PM&R最新文献

Background: Musculoskeletal injections are a common clinical procedure, often intended to reduce joint or muscular pain in patients. Further identification is warranted to identify additional clinical variables that may lead to increased or decreased pain perception with musculoskeletal injections.

Objective: To examine clinical, demographic, and injection-related factors with patient-perceived pain during musculoskeletal injections, which expands upon prior studies.

Design: Cross-sectional study.

Setting: Retrospective study involving outpatient orthopedic clinics. Consecutive adult patients (age ≥ 18 years) undergoing musculoskeletal injections were reviewed.

Patients: A total of 1371 injections from 935 patients were eligible for the analysis. Exclusion criteria included cognitive disability, non-English-speaking patients, and aphasia.

Interventions: N/A.

Main outcome measures: Patients reported their pre-, intra-, and postprocedural pain on a numerical scale from 0 to 10. Pain scores, demographics, and injection specifics were analyzed after retrospective chart review for their effect on intraprocedural pain.

Results: A total of 1371 injections (62.4% female, mean age 58.6 ± 16.1 years, body mass index 29.6 ± 7.3 kg/m²) were included for analysis. The median intraprocedure pain score was 2. According to the multivariate linear regression model, female gender (B = 0.42; 95% confidence interval [CI] = 0.15-0.69; p < .01), ultrasound image guidance (B = 0.66; 95% CI = 0.22-1.10; p < .01), presence of a trainee (B = 0.44; 95% CI = 0.15-0.73 p < .01), and body mass index (B = 0.04; 95% CI = 0.01-0.06; p < .01) were significantly associated with greater intraprocedure pain score, whereas use of sodium bicarbonate (B = -0.68; 95% CI = -1.01 to -0.35; p < .01), age (B = -0.01; 95% CI = -0.02 to -0.01; p = .04), and injectate volume (B = -0.06; 95% CI = -0.13 to -0.01; p = .04) had significant, inverse associations with intraprocedure pain score. The logistic regression model showed the significant association of presence of trainee (odds ratio = 1.86; 95% CI = 1.23-2.83; p < .01) to intraprocedure pain score of ≥1 (vs. 0).

Conclusions: This study identified clinical and demographic variables associated with worsened injection pain that may improve the counseling and expectations of patients and ideally lead to reduction in experienced procedural pain. Lower pain scores were associated with use of sodium bicarbonate, absence of a trainee, palpation guidance, and male gender of the patient.

Background: Radiofrequency ablation (RFA) of neuromas has emerged as a potential treatment option for refractory neuroma-associated postamputation pain (PAP).

Objective: To evaluate the feasibility of using internally cooled radiofrequency ablation (C-RFA) for treating neuroma-associated PAP.

Design: Prospective single-arm pilot study.

Setting: Tertiary academic medical center.

Participants: Eight participants with neuroma-associated PAP (mean age 56.5 [interquartile range, 50.5-68.5] years; mean body mass index 30.2 [interquartile range, 26.3-34.8] kg/m²).

Intervention: Participants were recruited and treated with C-RFA between 2019 and 2023.

Main outcome measures: Pain and functional outcomes were assessed at 1, 3, 6, and 12 months after C-RFA using Numeric Rating Scale (NRS), Groningen Activity Restriction Scale (GARS), Patient Global Impression of Change (PGIC), and Medication Quantification Scale III (MQS-III). Responder definitions for each outcome measure were ≥50% NRS reduction, ≥30% GARS improvement, ≥6 on PGIC, and ≥6.8-point MQS-III reduction.

Results: NRS responder rates at 1, 3, 6, and 12 months were 25.0% (95% CI, 7.0%-59.1%), 50.0% (95% CI, 21.5%-78.5%), 37.5% (95% CI, 13.7%-69.4%), and 50.0% (95% CI, 21.5%-78.5%), respectively. Responder rates for GARS were 25.0% (95% CI, 7.1%-59.1%) at 1 month and 12.5% (95% CI, 2.2%-47.1%) at 3, 6, and 12 months. The proportion of PGIC responders was 37.5% (95% CI, 13.7%-69.4%) at 1 and 3 months and 12.5% (95% CI, 2.2%-47.1%) at 6 and 12 months. MQS-III responder rates were 25.0% (95% CI, 7.1%-59.1%) at 1 month, 12.5% (95% CI, 2.2%-47.1%) at 3 months, and 37.5% (95% CI, 13.7%-69.4%) at 6 and 12 months. There were no complications associated with the C-RFA procedure.

Conclusions: These findings indicate the feasibility of neuroma C-RFA as a treatment for refractory neuroma-associated PAP but also suggest that further patient selection and C-RFA technique optimization are warranted before investigating this treatment paradigm in a larger prospective study.

