American Journal of Physical Medicine & Rehabilitation最新文献

Objective: The prevalence of burnout in Canadian physiatrists is unknown. This study describes the prevalence of burnout in Canadian physiatrists and explores predictors.

Design: This national cross-sectional web-based survey used convenience sampling, targeting Canadian physiatrists (staff, fellows, residents). The Checklist for Reporting Results of Internet E-Surveys was used to ensure reporting quality. Statistical analyses included descriptives, correlations, and logistic regressions. Survey items included personal and professional characteristics, and validated measures for burnout, relational compassion, emotion regulation, and moral injury.

Results: One hundred eighteen responses were collected from a possible 501 physiatrists across Canada. Majority were female (53%), White North American (55%), and working in an urban setting (93%). Forty-two percent ( n = 50) had burnout, 43% moral injury, and 40% difficulties regulating emotions. Burnout was more likely in females ( P = 0.0064; odds ratio 5.24, 95% confidence interval 1.60-17.3), and White respondents ( P = 0.0213; odds ratio 0.24, 95% confidence interval 0.07-0.81). Higher relational compassion conferred a lower risk of burnout ( P = 0.0006; odds ratio 0.80, 95% confidence interval 0.71-0.91); greater difficulty regulating emotions predicted higher risk of burnout ( P = 0.0406; odds ratio 1.06, 95% confidence interval 1.00-1.11), and moral injury ( P < 0.0001; 95% odds ratio 1.16, 95% confidence interval 1.09-1.24).

Conclusions: Burnout affects 4 in 10 Canadian physiatrists. Physiatrists who are female, White, and report greater difficulties regulating emotions are at greater risk.

Abstract: Education in quality improvement is linked to high-quality health care, and involving residents as key leadership in quality improvement projects ensures a level of engagement to reinforce principles in practice. Obtaining timely laboratory data in inpatient settings is critical to decision making. This resident-led group identified that the established forms of communication regarding uncollected laboratory draws at this inpatient rehabilitation facility were not standardized. There was significant variance in communication between phlebotomists and clinicians. Based on a root cause analysis, the quality improvement team concluded that a single unified email notifying clinicians about uncollected labs would be an effective and efficient communication method. A standardized email template was created and sent to the resident physicians and advanced practice providers during a 2-week feasibility pilot. After a successful pilot intervention, the communication email was expanded to include attending physicians. The standardized weekday email was distributed 100% of the time during both 2-week interventions. The residents leading the project gained a better understanding of the dynamics of interdisciplinary collaboration required within hospital operations to facilitate the success of a quality improvement intervention.

Abstract: Affiliated residency programs may provide key advantages to medical students, including early exposure, mentorship, and research opportunities. This study investigates the impact of having an affiliated home residency physical medicine and rehabilitation program on match patterns in allopathic medical students. Data were gathered from publicly available match lists from allopathic medical schools. The study included 153 allopathic medical schools with 89,191 medical students from 2020 to 2024. This study found that the presence of an affiliated physical medicine and rehabilitation residency program is associated with higher proportions of students matching into physical medicine and rehabilitation (1.54% vs. 1.05%; odds ratio = 1.48; 95% confidence interval: 1.30-1.67; P < 0.001) and a higher likelihood of matching into the same geographic region as one's medical school (54.98% vs. 46.08%; odds ratio = 1.43, 95% confidence interval: 1.11-1.84; P = 0.0074). In addition, 69.41% of the allopathic students matching into physical medicine and rehabilitation came from a medical school with an affiliate, and 31.57% of the students coming from a medical school with an affiliate matched into that home program. Thus, medical schools without a physical medicine and rehabilitation residency program may benefit from initiatives that enhance specialty engagement and support for students interested in physical medicine and rehabilitation.

Objective: The aim of the study is to evaluate the impact of aquatic treadmill walking on the pelvic dynamics of children with cerebral palsy.

Design: The study is a block-randomized cross-over design with 8 children with cerebral palsy and 15 typically developing children. All participants walked at fast, normal, and slow speeds on an aquatic (WET) treadmill and conventional (DRY) treadmill. Inertial measurement units recorded the participants' pelvic angles in the mediolateral, anteroposterior, and axial angles from which sample entropy values were determined.

Results: A multilevel model showed decreased irregularity in the pelvic dynamics of both cerebral palsy and typically developing groups in WET conditions compared with DRY and at slower compared with higher speeds in the mediolateral and axial planes. For the anteroposterior plane, the irregularity of the pelvic motion decreased at the slow speed-WET condition compared with the fast trial.

Conclusions: The study shows the potential of the aquatic treadmill environment to induce more typical postural dynamics for children with cerebral palsy compared with conventional dry treadmills. Postural dynamics also had decreased irregularity at slower walking speeds. A longitudinal study would show the retention tendencies of observed impacts on children with cerebral palsy.

Objective: The aim was to examine the potential impact of Tai Chi on the enhancement of both physical and mental well-being in individuals with knee osteoarthritis.

