American Journal of Physical Medicine & Rehabilitation最新文献

Objectives: The aims of this study were to characterize the electrodiagnostic findings of radial neuropathy using motor segmental conduction study and to determine the utility of subsequent inching test in precise lesion localization.

Design: Twenty-three patients with radial neuropathy were evaluated using radial neuropathy using motor segmental conduction study with three-point stimulation. The pathomechanism of the lesions according to the radial neuropathy using motor segmental conduction study was classified into three groups: conduction block, mixed lesion (combination of conduction block and axonal degeneration), and axonal degeneration. Inching test was performed in patients with conduction block to localize the lesion site, and needle electromyography identified the most proximal radial nerve-innervated muscles affected.

Results: Out of 23 cases, the radial neuropathy using motor segmental conduction study demonstrated probable partial conduction block in 10, mixed lesions in 2, and axonal degeneration in 10. One case could not be categorized with radial neuropathy using motor segmental conduction study alone. As determined by radial neuropathy using motor segmental conduction study and inching test, the most common cause of conduction block was compression, while the most common cause of axonal degeneration was iatrogenic. In the conduction block group, the lesion locations identified by radial neuropathy using motor segmental conduction study and inching test were consistent with needle electromyography localization.

Conclusions: The combined radial neuropathy using motor segmental conduction study and inching test technique can precisely localize radial motor nerve injuries and provide detailed information on electrodiagnostic characteristics of radial mononeuropathy.

Objective: The aim of the study is to investigate the association between adherence to spinal cord injury-specific physical activity guidelines in manual wheelchair users with spinal cord injury and shoulder pain prevalence.

Design: This is a cross-sectional analysis of the SwiSCI Community Survey 2022 data, assessing aerobic activity and muscle strength training adherence in manual wheelchair users with spinal cord injury and shoulder pain prevalence. Logistic regression analysis was used to identify the association between meeting the physical activity guidelines and shoulder pain.

Results: Low adherence to aerobic activity and strength training guidelines are observed, with 46% and 64% of the study sample not meeting the respective guidelines. The low adherence to physical activity guidelines contrasts with the general Swiss population from which around 75% is physically active for more than 2.5 hrs a week. Manual wheelchair users present a high prevalence of shoulder pain (40%) and nonadherence to aerobic guidelines in the study sample correlates with 1.55-1.97 higher odds of having shoulder pain.

Conclusions: Aerobic activity adherence is associated with lower shoulder pain prevalence, emphasizing its potential for injury prevention. Overall, the presented findings necessitate further longitudinal studies and interventions for a comprehensive understanding and effective management of shoulder pain in manual wheelchair users with spinal cord injury.

Abstract: Inappropriate urinary tract infection diagnosis in patients with neurogenic bladder may result from ambiguous symptoms experienced by these patients and contributes to antibiotic overuse. Characterization of patient-reported signs and symptoms may help providers more appropriately diagnose urinary tract infections. A previous study collected signs and symptoms recorded in electronic medical records of patients with neurogenic bladder due to spinal cord injury/disorder, multiple sclerosis, and Parkinson's disease with at least one urinary tract infection diagnosis between 2017-2018 at four medical centers. In this study, 23 veterans from this cohort with urinary tract infection diagnoses in the previous year participated in focus groups conducted May 2021-May 2022. Transcripts were coded using mixed deductive and inductive coding. Qualitative data were compared to electronic medical records data to give a comprehensive picture of signs and symptoms. Both providers and patients attributed nonspecific symptoms like urine changes to urinary tract infection, but there was discordance between patients and providers in the identification of other signs and symptoms. Several patients described providers disregarding symptoms other than fever or chills. Optimizing urinary tract infection care for patients with neurogenic bladder could involve improving patient-provider communication about urinary tract infection signs and symptoms and emphasizing thorough elicitation and evaluation of all signs and symptoms.

Objective: The aims of the study are to describe the use of professional home care in persons with spinal cord injury over a 10-yr period from 2012 to 2022 and to examine how the use of home care is associated with the future occurrence of secondary health conditions and hospitalizations.

Design: This is a longitudinal questionnaire survey as part of the Swiss Spinal Cord Injury Cohort Study, conducted in 2012, 2017, and 2022.

Results: There were 1549, 1294, and 1158 participants in the three surveys in 2012, 2017, and 2022. The percentage of home care users decreased from 23% in 2012 to 22% in 2017 and 19% in 2022. Fewer home care recipients reported pain (odds ratio 0.52, 95% confidence interval 0.29-0.94), with no reductions in other secondary health conditions, 5 yrs later. Study participants who received home care were more likely to be hospitalized (odds ratio 1.89, 95% confidence interval 1.05-3.42), 5 yrs later.

Conclusions: There is a declining trend in the use of home care services among persons with SCI. While home care is associated with lesser development of pain, it does not generally reduce secondary health conditions. Individuals who receive home care are significantly more likely to report hospitalization 5 yrs later.

Abstract: Artificial intelligence emerges as a transformative force, offering novel solutions to enhance medical education and mentorship in the specialty of physical medicine and rehabilitation. Artificial intelligence is a transformative technology that is being adopted in nearly every industry. In medicine, the use of artificial intelligence in medical education is growing. Artificial intelligence may also assist with some of the challenges of mentorship, including the limited availability of experienced mentors, and the logistical difficulties of time and geography are some constraints of traditional mentorship. In this commentary, we discuss various models of artificial intelligence in medical education and mentoring, including expert systems, conversational agents, and hybrid models. These models enable tailored guidance, broaden outreach within the physical medicine and rehabilitation community, and support continuous learning and development. Balancing artificial intelligence's technical advantages with the essential human elements while addressing ethical considerations, artificial intelligence integration into medical education and mentorship presents a paradigm shift toward a more accessible, responsive, and enriched experience in rehabilitation medicine.

Objective: The aim of the study is to investigate healthcare utilization and related costs in spinal cord injury compared to the Swiss population, addressing gaps in understanding this vulnerable group's needs.

Design: We analyzed healthcare utilization across age groups using data from the Swiss Health Survey and the Swiss Community Survey. Employing count models, Zero-Inflated Negative Binomial, and Poisson regressions, we estimated the adjusted healthcare visits across different age groups in the sample.

Results: Persons with spinal cord injury use 11 times more healthcare services than the healthy population and 4 times more than persons with other chronic health conditions. Notably, service providers for persons with spinal cord injury include physiotherapists, nursing services, general practitioners, and specialists. The high frequency of usage of persons with spinal cord injury translates into high costs, which is 3 times higher than in the general healthy population. These patterns become more evident as persons with spinal cord injury age, where nursing care and rehabilitation services become the most demanded services.

Conclusions: Our findings show the multiple healthcare needs of people with spinal cord injury, which makes them a high-needs, high-cost group. This characteristic underscores the importance of preventive measures to reduce the incidence of spinal cord injury in older adults.