Musculoskeletal and Sports Medicine Physical Medicine and Rehabilitation Curriculum Guidelines

Poor quality of sleep and musculoskeletal pains among highly trained and elite athletes in Senegal

BACKGROUND

Previous studies reported that poor sleep quality (PSQ) was associated with musculoskeletal pains (MSP) and poor physical performance in athletes.

OBJECTIVE

The current study aimed at determining PSQ and its associations with MSP in some sub-Saharan athletes.

METHODS

A cross sectional study was conducted among 205 highly trained and 115 elite athletes (aged: 25 ± 2 years, Body mass index: 22.8 ± 0.9 kg/m2) in Dakar, Senegal, during a competitive season in a variety of sport disciplines including athletics, basketball, football, rugby, wrestling, tennis. Quality of sleep and MSP were assessed using the French version Pittsburgh Sleep Quality Index (PSQI) and French version of Nordic questionnaire respectively. Pain on body joints during a week was defined as seven-day MSP (MSP-7d) and PSQ for a PSQI > 5.

RESULTS

27.8% (95%CI: 23.2-32.9) of the overall sample suffered PSQ, with 33.7% (95%CI: 24.7-44.0) in basketball and 24.7% (95%CI: 16.9-34.6) in football. According to athletic status and gender, PSQ was more prevalent among highly trained (66.3; 95%CI: 55.9-75.3) and men (69.7%; 95%CI: 59.5-78.7). Among athletes with PSQ 43.8% (95%CI: 33.9-54.2) suffered MSP-7d, with 36.6%; highly trained (95%CI: 23.7-42.9) and 28.1% female. Considering body region, hips/thigh (14.6%; 95% CI: 8.74-23.4) and upper back (13.5%; 95%CI: 7.88 -21, 1) were more affected. Basketball players were more affected from MSP (MSP-7d = 38.5%; 95%CI: 24. 9-54.1) on high on wrists/hands (MSP-7d = 44.4%; 95%CI: 18.9 -73.3; P = 0.04). Based on athletic status, MSP-7d were higher on highly trained necks (100%; 95%CI: 56.1-100; p = 0.04). PSQ was associated with basketball (OR: 3.062, 95%CI: 1.130-8.300, p = 0.02) compared to Athletic. PSQ and MSP-7d were associated on Wrist/hands (OR: 3.352, 95%CI: 1.235-9.099, p = 0.01), and at the upper back (OR: 5.820, 95%CI: 2.096-16.161, p = 0.0007).

CONCLUSION

These results indicate that PSQ is considerable among Senegalese athletes and is associated with MSP during a week. Hence, we recommend to look for strategies optimizing good quality of sleep in order to reduce pains, to improve health.

Physical medicine & rehabilitation residents' perspectives on women's musculoskeletal health

INTRODUCTION

Women are either disproportionately or uniquely affected by certain musculoskeletal conditions but have limited access to providers of sex-specific musculoskeletal care. Few physical medicine & rehabilitation (PM&R) residencies offer women's musculoskeletal health training, and it is unknown whether PM&R residents feel prepared to care for women's musculoskeletal health concerns.

OBJECTIVE

To examine PM&R residents' perspectives and experiences in women's musculoskeletal health.

DESIGN

Cross-sectional survey developed through clinical expertise and consistent with sports medicine guidelines.

SETTING

Electronic survey sent to all accredited PM&R residency programs within the United States, distributed through program coordinators and resident representatives.

PARTICIPANTS

PM&R residents.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

The primary outcome was residents' perspective of comfort with women's musculoskeletal health. Secondary outcomes were exposure to formal education on women's musculoskeletal health topics, exposure to various learning formats for these topics; and residents' perspectives on desire for further education, access to field-specific mentors, and interest in incorporating women's musculoskeletal health into future practice.

RESULTS

Two hundred eighty-eight responses were included for analysis (20% response rate, 55% female sex residents). Only 19% of residents self-reported feeling comfortable providing care for women's musculoskeletal health conditions. Comfort did not significantly differ by postgraduate year, program region, or sex. However, with regression modeling, the number of topics learned formally in their curriculum had an increased odds of residents self-reporting comfort (odds ratio [OR] 1.18, confidence interval [CI] 1.08-1.30, adjusted p value .01). The majority of residents viewed learning women's musculoskeletal health as important (94%) and requested more exposure to the field (89%).

CONCLUSIONS

Many PM&R residents do not feel comfortable in caring for women's musculoskeletal health conditions despite their interest in the field. To improve health care access for patients seeking care for these sex-predominant or sex-specific conditions, residency programs may want to consider increasing exposure to women's musculoskeletal health for residents.

