American Journal of Physical Medicine & Rehabilitation最新文献

Objective: Sacroiliac joint-mediated back pain has proven therapeutic benefit from fluoroscopically guided sacroiliac joint corticosteroid injections. We examined corticosteroid dose and pain relief after fluoroscopically guided sacroiliac joint injections to better understand their relationship.

Design: This is a retrospective observational cohort analysis of electronic health record data on 661 patients who received unilateral fluoroscopically guided sacroiliac joint intraarticular corticosteroid injection with 40 mg versus 80 mg of methylprednisolone from 2012 and 2019. Patients were injected by fellowship trained proceduralists after diagnosis by board-certified physiatrists in an academic physiatry practice. Absolute change in pain scores (postprocedure and first follow-up) was modeled using linear regression of methylprednisolone dosage (40 mg vs. 80 mg) controlling for age, sex, body mass index, baseline pain scores, and follow-up time.

Results: Linear regression indicated that dosage of methylprednisolone, age, and body mass index were not statistically significantly associated with change in pain scores. Sex approached significance ( P = 0.0501) indicating that females may have a lower degree of pain resolution than males.

Conclusions: Practitioners should consider corticosteroid dose when performing these beneficial procedures. This could reduce cost and potential side effects associated with larger doses, while still providing therapeutic benefit. This pilot study can guide future research and dosing guidelines for fluoroscopic spine injections.

Objective: The aim of the study is to investigate the prevalence and risk factors of osteosarcopenia in patients with acute stroke.

Design: Overall, 224 patients within 2 wks of having a stroke were enrolled. Demographic characteristics, National Institutes of Health Stroke Scale, modified Rankin Scale, modified Barthel Index, Functional Ambulation Category, Berg Balance Scale, and handgrip strength were recorded. Body composition was evaluated using dual-energy x-ray absorptiometry. Patients who met the diagnostic criteria for osteoporosis and sarcopenia were defined as having osteosarcopenia.

Results: The overall prevalence of osteoporosis and sarcopenia was 46.9% and 50.9%, respectively. The prevalence of osteoporosis without sarcopenia, sarcopenia without osteoporosis, and osteosarcopenia was 18.3%, 22.3%, and 28.6%, respectively. The proportion of female sex (71.9%), median age, and National Institutes of Health Stroke Scale score were significantly higher, and modified Rankin Scale, Berg Balance Scale, modified Barthel Index, Functional Ambulation Category, and grip strength were significantly lower in patients with osteosarcopenia. Older age (≥65 yrs) (odds ratio, 15.4), female sex (odds ratio, 6.23), and lower body mass index (<25 kg/m 2 ) (odds ratio, 43.13) were independently associated with the likelihood of osteosarcopenia.

Conclusions: Osteosarcopenia may occur in acute stroke survivors. Patients with osteosarcopenia have a significantly higher stroke severity and disability. A comprehensive diagnostic approach is imperative for osteosarcopenia, thereby facilitating implementation of optimal rehabilitative strategies.

Objective: We examined the impact of consenting to the Rick Hansen Spinal Cord Injury Registry on outcomes: acute length of stay, in-hospital mortality, medical complications (pressure injuries and pneumonia), and the final discharge destination following a spinal cord injury using the national Rick Hansen Spinal Cord Injury Registry dataset.

Design: A retrospective cohort study was conducted using Rick Hansen Spinal Cord Injury Registry participant data from 2014 to 2019. Participants approached for enrollment were grouped into 1) PC: provided full consent including community follow-up interviews, 2) DWC: declined community follow-up interviews but accepted minimal data collection that may include initial/final interviews and/or those who later withdrew consent, and 3) DC: declined consent to any participation. As no data was collected for the DC group, descriptive, bivariate, and multivariable regression analysis was limited to the PC and DWC groups.

Results: Of 2811 participants, 2101 (74.7%) were PC, 553 (19.7%) were DWC, and 157 (5.6%) were DC. DWC participants had significantly longer acute length of stay, more acute pneumonias/pressure injuries, and were less likely to be discharged home than PC participants. All these associations-except pneumonia-remained significant in the multivariable analyses.

Conclusions: Not participating fully in Rick Hansen Spinal Cord Injury Registry was associated with more complications and longer hospital stays.

