American Journal of Physical Medicine & Rehabilitation最新文献

Abstract: In this clinical vignette, we report the case of a 22-yr-old division I collegiate wrestler who presented with chronic left foot and ankle weakness, tightness, and a burning sensation extending from the midlateral calf to the dorsum of the foot. Initial magnetic resonance imaging completed of the left knee 1 yr before presentation was unremarkable. He was given a diagnosis of exertional compartment syndrome and he was medically cleared to compete. However, after sustaining an unrelated left knee injury during a match 4 wks later, a repeat magnetic resonance imaging revealed a multiloculated cystic lesion along the popliteal artery, consistent with adventitial cystic disease. The patient underwent surgical resection of the cyst and had worsening dorsiflexion weakness following the procedure. This was despite careful intraoperative preservation of the common peroneal nerve, suggesting the rare occurrence of intraarticular extension and possible nerve involvement. This case highlights the complex nature of adventitial cystic disease, drawing parallels to intraneural ganglion cysts. We detail the importance of early recognition through high-resolution imaging and electromyography to assess for intraarticular and neural involvement preoperatively. Additionally, patient counseling should address the potential risk of foot drop as a complication of both adventitial cystic disease progression and surgical intervention.

Abstract: Blood doping is a well-documented method of performance enhancement that increases red blood cell mass to improve oxygen transport and endurance. While its use in able-bodied athletes has been widely studied, its implications for Paralympic athletes remain understudied despite increasing participation and competitiveness in adapted sports. This review explores the physiological mechanisms of oxygen transport and utilization during exercise, emphasizing how these are affected by various impairments common in Paralympic athletes. It highlights how cardiovascular, respiratory, and muscular limitations in this population may alter both the effectiveness and risks of blood doping. Furthermore, the manuscript discusses the historical context and methods of blood doping, including the unique practice of "boosting" through autonomic dysreflexia. Key challenges in detection are addressed, particularly the variability of hematological markers that complicate standard anti-doping approaches. Health risks such as thrombosis, autonomic instability, and long-term cardiovascular complications are also reviewed. The paper concludes by identifying critical research gaps and advocating for individualized detection methods, longitudinal studies, and tailored education strategies. Given the complex physiology and ethical considerations in this population, a nuanced understanding of blood doping in Paralympic sport is essential for developing effective anti-doping policies and promoting athlete safety and fairness.

Objectives: Systematic reviews (SRs) are crucial for evidence-based medicine, but authors may add spin. This study investigated the prevalence of spin in abstracts and main texts of SRs published in rehabilitation journals and explored associated factors.

Design: This meta-epidemiological study secondary analysis 200 SRs from rehabilitation journals (2020-2022) focusing on pairwise meta-analyses of health interventions. Two independent reviewers extracted data. Spin was defined as reporting that highlights a beneficial effect greater than shown by results. We classified spin into misleading reporting, misleading interpretation, inappropriate extrapolation, and multiple spins based on analysis of the main text and abstract.

Results: Spin was present in 154 (77.0%) SRs in the main text and 151 (75.5%) in the abstract. Misleading interpretation was the most common category (86.4% in main text, 85.4% in abstract). PRISMA 2020 use was associated with reduced spin (Odds ratio (OR) 0.27 [95% CI; 0.13-0.57] for main text; OR 0.39 [95% CI: 0.20-0.76] for abstract).

Conclusion: There is a high prevalence of spin in SRs published in rehabilitation journals. To avoid spin in the SRs of rehabilitation journals, the authors must adhere to guidelines, such as PRISMA 2020.

Abstract: Isotretinoin is a widely prescribed retinoid for severe acne, with musculoskeletal adverse effects such -particularly sacroiliitis-well documented in the literature. However, isolated femoral neck bone marrow edema (BME) has not previously been reported. We describe a 27-year-old female physical medicine and rehabilitation resident who developed acute right hip pain while receiving isotretinoin therapy. Pelvic radiography and sacroiliac MRI, obtained independently by the patient, were normal, but as symptoms progressed, she was examined by a physiatrist, and careful clinical assessment with accurate localization of pain prompted a dedicated hip MRI, which revealed isolated femoral neck BME. Laboratory evaluation excluded infection, inflammatory arthritis, and metabolic bone disease. Isotretinoin was discontinued, and the patient was treated conservatively with weight-bearing restriction, vitamin D and calcium supplementation, and analgesics, leading to complete clinical and radiologic resolution within three months. This case represents the first report of isolated femoral neck BME linked to isotretinoin therapy and underscores the importance of early recognition, as timely diagnosis through precise clinical assessment and targeted imaging enables unloading strategies that can prevent progression to stress fracture and ensure favorable outcomes in isotretinoin-treated patients presenting with hip pain.

Objective: To compare adipose-derived cell therapies (ADCTs) versus non-active controls in treating knee osteoarthritis.

Design: This systematic review and meta-analysis included randomized controlled trials (RCTs) comparing ADCTs with placebo or no treatment in patients with knee osteoarthritis. Two reviewers extracted study, patient, and intervention data, as well as patient-reported outcomes. Random-effects meta-analyses were performed for outcomes reported in at least three studies. The primary outcome was pain improvement at six months, with secondary outcomes including function, quality of life, and adverse events.

