American Journal of Physical Medicine & Rehabilitation最新文献

Abstract: Resident teaching of medical students is integral to medical education; however, there are few studies surveying residents, especially U.S. Physical Medicine and Rehabilitation (PM&R) residents, about their perspectives on teaching medical students. This descriptive survey study consisted of a 23-item cross sectional survey to elicit the current state of medical student teaching by PM&R residents and formal education for PM&R residents on teaching medical students. During an eight-week period, 103 PM&R residents completed a web-based survey, which was distributed to residents via emails to PM&R residency program directors and coordinators. Ninety-seven (94.1%) respondents reported teaching medical students. A majority of these respondents (81.4%) reported favoring formalized education on medical student teaching; however, little more than half (51.5%) reported having that education. Majorities of residents with and without formal education on teaching medical students reported employing multiple teaching techniques to teach students in the clinical and non-clinical environments. The most commonly reported barrier to teaching students was time. While limited by study design and sample size, this study suggests that the availability of formalized education for PM&R residents on medical student teaching may not meet the needs or desires of residents.

Objective: To investigate the effectiveness of early continuous passive motion combined with physical therapy compared to physical therapy alone as the rehabilitation protocol after the release of elbow contracture.

Design: In this randomized controlled trial, 61 patients were randomly assigned to two groups (31 in the early continuous passive motion with physical therapy group vs. 30 in the physical therapy group). The patients received rehabilitation with or without early continuous passive motion for 4 weeks and were followed up for 6 months. The outcome measures were the range of motion and Mayo Elbow Performance Score.

Results: The early continuous passive motion with physical therapy group demonstrated statistically significant improvements in range of motion and the Mayo Elbow Performance Score compared with the physical therapy group at 6 weeks, 3 months, and 6 months postoperatively. These differences were not observed in the stability subscale of the Mayo Elbow Performance Score at any of the assessed time points, nor in its pain subscale at 6 months.

Conclusion: Compared with physical therapy alone, early continuous passive motion combined with physical therapy enabled a quicker recovery of functional elbow motion and early pain control within the 6-month follow-up after arthroscopic release of elbow contracture.

Abstract: We aim to investigate the association of Instagram and Twitter (rebranded X) adoption by Physical Medicine & Rehabilitation (PM&R) residencies with the number of National Resident Matching Program (NRMP) applications received in the 2020-2021 application cycle. Among 88 PM&R residency programs, 67 (77%) had Instagram accounts, 45 (51%) had Twitter accounts, and 41 (47%) had both. Forty (60%) Instagram accounts and 19 (42%) Twitter accounts were opened during the 2020-2021 application cycle, correlating with the introduction of virtual interviews and the COVID-19 pandemic. Residency programs with active Instagram or Twitter accounts had more NRMP applications (F(2,85) = 7.49, P = 0.001). Simple main effects analysis showed that programs with an Instagram account (P = 0.03) or a Twitter account (P = 0.03) received more residency applications. In multivariate linear regression analysis including presence of an Instagram account, program size, program setting, and program region, the presence of a Twitter account (coefficient 37.3, P = 0.04, 95% CI 1.71-72.96) and ≥ 16 residents in the residency program (coefficient 77.9, P < 0.001, 95% CI 44.43-111.31) were positively correlated with the number of residency applications. In conclusion, residency programs that were larger and adopted Twitter had more applicants in 2020-2021. Future research is needed to determine how social media activity impacts residency applicant decision-making.

