American Journal of Physical Medicine & Rehabilitation最新文献

Abstract: As endorsed by leading endocrine societies, a fragility fracture of the hip or spine warrants a diagnosis of osteoporosis, irrespective of bone mineral density. A fragility fracture occurs from a force equal to or less than a fall from standing height, an event unlikely to cause a fracture in healthy bone. Physiatrists often manage patients with such fractures, including fractures stabilized by surgery. However, many patients are not diagnosed with osteoporosis during their acute hospitalization or rehabilitation admission, leading to suboptimal care and an increased risk of repeat fractures. This project involves a 6-mo retrospective review of 77 patients with fragility fractures at an acute inpatient rehabilitation facility, which found that none of the 77 patients were diagnosed with osteoporosis either at the time of admission or during their stay. To address this, the authors developed an educational flowchart for admitting providers and a "smart-phrase" shortcut within the electronic health record that automatically entered a diagnosis of osteoporosis into the patient's record. After intervention, 93% of patients (56/60) admitted with fragility fractures over 6 mos had osteoporosis documented in their rehabilitation medical record. Additionally, 66% of patients discussed or received osteoporosis management during outpatient primary follow-up appointments.

Objective: Lee Silverman Voice Treatment is an exercise program developed for patients with Parkinson's disease. This systematic review and meta-analysis evaluate the benefits of Lee Silverman Voice Treatment on motor function in these patients.

Design: A comprehensive search was conducted in Embase, PubMed, Cochrane Library, Scopus, MEDLINE, ScienceDirect, and PEDro up to October 2024. Two investigators reviewed studies comparing Lee Silverman Voice Treatment with other interventions on motor function outcomes. Study quality was assessed using the Cochrane Risk of Bias tool, and certainty of the evidence was evaluated using Grading of Recommendations Assessment, Development, and Evaluation methodology.

Results: The search identified 827 studies, with 6 included in the systematic review and 5 in the meta-analysis. Lee Silverman Voice Treatment significantly improved walking speed, as measured by the 10-Meter Walk Test mean difference (MD) -0.60, (95% confidence interval (CI) = -1.17, -0.02, P = 0.04). No significant improvement was found in quality of life (Parkinson's Disease Questionnaire-39 items, MD -2.79, 95% CI = -7.38, 1.80, P = 0.23). Sensitivity analysis revealed significant improvement in motor function (Unified Parkinson's Disease Rating Scale Part III, MD -5.52, 95% CI = -7.72, -3.32, P < 0.05). The certainty of evidence ranged from moderate to low.

Conclusions: Lee Silverman Voice Treatment could be more effective than general exercise in improving gait speed and motor function in patients with mild to moderate Parkinson's disease. However, because of the variability in study quality and the limited number of participants, these findings should be interpreted with caution.

Objective: The aim of the study was to determine the effects of age on inflammatory markers and histological features in the injured mouse tail intervertebral disc.

Design: Inflammatory marker gene (e.g., Cxcl1 , Il6 , Adam8 , and Tipe2 ) expression and morphological changes (histological score and % red in Safranin O staining) in the injured intervertebral discs are recorded in 3-, 10-, and 18-mo-old mice 1 wk after injury.

Results: The injured intervertebral discs had higher histological scores (more degenerative) than intact discs at all ages post injury ( P < 0.01). However, there was no significant difference among the histological scores of injured intervertebral discs from mice of three ages ( P > 0.05). Expression of inflammatory marker genes (e.g., Cxcl1 and Il6 ) was elevated in the injured compared with intact discs in mice of all ages ( P < 0.01). The injury-induced increase in gene expression was greater in 10-mo and 18-mo-old mouse discs than in the 3-mo-old mice ( P < 0.01).

Conclusions: The intervertebral discs responded to injuries similarly, regardless of age. Because of the modest age-related differences in injury effects, using mice of the same age in experiments is essential, unless one aims to examine age-related differences. Given the costs of maintaining an aged mouse colony, the necessity of using old animals may need justification.

Objective: The aim of the study was to report on real-world use of a powered exoskeleton for outpatient gait training in multiple sclerosis.

Design: We conducted a retrospective chart review on 21 patients with multiple sclerosis who completed physical therapy gait training sessions using a powered exoskeleton. Training descriptors, powered exoskeleton parameters, adverse events, and performance on mobility tests without powered exoskeleton were compared between first and last session.

Results: The median number of gait training sessions was 11. There was a statistically significant increase in walk time ( P = 0.008), number of steps ( P = 0.011), and programmed step length ( P < 0.001) while using powered exoskeleton. Three patients exhibited a greater than 20% increase in walking speed on the Timed 25 Foot Walk. The time to complete the Timed Up and Go increased ( P = 0.029), although patients who did not use a wheelchair outdoors showed a smaller mean increase in Timed Up and Go time (0.59 secs vs. 8.69 secs, P = 0.050). Five patients had one mild adverse event without impact on training participation.

Conclusions: Our findings suggest that gait training with a powered exoskeleton is safe and feasible in individuals with multiple sclerosis. Changes in mobility outcomes without powered exoskeleton were highly variable between patients. Further research is needed to establish the value of powered exoskeleton gait training and predictors of response to gait training.