Abstract: Stiff-Knee gait (SKG) is a dysfunction commonly observed post-stroke characterized by a decreased swing phase knee flexion angle. Importantly, SKG can impair walking, ultimately reducing overall activity and participation. Interventions for SKG have shown mixed results, and combined with more recent observational evidence, suggest that there are other potential causes requiring the need to re-examine the etiology of SKG. The aim of this review is to compile and appraise the current state of the science regarding the neurophysiological and biomechanical impairments of individuals post-stroke with SKG. This narrative review will address the following topics to better understand SKG: operationally define SKG and further detail its presentation, describe the potential neurophysiological and biomechanical mechanisms of SKG, and synthesize findings. We explore evidence for quadriceps hyperreflexia, abnormal tone, motor incoordination, and impaired propulsion. We conclude that SKG needs a commonly accepted definition, that more attention needs to be devoted to understanding its mechanisms, and that in prospective designs, larger sample sizes are needed to account for the heterogeneity of the condition.

Objective: To provide evidence that catastrophizing is the primer of the cognitive-behavioural model of fear of movement/(re)injury (FAM).

Design: A cross-sectional analysis of 180 outpatients with chronic non-specific low back pain who completed the Pain Catastrophizing Scale (PCS), the Tampa Scale of Kinesiophobia (TSK), the Roland-Morris Disability Questionnaire (RMDQ), the Hospital Anxiety and Depression Scale - Depression (HADS-D), and a pain intensity numerical rating scale (NRS). The intercorrelations of the outcome measures were estimated using Pearson's correlation coefficient (r), and regression analyses were used to examine their predictive values by following the left side of the FAM clockwise from the PCS (p = 0.05). A postdictive analysis dichotomizing the sample into high- and low-level catastrophizers evaluated the effects of addressing catastrophizing on disability and pain.

Results: The intercorrelations of the PCS with the TSK, RMDQ, HADS-D and NRS were respectively r = 0.59, r = 0.54, r = 0.18, and r = 0.44. PCS was a significant predictor of TSK; PCS and TSK significantly predicted RMDQ and HADS-D; and PCS, TSK, RMDQ and HADS-D significantly predicted NRS. The postdictive analysis showed that addressing catastrophizing reduces disability and pain experience by 14% in high-level catastrophizers and 86% in low-level catastrophizers.

Conclusion: Our findings provide evidence that catastrophizing is the primer of the FAM.

Objective: This study aims to compare the efficacy of platelet-rich plasma (PRP) and corticosteroids (CS) in treating plantar fasciitis, focusing on pain relief, foot function, and plantar fascia thickness to identify the optimal treatment approach.

Design: A comprehensive search of medical databases was conducted following PRISMA guidelines, utilizing an extensive keyword strategy. Inclusion criteria encompassed prospective RCTs involving adult patients with plantar fasciitis treated with local PRP or CS injections, specifically assessing outcomes such as the Visual Analogue Scale (VAS), American Orthopaedic Foot and Ankle Society (AOFAS) scores, and plantar fascia thickness.

Results: The meta-analysis included 24 RCTs with 1653 participants. PRP injections yielded significantly better VAS scores compared to CS injections at 3 months (P = 0.03) and 6 months (P < 0.001), with no significant differences at 1 month (P = 0.12) and 12 months (P = 0.08). AOFAS scores demonstrated that PRP was superior to CS at 3 (P = 0.05), 6 (P < 0.001), and 12 months (P < 0.001), with no significant differences at 1 month (P = 0.31). Regarding plantar fascia thickness, there were no significant differences between PRP and CS at 1-1.5 months (P = 0.18), 3 months (P = 0.64), and 6 months (P = 0.05).

Conclusions: PRP injections offer superior pain control compared to corticosteroids in the medium term (3-6 months) but not in the short term or at one year.

Abstract: People with disabilities have recently been declared a population at increased risk of health disparities, and research has cited a lack of physician training as a cause of that increased risk. Prior studies demonstrate that physicians lack confidence in caring for people with disabilities, but there is little research on disability competency among medical students. This study assessed medical students' confidence in six disability-related competencies and tested for associations between perceived confidence and students' personal demographics and institutional characteristics. A cross-sectional survey was administered to measure student confidence, and students' perceived confidence was calculated using a 5-point Likert scale. Mean confidence ranged from 2.35 - 3.43, suggesting that most students felt either "slightly confident" or "somewhat confident" in their ability to meet the selected competencies. Confidence did not differ based on disability exposure or level of training; however, there was a significant positive relationship between attending a public (state) medical school and students' confidence in listing community-based services for people with disabilities. This study highlights that future physicians are not confident in their ability to meet the needs of people with disabilities. Additional training is needed to teach future physicians the skills necessary to provide this population with high-quality clinical care.