PM&R最新文献

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: 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.

Background: Parkinson's disease (PD) significantly impairs mobility and increases the risk of falls.

Objective: To evaluate the feasibility and safety of a randomized controlled trial protocol investigating the effects of transcranial direct current stimulation (tDCS) combined with gait training.

Methods: Twenty-five individuals with PD were assessed for eligibility to participate in either active tDCS walking training (experimental group) or sham tDCS walking training (control group) for 4 weeks, consisting of 12 30-minute sessions.

Results: Of the 25 individuals assessed, 11 met the eligibility criteria (44%), and 9 were enrolled in the study (36% of eligible, 22.5% of total). Adherence to the intervention was high (88.9%), and no serious adverse events were reported.

Conclusion: The protocol was found to be safe and feasible, though methodological adjustments, particularly in eligibility criteria and logistical procedures, are recommended to improve future implementation. These findings support the feasibility of conducting a full-scale randomized controlled trial to evaluate the combined effects of tDCS and gait training in individuals with PD.

Objective: To compare the pooled estimates and variability in pain and function outcomes for spinal manipulative therapy (SMT) versus sham SMT in randomized clinical trials (RCTs), which informs the potential for heterogeneity of treatment effect.

Design: Meta-epidemiological study.

Literature search: We used results from the previous Cochrane review and meta-analysis and performed updated electronic searches from May 2018 to June 2025.

Study selection criteria: RCTs comparing SMT to sham SMT for chronic low back pain.

Data synthesis: For the meta-epidemiological analysis, we estimated the variance ratios of pain and function outcomes for both pooled results and individual trials. Variance ratio statistically different than 0 indicate greater variability in one group, providing evidence that heterogeneity of treatment effect may be present.

Results: Fifteen trials (n = 1141) were included in the analysis. No statistically significant or meaningful variance ratios were found in 1-, 3-, 6-, and 12-month pooled results for pain and function. Among individual RCTs, greater variability was found in two trials for the SMT group and four trials in the sham SMT for pain or function at the 1-month analysis.

Conclusion: There were no significant differences in the variability of pain and function outcomes for SMT groups compared to sham SMT groups for chronic low back pain. This suggests there is no evidence the distribution around the mean estimate is different between interventions at all time points and does not support the potential for heterogeneity of treatment effect in this population. Nevertheless, we cannot conclusively rule out heterogeneity of treatment effect using variance ratios alone. This study provides an example of how using variance ratios in meta-analyses and RCTs can add other statistically and clinically meaningful findings.

Background: Spine pathologies are associated with an inflammatory microenvironment, with previous studies demonstrating systemic inflammation based on analysis of serum from patients with low back pain (LBP). This pilot study used gene expression profiling to identify candidate cellular mechanisms mediating systemic inflammation in patients with LBP, with and without radicular pain, compared to asymptomatic controls.

Objective: To identify differences in expression of inflammation- and immune-related genes in whole blood from patients with LBP and spine pathology compared to control participants. Also, identify relationships between differentially expressed (DE) genes and patient-reported outcomes (PROs) for pain (Visual Analog Scale [VAS]) and disability (Oswestry Disability Index [ODI]).

Design: Case control, observational study.

Setting: Outpatient clinic at academic institution.

Patients: Nine participants with LBP who were 18 years or older and diagnosed with lumbar disc herniation, spinal stenosis, or disc degeneration. Eight control participants who were 18 years or older and had no history of LBP or spinal treatment.

Interventions: N/A.

Main outcome measure: Expression levels of inflammation- and immune-related genes in patients with LBP compared to control participants measured using Nanostring nCounter analysis.

Results: Analysis of patients with LBP versus controls resulted in 11 DE genes (p-adj < .05) and 9 trending genes (p-adj < .1) falling into three clusters: "Interferon α/β Signaling," "Immunoglobulin Binding," and "Toll-like Receptor (TLR) Binding." VAS scores were also associated with expression level of FCER1G, FCGR3A/B, and KLRK1. Further analysis showed significantly lower expression of FCER1G in patients with high versus low VAS (p < .05). No relationships between DE gene expression and ODI was identified; however, a significant correlation between VAS and ODI scores was observed (p < .05).

Conclusions: Clustering of DE and trending genes suggested increased interferon α/β signaling and TLR signaling may contribute to systemic inflammation related to LBP. Immunoglobulin binding was also implicated and varied with pain severity in patients with LBP.

Background: Participation in American-style football (ASF) results in trauma-related concerns including joint injuries. Limited work has described arthritis and knee and hip total joint arthroplasty (TJA) in this population. The association of these conditions to pain interference and physical and mental function has not been well described.

Objectives: 1. To characterize demographic, football, and health-related factors in former ASF players associated with arthritis and knee or hip TJA. 2. To investigate the association of arthritis and knee or hip TJA with pain interference and physical and mental function.

Study design: Cross-sectional cohort study.

Setting: Academic medical multisite hospital system.

Participants: Former ASF players who played professionally from 1960 to 2019.

Assessment of risk factors: Self-completed standardized questionnaires.

Main outcome measures: Surveys included self-reported arthritis and knee and hip TJA, Patient-Reported Outcome Measure Instrument Scale (PROMIS), physical function and mental function, and pain interference scales. Multivariable logistic regression models assessed the association between demographic, football-related, and health characteristics with arthritis and knee and hip TJA. Multivariable linear regression models evaluated the association between arthritis and knee and hip TJA with pain interference and physical and mental function.

Results: In 4189 former ASF players (average and SD: 51.8 ± 14.4 years old) over half (n = 2237, 53.4%) had arthritis (n = 1547) or knee or hip TJA (n = 690). Both arthritis and knee and hip TJA were more common in those who were older, with higher body mass index, and prior surgery during playing years and were linemen (p < .05). Additionally, arthritis was more common in players who were never married (p = .01) and with higher concussion symptoms score (p < .001). Knee and hip TJA were more common in players who self-identified as White (p < .001). Both arthritis and knee and hip TJA were associated with greater pain interference and reduced physical function (all p < .001) but not with mental function.

Conclusion: More than half of former ASF players reported arthritis or knee or hip TJA. Higher pain interference and reduced physical function in former ASF players with arthritis and knee or hip TJA highlight the importance of advancing strategies to prevent and treat joint conditions.