability, and the interrater ICC was 0.80 (95% CI, 0.71-0.88) in 665 participants, reflecting good reliability. However, substantial heterogeneity was observed for both intrarater (I² = 99%) and inte-rater (I² = 98.3%) analyses, particularly for the MTT and Thomas Test. In contrast, the Thomas Test demonstrated the lowest interrater reliability (ICC, 0.62 [95% CI, 0.46-0.78]) with significant between-study variability.

Conclusions: Physical examination tests for hip flexor flexibility demonstrate generally high intra- and interrater reliability. However, considerable methodological variability was identified, particularly for the MTT and Thomas Test, suggesting a need for standardized protocols. Newer tests, such as the Falcon and Swing Tests, showed excellent reliability but require further validation.

The purpose of this scoping review is to evaluate biomechanical variables associated with bone stress injuries (BSI) in active individuals who participate in running. The goal of identifying differences in biomechanics by anatomical location of injury, gender, and/or primary physical activity is to help inform clinical management of BSI. A structured literature search initiated in September 2024 resulted in 21 studies (16 retrospective and 5 prospective) that were included in the analysis. Among retrospective studies, several biomechanical factors were found to be associated with BSI isolated to a specific anatomical site of injury (tibia: increased absolute free moment, greater peak hip adduction, and greater peak rearfoot eversion; metatarsals: lateral angle of peak horizontal braking force, reduced force under the middle forefoot, and faster time to peak rearfoot eversion; navicular: increased rearfoot eversion excursion, increased rearfoot eversion velocity, and decreased forefoot abduction excursion). In prospective studies across lower extremity anatomical locations of BSI, higher vertical ground reaction force, higher peak ankle plantarflexion moment, and spatiotemporal factors including higher vertical center of mass excursion and lower step rate were associated with developing BSI. Heterogenicity in the existing literature limits our understanding of the relationship of biomechanical variables and BSI. Inconsistent methodology, populations, and study designs limit generalizability and the ability to make definitive conclusions. This review identified candidate biomechanical factors to address in populations with BSI and highlights the need for more standardized, prospective studies with broader populations to strengthen evidence-based clinical strategies for the management and prevention of BSIs.

Background: Since the first physical medicine and rehabilitation (PM&R) board certification in 1947, PM&R's board-certifying Part I Examinations have been created by volunteer subject matter experts (SME) in private and academic practices. The American Board of PM&R (ABPMR) relies on the SMEs to create the exam's content outline that is then used as the framework to craft questions for the exam. Although this is a rigorous process with representative specialties across the entire spectrum of PM&R, it relies on the opinions and experiences of these SMEs. Because PM&R has grown in many clinical directions, in 2023, the ABPMR determined that the content outline should more appropriately reflect an updated scope of practice for the specialty. To achieve this goal, ABPMR contracted a psychometric consulting company, with experience in high-stakes professional credentialing, to complete a practice analysis for PM&R.

Objective: To develop an updated content outline for the PM&R Part I certifying exam that embodied the breadth of the specialty including the knowledge and skills required of a competent PM&R physician upon completion of residency training.

Design: Pursuant to this goal, the rigorous research methodology called practice analysis was employed. This article describes the process of practice analysis including project planning; use of focus groups; survey development, dissemination, and analysis; and decision making to determine content and domain weighting for the ABPMR Part I Examination. This information was used by SMEs to assemble a revised content outline to be used for future board Part I Examinations in PM&R.

Conclusion: For the first time since its inception, the content outline of the ABPMR Part I Examination was successfully updated using a practice analysis method. This report described the process to achieve this goal.

Background: Racial disparities are present in the U.S. medical system and lead to detrimental health outcomes and reduced quality of life for many patients. These can be seen in the increased number of amputations among patients from underrepresented minority groups, in addition to differences in access to appropriate rehabilitation care in many debilitating diagnoses.

Objective: To examine racial differences in access to rehabilitation consultation and discharge to an inpatient rehabilitation facility (IRF) among patients in an acute care setting following an amputation.

Methods: Retrospective convenience sample at a tertiary care hospital from a limited database. The study included 640 participants ≥18 years of age who had undergone an amputation at an academic hospital between January 2020 and March 2023. Patients <18, pregnant women, prisoners, those who identified as Native Hawaiian due their low number (n = 1), or those who had undergone solely phalangeal amputations were excluded. The primary outcomes of this study were the discharge destination after acute care hospital and acute care length of stay.

Results: There was a statistically significant association between age and discharge disposition, with a 2% increase in the likelihood of discharge to IRF for each additional year. The length of stay between different racial and ethnic groups showed statistically significant differences, with Asian patients having the longest (23.3 days) and those identifying as "two or more races" having the shortest (11.9 days) stays. When comparing between White, Black, and Hispanic patients, Black patients had the longest length of stay (19.9 days). Lastly, patients who received physiatry consultation were 20 times more likely to be discharged to IRF.

Conclusion: Patients from underrepresented minority groups had a longer acute care length of stay. Race and ethnicity did not appear to affect the amputation level or discharge disposition, including discharge to acute inpatient rehabilitation. Age and the presence of physiatric consultation had the greatest impact on determining the discharge disposition of patients with amputations.