Background: In-reach rehabilitation is a relatively new model of care available in a small number of Australian public hospitals. These multidisciplinary teams deliver evidence-based structured rehabilitation to carefully selected patients during acute care. There are no published rehabilitation outcomes in heart and/or lung transplant recipients.

Objective: To describe the rehabilitation outcomes of a cohort of heart and/or lung transplant recipients.

Design: Retrospective cohort study.

Setting: One metropolitan institution with the largest heart and lung transplant service in Australia.

Patients: Between 2014 and 2023, a total of 957 heart and/or lung transplants were performed at this institution.

Intervention: In-reach rehabilitation was delivered to selected patients during the 10-year period. However, from 2019 onwards, patients were proactively screened by the rehabilitation team for eligibility as well as referred from the acute transplant teams.

Main outcome measures: Functional independence measure (FIM) changes and percentage of patients going to inpatient rehabilitation after completion of acute care.

Results: In-reach rehabilitation was received by 223 (24.3%) patients. With the exception of three patients (who died), the vast majority were able to complete an in-reach rehabilitation program and were discharged to the community (n = 98, 43.9%), inpatient rehabilitation (n = 119, 53.4%), or transferred to another hospital (n = 3, 1.3%), demonstrating feasibility. Across the cohort, the median admission and discharge FIM scores were 77.0 (interquartile range, 60-94.8) and 100 (interquartile range, 77-118), respectively, demonstrating significant functional improvements from start to finish of the in-reach rehabilitation program (p < .001). Over this period, the number of patients discharged to inpatient rehabilitation decreased as a proportion of the total number of transplants (25.7% in 2014, 47.8% in 2017, 34.7% in 2019, 26.2% in 2021, 8.0% in 2023). Proactive rehabilitation screening implemented from 2019 allowed for earlier and longer program delivery to more patients.

Conclusions: In-reach rehabilitation is feasible in acute care after heart and/or lung transplantation and was associated with functional improvements. The addition of proactive rehabilitation screening appeared to improve the effectiveness of the in-reach rehabilitation program.

Background: Mild traumatic brain injury (mTBI) is common among military service members. Moderate-to-vigorous aerobic exercise (MVAE) is a modifiable behavior with potential benefits for individuals following mTBI but is poorly understood for long-term mTBI health.

Objective: To explore the associations between mTBI history and MVAE participation and appreciate their association with health-related quality of life (HR-QOL) among service members and Veterans.

Methods: Data from a larger study were used in these secondary cross-sectional analyses. Lifetime mTBI history (0, 1-2, 3+) was captured via validated structured interviews. Self-reported weekly MVAE (none, below, meeting, or ≥2 times the recommendation) was recorded from the Behavioral Risk Factor Surveillance System questionnaire. Participants' HR-QOL was self-reported via Traumatic Brain Injury-Quality of Life instrument and the Patient Health Questionnaire-9 (depression symptoms). Univariate mTBI history and MVAE associations were assessed via Pearson's chi-square and Kendall's Tau. Multivariable linear regression models with unstandardized beta values and 95% confidence intervals were fit for each HR-QOL questionnaire outcome, with current age, sex, and posttraumatic stress disorder symptoms as covariates (α = .05).

Results: Among the 1995 participants (87.7% male; aged 41.7 ± 10.1 years), those meeting or exceeding (≥2 times) MVAE recommendations had significantly higher HR-QOL for fatigue, executive function, pain interference, resilience, social participation, and depression than the inactive MVAE group. Exceeding MVAE recommendations by ≥2 times was also significantly associated with better self-reported cognition - general concerns. Those who participated in exercise but didn't meet the MVAE recommendations had higher pain interference, social participation, and depression scores compared to the inactive group. More lifetime mTBIs were associated with worse HR-QOL across all domains. Level of MVAE participation was not dependent on mTBI history.

Conclusions: More MVAE was associated with better TBI-related HR-QOL regardless of mTBI history. MVAE is recommended for service members and Veterans due to these findings and previously reported health benefits.

Background: All physicians will care for persons with disabilities over the course of their careers. However, most medical school curricula do not adequately prepare students to recognize and address the specific needs of persons with disabilities. Despite physician requirements under the Americans with Disabilities Act (ADA), patients with disabilities may receive substandard care due to a lack of accommodations.

Objective: To examine the effect of a physical medicine and rehabilitation (PM&R) clerkship on fourth-year medical students' understanding of physician responsibilities under the ADA as well as comfort levels when caring for persons with disabilities.

Design: Subjective pre- and postintervention surveys.