Results: Eight RCTs (585 patients) were included. ADCTs showed superior pain improvement versus controls at six months, with WOMAC Pain (MD -1.75, 95% CI -2.62 to -0.88) and KOOS Pain (MD 7.95, 95% CI 0.98 to 14.93) achieving statistical significance. Functional outcomes also improved significantly, while quality of life favored ADCT but did not reach significance. No serious adverse events occurred, although two patients reported severe events after ADCT.

Conclusions: At six months, ADCTs provided greater pain relief and functional improvement than non-active controls, though no benefit was observed for quality-of-life. Severe adverse events were uncommon, but additional studies are needed for long-term efficacy and safety.

Objective: Stroke is a leading cause of long-term disability, often requiring inpatient rehabilitation. Frailty, characterized by reduced physiological reserve and vulnerability to stressors, is associated with poorer outcomes. This study examined the association between pre-stroke frailty and functional recovery during inpatient rehabilitation.

Design: Retrospective cohort study of 224 stroke patients admitted between 2020 and 2022; 206 were included in the analysis. Pre-stroke frailty was assessed using the Clinical Frailty Scale (CFS), and rehabilitation outcomes were measured using Functional Independence Measure (FIM) gain and efficiency. Associations were evaluated using Spearman correlations and linear regression.

Results: Of 206 patients, 42.7% were female and 75.7% were aged ≥60. FIM gain and efficiency did not differ significantly across CFS categories (p > 0.05). CFS was not correlated with FIM gain (r = -0.07, p = 0.316) or efficiency (r = 0.02, p = 0.755). Admission and discharge FIM scores differed across CFS categories (p = 0.041 and p = 0.002).

Conclusion: Although patients with higher pre-stroke frailty had lower functional scores at admission and discharge, functional improvement and efficiency did not differ significantly. However, the small number of patients with moderate to severe frailty (6.8%) may have limited the ability to detect a difference.

Objective: To compare the effects of a 6-week whole-body vibration (WBV) program versus floor exercises on physical and psychosocial outcomes in pre-frail elderly.

Design: In this randomized, single-blind, parallel-group superiority trial, 58 pre-frail participants aged ≥65 were randomized 1:1 to WBV or floor groups. Both groups performed structurally similar exercise programs (5 sessions/week), tailored to either a vibration platform or the floor. Primary outcomes were quadriceps thickness, Sonographic Thigh Adjustment Ratio (STAR), and Chair Stand Test (CST). Secondary outcomes included handgrip strength, body composition, performance, mobility, balance, and questionnaires on physical activity, mood, kinesiophobia, depression, quality of life, sleep, and fatigue. Assessments occurred at baseline and week 6, except for quadriceps thickness and STAR, also measured at weeks 2 and 4.

Results: While both interventions significantly improved quadriceps thickness, STAR, CST, performance, balance, mood, fatigue, and sleep quality, WBV showed greater STAR gains at week 6 (right: p = 0.027, left: p = 0.043) and better outcomes in Timed Get-Up-and-Go (p = 0.008), depressive symptoms (p = 0.036), fatigue (p = 0.036), and trunk fat percentage (p = 0.008) and mass (p = 0.006), with no serious adverse events.

Conclusion: WBV yielded greater benefits in sarcopenia prevention, mobility, mood, fatigue, and body composition, though other outcomes showed no between-group differences, suggesting domain-specific rather than universal effects.

Abstract: Women remain underrepresented in Physical Medicine and Rehabilitation (PM&R), comprising only 36-39% of residents despite evidence that diverse teams improve patient outcomes. Limited early exposure and systemic barriers may contribute to this disparity. In this cross-sectional study, we surveyed 1,101 U.S. premedical students from 198 colleges across 40 states and territories to assess perceptions of PM&R and identify effective early intervention strategies. While respondents included all gender identities, the analysis focused on the 870 female-identifying students (78.8%) due to the study's primary aim of addressing gender equity in PM&R. Only 30.6% were familiar with PM&R, with exposure primarily through social media (42.6%) and personal connections (31.1%); just 9.0% had shadowed a PM&R physician. Financial concerns were prevalent, with 68.6% citing medical education costs and 66.4% citing application fees as deterrents. Despite these barriers, 60.6% expressed interest in learning more about PM&R. Preferred engagement strategies included shadowing (81.8%), interactive workshops (76.6%), mentorship programs (60.1%) and gender-specific events such as "Women in PM&R" (62.8%). These findings underscore the need for targeted, early outreach initiatives that address both informational and financial barriers, aiming to foster greater awareness and representation of women in PM&R and ultimately support a more inclusive physician workforce.

Abstract: Persons with disabilities represent over 20% of the U.S. population, yet medical education lacks standardized disability training. Physical Medicine and Rehabilitation physicians are well-positioned to address this gap, but very few medical schools require a PM&R clerkship. This study evaluates a targeted educational supplement within the PM&R clerkship to teach fourth year medical students about adaptive equipment and assistive devices. A standardized checklist was created by a multidisciplinary team to lead students in "Functional Assessment Rounds" which included a didactic session, hands-on demonstration, and patient observation. 127 students completed pre- and post-clerkship surveys which assessed perceptions and confidence. Compared to baseline, students reported higher confidence identifying all categories of adaptive equipment, communicating with, and providing care to persons with disability. A targeted educational intervention focused on assistive devices and adaptive equipment can be a valuable addition to the medical school curriculum and can improve medical student confidence in their interactions with persons with disability as well as influence their perceptions on the importance of disability-related education.