Abstract: Sometimes out of necessity and sometimes out of convenience, medicine is wasteful. Resource stewardship is a critical and expanding field for reducing wasteful practices. Numerous international organizations are driving resource stewardship globally, including >20 countries worldwide participating in Choosing Wisely initiatives. However, opportunities for environmental stewardship have been long overlooked. Planetary health, climate action, and environmental stewardship in medicine consider opportunities which offer a co-benefit to the planet while improving or maintaining appropriate patient care across the healthcare continuum, including acute care, transitions in care, and post-acute care, as well as in primary, secondary, and tertiary care settings. As rehabilitation is necessary across all healthcare settings, developing a culture amongst rehabilitation care providers that is conscientious about planetary health is imperative for sustainability of rehabilitation medicine and the health of our planet. We devised a recommendation for Choosing Wisely Canada's planetary health focus: don't dispose of adaptive equipment, mobility devices, orthoses, and prostheses that could be reused or recycled. This brief report discusses 1) why rehabilitation providers should engage with planetary health and climate action; 2) the rationale for the Choosing Wisely Canada Physical Medicine & Rehabilitation planetary health recommendation, and 3) existing avenues and novel opportunities for rehabilitation care providers worldwide to reduce waste in rehabilitation.

Abstract: Lack of information is cited as a source of distress for caregivers of patients with brain injury during the recovery process. This is a quality improvement project with the purpose of educating family members of brain injury patients about acute inpatient rehabilitation and providing a reliable source of information through the Model Systems Knowledge Translation Center Traumatic Brain Injury Model Systems Factsheets. The study was conducted in the brain injury unit of an acute inpatient rehabilitation facility and a total of 32 family members participated in the study. Educational sessions were provided verbally by phone based on the Model Systems Knowledge Translation Center-Traumatic Brain Injury Model Systems "Traumatic Brain Injury and Acute Inpatient Rehabilitation" Factsheet. Surveys with five confidence statements and Likert scale-graded responses were verbally administered by phone immediately before and after each educational session to evaluate for understanding. There was a statistically significant increase in confidence for all five confidence statements when comparing pre- and posteducation responses ( P < 0.05, Wilcoxon signed-rank test). This quality improvement project thereby presents an effective and feasible framework for teaching, improving communication, and providing valuable information to families early in the brain injury rehabilitation course.

Objective: This study investigated the effect of neuromuscular electrical stimulation on the frontal ankle motor control in individuals with chronic ankle instability during drop landing.

Design: This was a randomized, controlled, double-blind trial. Thirty-six individuals with chronic ankle instability were randomly assigned to each group. Participants received 6-wk neuromuscular electrical stimulation intervention and sham stimulation in the neuromuscular electrical stimulation and control groups, respectively. Data were collected at week 0 and week 6 . A mixed-effects model and analysis of covariance were employed to investigate the between-group differences in continuous and discrete outcome variables at week 6 , with the outcome variables at week 0 as covariates.

Results: Compared to control group, neuromuscular electrical stimulation group exhibited a 2.66° (2.45, 2.86) reduction in frontal ankle inversion angle, a 47.41°/sec (-16.05, -78.77) decrease in peak ankle inversion angular velocity, and a 0.43 Nm/kg (0.18, 0.68) increase in peak ankle eversion moment during drop landing at week 6 .

Conclusions: Applying 6-wk neuromuscular electrical stimulation to the fibularis longus resulted in decreased ankle inversion angle and ankle inversion angular velocity and increased peak ankle eversion moment during drop landing. Consequently, neuromuscular electrical stimulation could be considered an effective modality for individuals with chronic ankle instability to enhance the frontal ankle movement patterns and overall ankle motor control.

Objective: The aim of the study is to determine whether a health service system is an independent influencing factor of having pressure injury problems in individuals with chronic spinal cord injury living in three countries.

Design: This is a cross-sectional study.

Methods: Data from the International Spinal Cord Injury Community Survey were analyzed. The pressure injury problems were assessed using the Spinal Cord Injury Secondary Condition Scales (dichotomized to "having problem" and "not having problem"). Health service systems were categorized as an inpatient-oriented spinal cord injury-specialized system and a primary care-oriented system. A directed acyclic graph was applied to create a multivariable logistic regression model to determine the independent influencing factors of pressure injury problems.