Musculoskeletal pains among amateur and professional athletes of five disciplines in Senegal: a preliminary study

BACKGROUND

Musculoskeletal pains (MSPs) in sport are cause of poor performances and loss of competition in athletes. The present study aimed at determining the prevalence of MSPs with regard to sport disciplines and athletic status.

METHODS

A cross-sectional study was conducted among 320 Senegalese professional and amateur athletes practicing football, basketball, rugby, tennis, athletics, and wrestling. Rates of MSPs in the past year (MSPs-12) and week (MSPs-7d) were assessed using standard questionnaires.

RESULTS

Overall proportions of MSPs-12 and MSPs-7d were 70 and 74.2%, respectively. MSPs-12 were more frequently reported on shoulders (40.6%), neck (37.1%) and hips/thigh (34.4%), while MSPs-7d were predominant on hips/thigh (29.5%), shoulders (25.7%), and upper back (17.2%). Proportions of MSPs-12 and MSPs-7d varied significantly by sport disciplines, with highest values among basketball players. Again, highest MSPs-12 proportions on shoulders (29.7%, P = 0.02), wrists/hands (34.6%, P = 0.001), (40.2%, P = 0.0002), and knees (38.8%, P = 0.002) were seen among basketball players. High proportions of MSPs-7d were seen on shoulders (29.6%, P = 0.04) for tennis players, wrists/hands (29.4%, P = 0.03) for basketball and football players, and hips/thigh (38.8%, P < 0.00001) for basketball players. Football players had reduced risk of MSPs-12 by 75% on lower back (OR = 0.25; 95% CI. 0.10-0.63; P = 0.003) and by 72% on knees (OR = 0.28; 95% CI. 0.08-0. 95; P = 0.04). In contrast, tennis players were more at risk of MSPs-12 on shoulders (OR = 3.14; 95% CI. 1.14-8.68; P = 0.02), wrists/hands (OR = 5.18; 95% CI.1.40-11.13; P = 0.01), and hips/thigh (OR = 2.90; 95% CI. 1.1-8.38; P = 0.04). Professionals were protected from MSPs-12 on neck pain with a significant reduction of risk by 61% (OR = 0.39, 95% CI. 0.21-0.75, P = 0.03).

CONCLUSION

MSPs are a reality among athletes and their risk is modulated by sport disciplines, athletic status and gender.

Meniscus Root Tears: A Clinical Review

ABSTRACT

Meniscus root tears are important to recognize early given their potentially devastating consequences on joint health. This injury results in the lost ability of the meniscus to transfer axial loads into hoop stress; therefore, it is functionally equivalent to a complete meniscectomy. This causes rapid progression of osteoarthritis and increased need to total knee arthroplasty in a previously healthy joint. Despite these consequences, root tears have only been discussed in the orthopedic literature in the last 10 to 15 years and have not been routinely integrated into nonoperative sports medicine education. It is important for all nonoperative sports medicine providers to properly diagnose and triage this injury early in its course to maximize joint preservation efforts. The goal of this manuscript is to review the anatomy, presentation, natural history, imaging, and treatment options for meniscal root tears.

Suggested Curricular Guidelines for Musculoskeletal and Sports Medicine in Physical Medicine and Rehabilitation Residency Training

ABSTRACT

A sports medicine physician manages musculoskeletal (MSK) injuries and sport-related medical and MSK conditions of patients of all ages and abilities. Physical medicine and rehabilitation physicians (physiatrists) must be adequately trained to provide this care for all patients including, but not limited to, athletes participating in organized sports, the weekend warrior as well as athletes with disabilities. Accreditation Council of Graduate Medical Education core requirements and basic guidelines help physiatry residency training programs develop and implement residency curriculums. The goal of this article is to provide suggested curricular guidelines to optimize physiatrist training in MSK and sports medicine.

COVID-19 Outbreak During Inpatient Rehabilitation: Impact on Settings and Clinical Course of Neuromusculoskeletal Rehabilitation Patients

OBJECTIVE

The COVID-19 pandemic affects a large number of patients. The impact on feasibility and outcome of rehabilitation during COVID-19 actually remains unclear. Nosocomial infection of healthcare workers or hospitalized patients is common, and prevention of nosocomial infections during rehabilitation is challenging. Therefore, we analyzed a cohort of nosocomial infected COVID-19 patients in a single-center inpatient rehabilitation clinic and described performance and outcome.