Design: In this study, a search was conducted across the databases of PubMed, Cochrane Library, and Embase. The keywords "Tai Chi" and "knee osteoarthritis" were employed.

Results: Seventeen randomized controlled trials comprising 980 participants were included. The results indicated that Tai Chi was significantly associated with improvements in various measures, including the Western Ontario and McMaster Universities Arthritis Index (WOMAC) pain score (weighted mean difference -1.87), WOMAC stiffness score (weighted mean difference -0.62), WOMAC physical function score (weighted mean difference -10.33), Short Form Health Survey physical component summary score (weighted mean difference 3.17), and Short Form Health Survey mental component summary score (weighted mean difference 2.31). Furthermore, Tai Chi exercise demonstrated superior performance in the Timed Up and Go test, while no significant difference was observed in the 6-Min Walk Test (weighted mean difference 10.43). No serious adverse events were reported.

Conclusions: The results of this study suggest that Tai Chi may have a significant effect on reducing pain, joint stiffness, and improving physical function in individuals with knee osteoarthritis, as measured by the WOMAC scale. Furthermore, Tai Chi shows promise in enhancing both the physical and mental aspects of quality of life, as well as improving performance in the timed up and go test.

Objective: The present study aimed to compare shoulder functional ratio and bilateral strength asymmetry between overhead para athletes and able-bodied peers, and ascertain whether those factors could be associated with shoulder injury history in para athletes under resting and fatigued conditions.

Design: Sixteen sitting volleyball para athletes and 12 able-bodied volleyball players were evaluated. The shoulder functional ratio was measured at rest and after a fatiguing shoulder internal-external rotation exercise on dominant and nondominant shoulders. Imbalanced muscle strength profiles were identified as a functional ratio <0.7 and bilateral peak torque asymmetry either >10% or >15%. All injuries incurred over the past 2 mos before testing were reported.

Results: No injury was surveyed in able-bodied athletes while nine dominant shoulder overuse injuries were reported in nine para athletes. Functional ratio and bilateral asymmetry were not significantly different between groups at rest or after exercise in either shoulder ( P > 0.05). Functional ratio <0.7 and bilateral asymmetry of either >10% or >15% were statistically associated with shoulder overuse injury history in the dominant limb in para athletes ( P < 0.05), but with a higher relative risk under fatiguing-conditions ( P < 0.01).

Conclusions: External rotator muscle conditioning should be implemented in overhead para athlete regular training to alleviate shoulder imbalance and bilateral asymmetry, especially in fatigued conditions.

Abstract: We conducted an online survey of 574 physiatrists in the Department of Veterans Affairs (VA) system to assess demographics and practice patterns in July 2024 and obtained 392 responses (68.3%). The majority of the physiatry workforce reported being between the ages of 36-65 yrs old (82.1%). Most physiatrists (35%) have been employed by the VA between 1 and 5 yrs. The number of physiatrists per facility ranged from 1 to 27 and most (86%) reported being employed full-time. Only 62% of the physiatrists have a faculty appointment with their affiliated academic institution while 67% teach physical medicine and rehabilitation residents. The majority of the physiatrists (96%) are board-certified in physical medicine and rehabilitation and 40% hold subspecialty certification. Electrodiagnostics is practiced exclusively by physical medicine and rehabilitation in 30% and is shared between physical medicine and rehabilitation and neurology in 64%. The most commonly reported practice type for physiatrists in the VA system was outpatient musculoskeletal medicine. Joint and soft tissue injections top the list of procedures performed by physiatrists. About 11% perform spinal injections. Use of orthobiologics for was reported by 14%. The greatest need identified was cancer rehabilitation. This VA physiatry workforce sheds light into the evolving practice of physiatry and future needs, essential for program and succession planning.

Objective: The aim of the study was to determine if a low admission Karnofsky Performance Scale score is indicative of a higher likelihood of death within 3 mos of discharge from inpatient rehabilitation with an active cancer diagnosis.

Design: A retrospective, observational design was employed to analyze electronic medical records of 385 patients with a primary or concurrent diagnosis of cancer admitted from a multicenter, acute inpatient rehabilitation hospital system between January 1, 2020, and December 31, 2020.

Results: Of the 385 patients, a total of 77 patients (20%) had an observed death within 3 mos. Out of the sample of patients with an observed death within a 15-mo window ( n = 157), 49% died within 3 mos of discharge from the IRF. Patients with a Karnofsky Performance Scale score of 40 or less had a significantly higher risk of mortality within 3 mos of discharge (hazard ratio = 1.49, 95% confidence interval = 1.09-2.04, P = 0.013). For those surviving less than 3 mos, average survival was 32 days. Improvements in Karnofsky Performance Scale score during the inpatient stay were linked to better survival outcomes.

Conclusions: These findings provide insight into the prognosis of patients with cancer in inpatient rehabilitation, emphasizing the importance of functional assessment in predicting mortality within 3 mos of discharge.