American Journal of Physical Medicine & Rehabilitation最新文献

Background: Since the introduction of educational milestones by the Accreditation Council for Graduate Medical Education, residency programs have sought to identify the optimal approach to assess progression through these milestones. Entrustable Professional Activities and Observable Practice Activities are tools that can be customized for each medical specialty and utilized to assess a learner's advancement. An effective process for creating and implementing specialty-specific Entrustable Professional Activities and their corresponding Observable Practice Activities into the residency curriculum remains unclear.

Objective: The aim of this report is to present a 10-yr experience in developing and using Observable Practice Activities to assess residents' performance and competence in physical medicine and rehabilitation.

Methods: A physical medicine and rehabilitation residency program developed 63 Observable Practice Activities in 2014 and subsequently incorporated them into their curriculum in 2015. These have been in active use since then. Assessment of the tool's effectiveness and ease of use were evaluated and monitored through annual surveys of residents and faculty. Generalizability was assessed by another physical medicine and rehabilitation residency program. Finally, the value of the process was evaluated when shared with the Physical Medicine and Rehabilitation Residency and Fellowship Directors Council, a multispecialty competency based medical education round table, and in a competency based medical education workshop of the American Board of Physical Medicine and Rehabilitation.

Results: At the time of this report, 100% of residents, 65 total, have utilized the tool. The Observable Practice Activities covered the core physical medicine and rehabilitation conditions, allowed residents real time monitoring of their progression through each domain, and were felt to be a valuable tool by faculty, residents, and education leaders.

Conclusions: Observable Practice Activities can be crafted and effectively incorporated into a physical medicine and rehabilitation residency curriculum to assess resident progression through the Accreditation Council for Graduate Medical Education milestones.

Abstract: Knee osteoarthritis leads to pain, functional limitations, and muscle weakness. This study compared the efficacy and safety of blood flow restriction training with high- and low-intensity resistance training in knee osteoarthritis patients. Randomized controlled trials comparing these interventions were identified through database searches. Primary outcomes included knee pain, function, muscle strength, safety, and quality of life. A network meta-analysis estimated treatment effects, ranked interventions, and assessed risk of bias (Cochrane tool) and network consistency. Fourteen randomized controlled trials involving 866 participants were included. Blood flow restriction significantly reduced knee pain (mean difference: -1.72; 95% confidence interval: [-2.44, -1.00]), improved function (mean difference: 7.12; 95% confidence interval: [2.21, 12.02]), and increased muscle strength (mean difference: 0.89; 95% confidence interval: [0.18, 1.20]) compared to low-intensity resistance training. Compared to high-intensity resistance training, blood flow restriction yielded comparable or slightly better outcomes in pain (mean difference: -0.43; 95% confidence interval: [-2.26, 1.40]) and strength (mean difference: 0.54; 95% confidence interval: [0.39, 1.48]), with fewer adverse effects. Funnel plots and rankograms showed no major publication bias or inconsistency. Blood flow restriction training seems to be a safe and effective alternative to high- and low-intensity resistance training for improving pain, strength, and function in knee osteoarthritis patients, especially those intolerant to high-intensity exercise.

Objective: The current study explored the association between knee extensor strength asymmetry and the risk of total knee arthroplasty in individuals with or at risk of knee osteoarthritis.

Design: This longitudinal cohort study analyzed data from the Osteoarthritis Initiative, including 3860 individuals with or at risk for knee osteoarthritis. Participants were categorized as having symmetrical or asymmetrical knee extensor strength based on a 10% difference between limbs. Kaplan-Meier curves and Cox regression assessed the risk of total knee arthroplasty over 10 yrs, adjusting for age, sex, body mass index, baseline Kellgren-Lawrence grade, absolute weakness, and baseline pain.