DESIGN

The cohort (N = 27) describes patients with nosocomial SARS-CoV-2 infection while participating in neuromusculoskeletal rehabilitation. Infection was caused by an initially unidentified so-called superspreader. We compared this cohort with all neuromusculoskeletal rehabilitation inpatients of 2019 (comparison group). Normally distributed continuous variables were presented as mean with standard deviation and the t test was used for comparison between groups. Linear regression was used to assess the impact of COVID-19 on Functional Independence Measure at discharge.

RESULTS

COVID-19 patients were mostly male (66.7%) with an age of 71.5 ± 12.3 yrs. Age, sex, and cumulated comorbidities of the comparison group (n = 786) were not different from the COVID-19 group. A total of 92.6% of COVID-19 patients had a mild or moderate course, two patients had to be referred to acute hospital because of respiratory failure, and one of these patients died in the acute hospital. After implementation of a strict hygiene concept, no further nosocomial COVID-19 infections were detected. The rehabilitation duration was significantly longer in the COVID-19 group (54.2 ± 23.6 days vs. 32.1 ± 17.7 days, P < 0.001). Daily therapy duration was 132.3 ± 44 mins before SARS-CoV-2 infection and reduced to 81.9 ± 27.3 mins during COVID-19 (P < 0.001). After discontinuation of isolation measures, therapy duration increased significantly (99.3 ± 70.2 mins, P < 0.05).The baseline Functional Independence Measure score was higher in the COVID-19 group (91.93 ± 25.64 points vs. 82.98 ± 22.73 points) and Functional Independence Measure improvements were lower in COVID-19 patients than in the 2019 comparison group (6.96 ± 8.96 points vs. 20.3 ± 15.98 points, P < 0.001). COVID-19 infection itself had a strong negative impact on Functional Independence Measure change as identified by regression analysis. Linear regression analysis showed that COVID-19 reduced the Functional Independence Measure at discharge by 8.9 points (95% CI = -14.725 to -3.097, P = 0.003) after correction for Functional Independence Measure at admission, age, sex, and morbidity index at admission.

CONCLUSIONS

COVID-19 had a strong negative impact on rehabilitation benefits as assessed by Functional Independence Measure. Neuromusculoskeletal rehabilitation could be continued, but all patients received less therapy minutes during isolation. After implementation of a strict COVID-19-specific hygiene concept, no further infections were detected.

Musculoskeletal Women's Health Education in Physiatry: A Mismatch in Residency Education and Clinical Practice

BACKGROUND

Musculoskeletal Women's Health (MSK WH) is a niche subspecialty within physical medicine & rehabilitation (PM&R). Women make up 50.7% of the population of the United States but are burdened with higher rates of musculoskeletal disease compared to men. MSK WH topics are not included in PM&R or Primary Care Accreditation Council for Graduate Medical Education (ACGME) program requirements. Given the comprehensive training provided in PM&R, physiatrists are ideal candidates to diagnose, treat, and provide education on MSK WH conditions.

OBJECTIVE

To identify the prevalence of formalized MSK WH education and of WH physiatrists at ACGME-accredited PM&R residency programs.

DESIGN

Cross-sectional survey design.

SETTING

Computer-based survey.

PARTICIPANTS

ACGME-accredited residency programs (N = 86; as of February 2017).

METHODS

A single, multiple choice, computer-generated Research Electronic Data Capture (REDCap) survey with branching logic was sent to all ACGME-accredited PM&R residency programs (N = 86).

OUTCOMES

The primary outcome was to assess the prevalence of women's health curricula at ACGME-accredited PM&R residency programs in the United States. The secondary outcome was to assess the prevalence of WH physiatrists at these programs.

RESULTS

Eighty-six ACGME-accredited PM&R residency programs were contacted with 55 completed responses (64% response rate). Only six programs (11%) reported the presence of a formal WH curriculum at their residency program. In contrast, 25 programs (45%) reported having WH physiatrists at their institutions, and 36 programs (65%) reported that general physiatrists were providing WH-related care.

CONCLUSIONS

The study findings identify a mismatch between the prevalence of MSK WH residency education (11% of programs) and the prevalence of physiatrists providing MSK WH care (66% of programs). Physiatrists are ideally suited to manage MSK WH care. Based on the findings of this cross-sectional study, residency programs and governing bodies should evaluate these trends and consider the addition of topics pertinent to women's musculoskeletal health into PM&R graduate medical education.

LEVEL OF EVIDENCE

III.