Abstract: This study aimed to measure how many physical medicine and rehabilitation residencies include a disability awareness program, investigate the format and content of existing programs, understand barriers to including a disability awareness program, and evaluate receptiveness to adopting provided disability awareness resources. A Qualtrics survey was distributed through the physical medicine and rehabilitation residency program director listserv to all 112 accredited physical medicine and rehabilitation residencies in the US. Fifty-three program directors completed surveys (47%), and 52 responses were analyzed. Fifty-eight percent of physical medicine and rehabilitation residencies included a disability awareness program. Frequently utilized formats included didactic courses/lectures (82%), adaptive sports experiences (64%), and panels of individuals with disability (or their caregivers) (46%). Physical disabilities were most commonly covered in the curriculum (96%), followed by intellectual (61%) and sensory disabilities (50%). There was minimal curriculum coverage of the Alliance for Disability in Health Care Education's Core Competencies on Disability. For residencies without a disability awareness program, barriers included lack of faculty expertise in disability advocacy education (55%), insufficient resources for curriculum development (50%), and limited faculty time (41%). The majority (59%) of residencies reported they would likely or very likely adopt a provided disability awareness program. This study identifies a demand for a comprehensive, standardized disability awareness curriculum for physical medicine and rehabilitation residency programs.

Objective: The aim of the study was to perform a systematic review comparing the accuracy and the efficacy of ultrasound-guided versus landmark-guided and other image-guided glenohumeral joint injections.

Methods: Embase, PubMed, Scopus, and Web of Science were searched up to June 24, 2023. Independent authors reviewed and selected qualifying randomized controlled studies, cohort studies, and case control/case series comparing either the accuracy and/or clinical efficacy of ultrasound-guided versus landmark-guided and other image-guided glenohumeral joint injections. Two independent authors extracted and synthesized the data. Quality appraisal of the studies was performed using the Cochrane Assessment of Bias tool (RoB2) and Newcastle-Ottawa Quality Assessment Scale, where applicable.

Results: A total of nine studies were included in the review, which included eight live human studies and one cadaveric study. Eight studies assessed for accuracy of ultrasound-guided glenohumeral joint injections. Cumulatively, there was a 63%-100% accuracy rate with ultrasound-guided injections compared with 40%-76.19% accuracy rate with blind injections and 72%-100% with fluoroscopic-guided injections. The accuracy rate of ultrasound-guided glenohumeral joint aspirations was 69.4% compared with the accuracy rate of other image-guided modalities, which was 70.6%. Three randomized control studies evaluated the efficacy of ultrasound-guided injections compared with landmark-guided injections by examining pain, range of motion, and function. All three studies did not show a statistically significant difference in the either group in all measures, although one study did show a statistically significant improvement in pain reduction sooner in the ultrasound-guided group.

Conclusions: Ultrasound-guided glenohumeral joint injections are more accurate than landmark-guided injections and have similar accuracy rates compared with other imaging modalities. Ultrasound-guided injections are efficacious in treating glenohumeral joint disorders but not superior to landmark-guided injections. Future research should focus on standardized protocols, larger sample sizes, and long-term follow-up to obtain more robust evidence to determine the superiority of ultrasound-guided injections.

Abstract: Clinical and translational research is important for health care and the growth of medical specialties. Physical medicine and rehabilitation offers many opportunities for research, but research growth in physical medicine and rehabilitation is lacking, and research resources and productivity vary across academic physical medicine and rehabilitation departments across North America. The Physiatric Research Consulting Program was developed by the Association of Academic Physiatrists to provide customized recommendations to enhance research capacity and productivity in physical medicine and rehabilitation departments. This report outlines the three components of the Physiatric Research Consulting Program, including a previsit needs assessment, an in-person visit, and a postvisit follow-up final report. The report also provides a qualitative assessment of the impact of the Physiatric Research Consulting Program, with general themes of feedback, site visit evaluations, and final report evaluations. The Physiatric Research Consulting Program was found to be valuable in identifying gaps and needs for physical medicine and rehabilitation departments, providing outside perspectives, and energizing faculty toward research growth in their departments.

Objective: The aim of the study was to identify the self-care and mobility functional response in patients with and without COVID-19 who were admitted to inpatient rehabilitation.

Design: Cross-sectional retrospective multisite study using data collected from routine care data from the Rehabilitation Registry of COVID-19 patients within 12 inpatient rehabilitation facilities across the United States from March 1 through December 31, 2020, was used.

Results: Data included 11,734 patients admitted to one of the participating hospitals. Of the patients admitted, 868 had active or had recently recovered from COVID-19 before their admission to the rehabilitation hospital. Patients with active or who had recently recovered from COVID-19 were younger with a mean age 65.74 yrs, over half being male (60.0%) and White (64.4%), with significance seen in the African American population. Fewer patients with COVID returned home, and the majority in both groups had neurological diagnoses, longer lengths of stay, fewer minutes of therapy, and a lower functional response in the self-care domain.

Conclusions: This study demonstrates patients with active and recovered COVID-19 who received inpatient rehabilitation made significant gains in self-care and mobility. These findings suggest that a structured inpatient rehabilitation program may provide benefit in patients with active and recovered COVID-19.

Objective: The aim of the study was to investigate the effect of cognitive training on sleeping disorders in poststroke.

Design: Forty stroke patients who suffered from sleep difficulties were split into two equal groups at random: the study group had cognitive training plus instructional sleep hygiene therapy for 4 wks, whereas the control group just received instructional sleep hygiene therapy for three sessions a week. The Mini-Mental State Examination, Pittsburgh Sleep Quality Index, and Epworth Sleeping Scale were used to evaluate the patients both before and after treatment.

Results: The study demonstrated a statistically significant improvement impact in the study group compared to the control group on the Mini-Mental State Examination, Pittsburgh Sleep Quality Index, and Epworth Sleeping Scale ( P < 0.05).

Conclusions: After a stroke, cognitive training significantly improved the rehabilitation of sleep disturbances.