Results: Participants with asymmetrical knee extensor strength had a 30% greater risk of undergoing total knee arthroplasty over 10 yrs compared to those with symmetrical strength (hazard-ratio: 1.30, 95% CI [1.05,1.62]). Limb-specific analyses revealed that a 10% reduction in right and left knee extensor strength were associated with a 40% and 80% increased risk of right and left total knee arthroplasty, respectively.

Conclusions: Knee extensor strength asymmetry was associated with the risk of total knee arthroplasty in individuals with or at risk for knee osteoarthritis. Findings support the need to further examine if an intervention targeted at quadriceps strengthening aimed at achieving and maintaining strength symmetry can reduce total knee arthroplasty risk.

Objective: This study aims to compare the long-term results of continuous intrathecal baclofen therapy rehabilitation against those of conventional treatment for intractable spasticity in children with cerebral palsy using the International Classification of Functioning, Disability and Health of Children and Youth.

Design: This is a 5-yr single-center retrospective cohort study.

Results: The International Classification of Functioning, Disability and Health of Children and Youth data from 24 patients with cerebral palsy of Gross Motor Function Classification System levels IV-V (aged between 8 and 18 yrs) were retrospectively analyzed for 5 yrs. The results show different trends between the 12 patients who received continuous intrathecal baclofen therapy and the 12 who were excluded because of contraindications.The continuous intrathecal baclofen therapy group improved spasticity, pain, and body mass index z-scores over 12 mos and during the 5-yr follow-up with a continuous simple Baclofen administration at a maximum of 140 μg/d at a concentration of 2000 μg/mL.

Conclusions: Continuous intrathecal baclofen therapy improves structure and function, autonomy, and participation in both short and long term. Overall, the continuous intrathecal baclofen therapy group, with its characteristics of initially greater pain and hypertonia, benefited significantly from the efficacy of intrathecal Baclofen treatment compared with the control group, which continued to receive conventional treatment.The International Classification of Functioning, Disability and Health of Children and Youth outcome measures demonstrated an interrelationship between spasticity and weakness and disease progression over childhood to adolescence.Follow-up will be vital for effective personalized treatment, quality of life, and research.Long-term International Classification of Functioning, Disability and Health of Children and Youth data collection is key to comparing treatment outcomes.

Abstract: This report describes a case of stretching-induced gastrocnemius muscle rupture in a patient with lower limb spastic paresis. To the best of our knowledge, this is the first reported case of such an injury in this patient population. After 6 mins of progressive stretching of the gastrocnemius muscle, the patient experienced localized pain at the medial gastrocnemius musculotendinous junction. Ultrasonography confirmed a partial rupture of the medial gastrocnemius. In addition to presenting this clinical case, we propose a potential treatment approach based on recent evidence-based physiotherapy methods.

Objective: While cycling and walking are different motor tasks, both require the rapid reciprocal activation and relaxation of lower extremity muscles in a synergistic manner, promoting coordination patterns similar to walking. The aim of this secondary analysis was to examine the effects of forced-rate cycling on gait biomechanics after stroke.

Design: A randomized controlled trial was conducted investigating the neuroplastic effects of forced-rate cycling on upper extremity motor recovery in individuals ( n = 60) after stroke. In this secondary analysis, a subset of participants ( N = 45) completed biomechanical gait assessment at baseline and postintervention.

Results: Gait velocity increased in the cycling group by 0.08 m/sec and in the control group by 0.02 m/sec, though a group difference was not observed ( P = 0.195). Walking capacity (6-min walk test) significantly improved by 53.3 m for the cycling group versus 15.6 m for the control group ( P = 0.0036). Improvements in spatiotemporal characteristics in the cycling group included increased step length, cadence, and time spent in single-limb support, in addition to paretic limb kinetics.

Conclusions: Improvements in gait velocity after forced-rate cycling were accompanied by normalization of gait biomechanics rather than exaggerated compensatory strategies, supporting the use of aerobic cycling as a viable and safe intervention to improve locomotor control after stroke.