PM&R最新文献

Background: The recruitment of high-quality applicants is critical to the vitality of the sports medicine physician workforce.

Objective: To analyze changes in the total number of available training positions, applicants, and unfilled training positions in the Sports Medicine Match from 2012 to 2022.

Design: This was a retrospective cohort study of sports medicine fellowship applicants.

Setting: Accreditation Council for Graduate Medical Education-accredited sports medicine fellowship training programs.

Participants: A total of 3763 individuals applying for sports medicine fellowship training from 2012 to 2022.

Interventions: Not applicable.

Main outcome measures: Annual number of applicants, training positions, and number of unfilled training positions.

Results: From 2012 to 2022, the annual number of training positions in sports medicine increased from 177 to 353 (99% increase, p < .001) while the annual number of applicants increased from 256 to 428 (67% increase, p < .001). The annual applicant-to-training position ratio decreased (1.4 to 1.2, p < .001). Annual match rates increased for both U.S. MD graduates (64% to 86%, p < .001) and non-U.S. MD graduates (64% to 77%, p < .001). U.S. MD graduates had higher match rates than non-U.S. MD graduates in 2021 (79% vs 70%, p < .05) and 2022 (86% vs 77%, p < .05). The percentage of applicants who matched at their first (36%-36%, p > .05), second (14%-15%, p > .05), and third (9%-8%, p > .05) ranked programs did not change. The percentage of applicants who did not match decreased (33%-19%, p < .001). The percentage of available fellowship training positions that went unfilled decreased (8%-2%, p < .001).

Conclusions: Interest in sports medicine fellowship training is increasing as evidenced by an increasing number of applications and decreasing rate of unfilled training positions. Continued monitoring of future match cycles is important given projected shortages in the physician workforce.

Background: This study describes the gender and racial/ethnic trends in academic physical medicine and rehabilitation (PM&R) and the shifts that have taken place in more than 4 decades.

Objective: To gauge the diversity in gender and race/ethnicity across academic degrees, academic ranks, chair positions, and tenure status in the academic workforce of PM&R.

Design: Surveillance study.

Setting and methods: The data for academic PM&R faculty were self-reported and obtained from the annual Faculty Roster report of the Association of American Medical Colleges from 1977 to 2021.

Main outcome measures: To compare the distribution of academic degree, rank, chair position, and tenure status over time, the percentage composition for each category was calculated for a period of 45 years. The temporal trends were depicted by plotting the counts and proportion changes, and the progress in terms of racial representation was illustrated by graphing the absolute changes in the percentage composition.

Results: Despite an overall increase in the representation of women, women remained underrepresented in the full professor rank in 2021, at only 32.1% of full professors. The instructor category was the only category in which the proportion of women faculty was higher in 2021 (62.8%) than in 1977 (58.5%). Asian faculty had the greatest increase in representation at all ranks, with the proportion of Asian full professors increasing from 1.8% to 11.4%, associate professors increasing from 7.4% to 14.4%, and assistant professors increasing from 11.2% to 20.2%. Women's representation as department chairs increased from 12.5% to 23.7% and Asians from 2.5% to 15.3%.

Conclusion: Overall, although there was an increase in the number of women and underrepresented minority faculty in academic PM&R over the study period, disparities based on gender and ethnicity/race persisted, particularly in higher academic ranks and leadership positions.

Background: White stroke survivors often experience better outcome compared to their counterparts. Poststroke discharge location influences the subsequent rehabilitation that can support recovery and improve outcomes. However, few studies have looked at the association of race and discharge to home.

Objective: To investigate the association between demographic and clinical characteristics of stroke survivors and their discharge location.

Design: Retrospective cohort.

Setting: Large, urban, academic medical center.

Patients: A total of 4633 stroke survivors admitted to the hospital with an acute onset diagnosis of ischemic stroke, hemorrhagic stroke, or transient ischemic attack between January 1, 2015 and April 30, 2023.

Interventions: Not applicable.

Main outcome measure: Discharge location as reported in the electronic health record. The Social Vulnerability Index was used to examine the association between social vulnerability and discharge location from the hospital.

Secondary outcome measure: Demographic and clinical characteristics of routine clinical care.

Results: The majority of participants were White (62.1%), followed by Black (21.6%). Most patients were discharged home from the hospital (58.5%). White patients had the highest percentage of transient ischemic attacks (24.4%), lowest scores on the National Institutes of Health Stroke Scale, (4.5), shortest lengths of stay (6.5 days), highest percentage of patients with no symptoms on the modified Rankin Scale (10.7%), and highest rates of home discharge (63.4%). Black stroke survivors had the highest rates of skilled nursing facility discharges (15.6%). Compared to White patients and patients of all other races, Black patients had a 27% lower odds of discharging home (odds ratio = 0.73, p = .001). Patients with higher levels of vulnerability in housing type and transportation had 35% lower odds of being discharged home compared to those with lower scores (odds ratio = 0.65, p = .002).

Conclusions: Racial differences in stroke outcomes and home discharge were observed between stroke survivors in this study, emphasizing the importance of addressing these disparities in order to promote equitable health care delivery and optimal outcomes.

Purpose: To determine the effect of obesity on physical function and clinical outcome measures in patients who received inpatient rehabilitation services for lower extremity amputation.

Methods: A retrospective review was performed on patients with lower extremity amputation (n = 951). Patients were stratified into five categories adjusted for limb loss mass across different levels of healthy body mass index (BMI), overweight, and obesity. Outcomes included the Inpatient Rehabilitation Facility Patient Assessment Instrument functional scores (GG section), discharge home, length of stay (LOS), therapy time, discharge location, medical complications and acute care readmissions. Deep learning neural networks (DLNNs) were developed to learn the relationships between adjusted BMI and discharge home.