Results: Of 790 included participants, 277 (35%) had pressure injury problems. Being recruited from countries with inpatient-oriented spinal cord injury-specialized systems (model 1) and visiting rehabilitation medicine/spinal cord injury physicians at least once a year (model 2) is an independent negative correlating factor of pressure injury problems (odds ratio = 0.569 [95% confidence interval = 0.374-0.866] and 0.591 [95% confidence interval = 0.405-0.864], respectively).

Conclusions: Spinal cord injury-specialized health service systems might be a protective factor of pressure injury problems in middle-income country contexts. This result suggests the importance of having spinal cord injury-specialized services in middle-income countries to reduce the prevalence of pressure injury problems.

To claim cme credits: Complete the self-assessment activity and evaluation online at http://www.physiatry.org/JournalCME.

Cme objectives: Upon completion of this article, the reader should be able to: (1) Identify the best strategy for managing pressure injury problems in people with spinal cord injury. (2) Describe common methods for determining health service utilization and evaluating secondary health conditions in people with spinal cord injury. (3) Discuss the advantage of having a SCI-specialized rehabilitation system in middleincome countries as a protective factor from having pressure injury problems.

Level: Advanced.

Accreditation: The Association of Academic Physiatrists is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.The Association of Academic Physiatrists designates this Journal-based CME activity for a maximum of 1.0 AMA PRA Category 1 Credit(s) ™. Physicians should only claim credit commensurate with the extent of their participation in the activity.

Abstract: Venous thromboembolism is a frequent complication of acute hospital care, and this extends to inpatient rehabilitation. The timely use of appropriate thromboprophylaxis in patients who are at risk is a strong, evidence-based patient safety priority that has reduced clinically important venous thromboembolism, associated mortality and costs of care. While there has been extensive research on optimal approaches to venous thromboembolism prophylaxis in acute care, there is a paucity of high-quality evidence specific to patients in the rehabilitation setting, and there are no clinical practice guidelines that make recommendations for (or against) thromboprophylaxis across the broad spectrum of rehabilitation patients. Herein, we provide an evidence-informed review of the topic with practice suggestions. We conducted a series of literature searches to assess the risks of venous thromboembolism and its prevention related to inpatient rehabilitation as well as in major rehabilitation subgroups. Mobilization alone does not eliminate the risk of venous thromboembolism after another thrombotic insult. Low molecular weight heparins and direct oral anticoagulants are the principal current modalities of thromboprophylaxis. Based on the literature, we make suggestions for venous thromboembolism prevention and include an approach for consideration by rehabilitation units that can be aligned with local practice.

Abstract: Medical students can be powerful advocates for and in partnership with the disability community, yet opportunities for targeted advocacy training are sparse. In February 2023, a medical student-led workshop on disability advocacy for trainees took place at the Association of Academic Physiatrists' Annual Conference. The aims of this session were for trainees to (1) identify existing gaps in disability education at their institution and in policy around disability-related issues; (2) improve perceived ability to engage in disability-related education and policy-based advocacy; and (3) apply an intersectional lens to identify opportunities for intersectionality in disability advocacy. Presession and postsession responses were anonymously submitted via Qualtrics. Of 31 presurvey respondents, 18 responded to the postsurvey, and 12 were identified as having matching unique identifiers. After the workshop, participants overall were more likely to report being very/somewhat confident about their ability to identify gaps in disability education at their institution (75.0% vs. 100.0%, P = 0.011), policy around disability-related issues (41.7% vs. 100.0%, P < 0.006), and opportunities for intersectionality in disability advocacy (33.3% vs. 91.7%, P < 0.015). Participants were more likely to report being very/somewhat confident in engaging in education-based advocacy (58.3% vs. 100.0%, P = 0.006), policy-based advocacy (16.7% vs. 91.7%, P < 0.002), and intersectional disability advocacy (41.7% vs. 91.7%, P < 0.006). All attendees strongly/somewhat agreed with the statements "I hope that this session will continue in future years" and "I think that other trainees would benefit from a similar course." This session was shown to effectively meet the intended goals of the program.