Setting: A single institution U.S. allopathic medical school.

Participants: All fourth-year medical students enrolled in the mandatory PM&R clerkship during the 2022-2023 academic year were eligible for participation in the study. Surveys were distributed to all eligible students and 99 students successfully completed both surveys for inclusion in the study.

Interventions: For the 2022-2023 academic year, the mandatory 2-week PM&R clerkship included didactic lectures on the ADA and additional interactive, first-hand accounts from persons living with a disability.

Main outcome measures: The change from medical students' baseline to postclerkship knowledge regarding the ADA responsibilities for physicians and overall comfort in working with persons with a physical disability.

Results: Medical students' overall knowledge of the clinical and financial responsibilities of physicians under the ADA and comfort in interacting with persons with disabilities improved following the clerkship (p < .001).

Conclusions: These findings highlight the importance of disability education as part of medical school curricula to improve medical student knowledge about physician responsibilities under the ADA and overall comfort level in caring for persons with disability. Further studies are needed to determine if these results carry over into clinical practice to combat the health care disparities experienced by persons with disabilities.

Background: Stroke, whether or not accompanied by concurrent COVID-19 infection, has been associated with varying acute care outcomes, with patients who are COVID-19 positive typically faring worse. This study aims to explore the functional outcomes of patients with stroke -with and without simultaneous COVID-19 infection-who survived their acute care stay and progressed to acute inpatient rehabilitation (IRF).

Objectives: To identify differences in sociodemographic factors, medical complexity, and rehabilitation outcomes from an IRF stay between patients with stroke with concurrent COVID-19 and those without.

Design: A retrospective, observational cohort study using electronic medical records (EMR) data.

Setting: EMR data from 138 IRFs across 34 states of the United States and Puerto Rico involving 40,282 individuals following stroke discharged between April 1, 2020 and May 31, 2021 of whom 1483 (3.7%) were COVID-19 positive.

Participants: NA.

Interventions: NA.

Main outcome measures: Variables collected included sociodemographic and medical complexity along with outcome variable categories included functional complexity, process outcomes, and functional abilities.

Results: Significant differences were found between the two groups using standardized effect sizes >0.2. COVID-19 positive patients with stroke had more comorbidities (94.1% vs. 51.8%, standardized effect = 1.1), lower admission mobility (26 vs. 30, standardized effect = 0.27), lower discharge mobility scores (56 vs. 65, standardized effect = 0.27), and a longer IRF stay (17 days vs. 14 days, standardized effect = 0.30). They also were less likely to return to the community (65.5% vs. 78.3%) but had a higher acute care transfer rate (19.1% vs. 10.6%). Logistic regression showed that Hispanic COVID-positive individuals and those with higher mobility scores were more likely to be discharged to the community.

Conclusions: There are meaningful differences in rehabilitation outcomes between COVID-19 positive and negative individuals with stroke that clinicians can use to better understand, anticipate and mitigate outcome challenges facing the COVID-19 positive population with stroke.

Background: Awareness of physical medicine and rehabilitation (PM&R) is limited among students, contributing to underrepresentation in the field. Underrepresentation can be tackled through early exposure, which has shown promise as early as high school in inspiring future physicians.

Objective: To develop a structured, multi-institutional half-day workshop to introduce high school students to PM&R, highlighting innovative technologies and approaches.

Design: The workshop involved collaboration between physicians, medical students, and premedical students from New York City. The curriculum included lectures on PM&R, discussion about virtual reality, and hands-on activities like ultrasound training, yoga, medical device design, and networking with doctors and students.

Setting: Multi-institutional.

Participants: High school students.

Interventions: Half-day workshop.

Main outcome measure: Baseline knowledge of PM&R, demographics, learning environment, and workshop learning objectives post workshop and at 3-month follow-up.

Results: Seventy-nine students attended the workshop and 69 students completed the preworkshop survey, with 65% self-identifying as female. Most participants (71%) belonged to an underrepresented racial minority group and/or were prospective first-generation medical students. None had prior experience shadowing or being mentored by a PM&R physician. Postworkshop results (n = 63) indicate a significant increase in the appreciation of virtual reality in medicine, yoga as rehab, the importance of continuity of care, and overall understanding of PM&R and the physiatrists' role (p < .05). Three-month follow-up (n = 23) demonstrates sustained outcomes and no significant differences in metrics such as interest in medicine and PM&R (p > .05).

Conclusion: This workshop is the first to provide structured mentorship and lectures to high school students within PM&R, highlighting innovative technologies and approaches. The curriculum was well received by students and successfully promoted awareness and interest in PM&R, both short and long-term. The results could inspire other programs and specialties to adapt the workshop curriculum.