Results: The severely obese group (BMI > 40 kg/m²) demonstrated 7%-13% lower toileting hygiene functional scores at discharge compared to the remaining groups (p < .001). The severely obese group also demonstrated 8%-9% lower sit-to-lying and lying-to-sitting bed mobility scores than the other groups (both p < .001). Sit-to-stand scores were 16%-21% worse and toilet transfer scores were 12%-20% worse in the BMI > 40 kg/m² group than the other groups (all p < .001). Walking 50 ft with two turns was most difficult for the BMI > 40 kg/m² group, with mean scores 7%-27% lower than the other BMI groups (p = .011). Wheelchair mobility scores for propelling 150 ft were worst for the severely obese group (4.9 points vs. 5.1-5.5 points for all other groups; p = .021). The LOS was longest in the BMI > 40 group and shortest in the BMI < 25 group (15.0 days vs. 13.3 days; p = .032). Logistic regression analysis indicated that BMI > 40 kg/m² was associated with lower odds risk (OR) of discharge-to-home (OR = 0.504 [0.281-0.904]; p < .022). DLNNs found that adjusted BMI and BMI category were ranked 11th and 12th out of 90 model variables in predicting discharge home.

Conclusion: Patients with severe obesity (>40 kg/m²) achieved lower functional independence for several tasks and are less likely to be discharged home despite higher therapy volume than other groups. If a patient is going home, obesity will pose unique demands on the caregivers and resources can be put in place to help reintegrate the patient into life.

Background: Dry needling (DN) has been demonstrated as an effective treatment for patients with fibromyalgia (FM). It is crucial to take into consideration catastrophizing, a psychological construct that could potentially undermine the short-term efficacy of DN.

Objective: To analyze the effects of DN in the infraspinatus muscle on both local and remote pressure pain thresholds (PPTs) and its relationship with baseline levels of pain catastrophizing in patients with FM.

Design: Randomized controlled trial.

Methods: All participants were randomly assigned to one of three interventions: DN, sham DN, and no intervention. Hong's fast-in and fast-out technique was implemented during the DN intervention.

Main outcomes measures: The primary study outcome pain sensitivity (local and remote PPTs) was assessed at baseline, immediately post, and 24 h post intervention to evaluate short-term effect. Pain catastrophizing was measured at baseline in all participants using the Pain Catastrophizing Scale. To analyze the effect of DN on local and remote PPTs, an analysis of covariance was performed using catastrophism as covariate. Additionally, to examine the possible influence of catastrophism on local PPTs ratings in the subsequent assessment we performed a moderation analysis.

Patients: A total of 120 women diagnosed with FM. However, during the follow-up period, 24 participants discontinued their involvement, leaving a final cohort of 96 patients who successfully concluded the study.

Results: DN showed significant differences in both local PPTs immediately post intervention and 24 h post intervention (MD [95% confidence interval] = 3.21 [0.40-6.02] kg/cm², p = .019; and 2.84 [0.10-5.58] kg/cm², p = .039, respectively) compared to sham and no-intervention groups. In addition, DN group results suggest that moderate values of catastrophizing (<35) diminish the effect of DN immediately postintervention.

Conclusions: The infraspinatus DN led to a notable reduction in local PPTs among individuals with FM. Additionally, the effectiveness of the DN treatment was influenced by pain catastrophizing.

Background: Adhesive capsulitis (AC) is a common cause of shoulder disability. Interventional procedures are used along with many other treatment methods. There are insufficient studies directly comparing the superiority of suprascapular nerve block (SSNB) and intra-articular shoulder injection (IAI) techniques, which are frequently used interventional methods in treatment.

Objective: To compare the efficacy of ultrasonography-guided SSNB and IAI techniques in terms of pain and functional status in the treatment of AC.

Design: A single-center, double-blind randomized study.

Setting: The study was conducted at the Physical Therapy and Rehabilitation outpatient clinic of Antalya Training and Research Hospital between March and October 2022.

Participants: Eighty-four participants aged 15 to 75 years with a clinical diagnosis of AC were screened for the study, and 60 participants were included in the study after excluding participants who did not meet the criteria.

Interventions: Participants were randomized into two groups with 30 participants in each group. Both groups received an injection of 1 mL of 40 mg of triamcinolone acetonide and 9 mL of 0.5% bupivacaine hydrochloride under ultrasonographic guidance.

Main outcome measures: The patients' Shoulder Pain and Disability Index (SPADI) scores, shoulder active and passive range of motions (ROM), and visual analog scale (VAS) scores were evaluated before and after the injection in the 1st week, 4th week, and 12th week.

Results: Our study found no significant difference in SPADI and ROM between the two groups when comparing pre-injection and post-injection results in 1st week, 4th week, and 12th week. When pre-injection and 1st week, 1st week and 4th week, 4th week and 12th-week measurements were compared, improvement in SPADI-Disability scores, SPADI-Total scores, active flexion, passive flexion, active abduction, passive abduction, and active extension ROM values continued until the 12th week in both groups. In both groups, improvement in SPADI-Pain scores, active external rotation, and passive external rotation ROM values continued until the 4th week. In terms of VAS scores, passive extension, active internal rotation, and passive internal rotation ROM values, there was a statistically significant improvement in both groups after the injection compared to pre-injection.

Conclusion: The efficacy of SSNB and IAI techniques in the treatment of adhesive capsulitis was found to be similar. In both methods, significant improvements were observed in SPADI, ROM, and VAS measurements compared to baseline.