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Miclau TA, Pascual L, Ndoja S, Frazer A, Beaupre L, Schemitsch EH. Rehabilitation after musculoskeletal injury: an overview of systems in the United States and Canada. OTA Int 2024; 7:e311. [PMID: 39135904 PMCID: PMC11318513 DOI: 10.1097/oi9.0000000000000311] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2023] [Accepted: 12/14/2023] [Indexed: 08/15/2024]
Abstract
As North America is largely industrialized with a variety of available private transportation options, trauma is a common occurrence, resulting in significant burdens of disability and costs to the health care system. To meet increasing trauma care needs, there is a robust organization of trauma and rehabilitation systems, particularly within the United States and Canada. The American and Canadian health care systems share multiple similarities, including well-equipped Level I trauma centers, specialized inpatient rehabilitation units for polytrauma patients, and thorough evaluations for recovery and post-discharge placement. However, they also have several key differences. In Canada, the criteria for admission to inpatient rehabilitation vary by location, and inpatient rehabilitation is universally accessible, whereas outpatient rehabilitation services are generally not covered by insurance. In the United States, these admission criteria for post-acute inpatient rehabilitation are standardized, and both inpatient and outpatient services are covered by private and government-funded insurance with varying durations. Overall, both health care systems face challenges in post-acute rehabilitation, including benefit limitations and limited provider access in rural areas, and must continue to evolve to meet the rehabilitation needs of injured patients as they reintegrate into their communities.
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Affiliation(s)
- Theodore A. Miclau
- School of Medicine, University of California San Francisco, San Francisco, CA
| | - Lisa Pascual
- Department of Orthopaedic Surgery, Orthopaedic Trauma Institute, Zuckerberg San Francisco General Hospital, University of California, San Francisco, San Francisco, CA
| | - Silvio Ndoja
- Division of Orthopedic Surgery, Department of Surgery, Western University, London, ON, Canada
| | - Abigail Frazer
- Faculty of Medicine, McGill University, Montréal, QC, Canada
| | - Lauren Beaupre
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Emil H. Schemitsch
- Orthopaedic Biomechanics Lab, Victoria Hospital, London, ON, Canada
- Division of Orthopaedic Surgery, Western University, London, ON, Canada
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Wade DT, Nayar M, Haider J. Management of traumatic brain injury: practical development of a recent proposal. Clin Med (Lond) 2022; 22:353-357. [PMID: 35705451 PMCID: PMC9345207 DOI: 10.7861/clinmed.2021-0719] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
A recent article identified weaknesses in the management of patients with traumatic brain injury (TBI). The authors suggested some reasons but overlooked two of the reasons for the low quality of services: a lack of resources and a systemic failure to organise rehabilitation services. They suggested early involvement of a condition-specific service with a new 'neuroscience clinician' and additional neuro-navigators, but the evidence shows this approach does not work. Their proposal failed to acknowledge the neuroscience skills of existing rehabilitation medicine consultants and teams, and ignored the many non-TBI problems patients will have and the consequent need for expert rehabilitation input. We revise and develop their proposal, suggesting an alternative way to improve services. Rehabilitation teams should work in parallel with acute services and remain responsible for the rehabilitation of patients as they move through different settings. This suggested development of rehabilitation mirrors the development followed by geriatric medicine from 40 years ago.
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Tracy BM, Hoover E, Jones N, Hinrichs MJ, Gelbard RB. The Effect of Physiatry Involvement for Patients With Acute Traumatic Spinal Cord Injury at a Level 1 Trauma Center. Top Spinal Cord Inj Rehabil 2022; 28:76-83. [PMID: 36457359 PMCID: PMC9678214 DOI: 10.46292/sci21-00050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2023]
Abstract
Objective To explore the impact of physiatry on acute traumatic spinal cord injury (ATSCI) outcomes using a propensity score matching (PSM) analysis. Methods We retrospectively reviewed all patients with ATSCI at a level 1 trauma center from 2018 to 2019. In a 1:1 fashion, we matched patients who were evaluated by physiatry to those who were not. Our PSM analysis controlled for patient demographics, Glasgow Coma Scale (GCS) score, Injury Severity Score (ISS), comorbidities, mechanism, and presence of a traumatic brain injury (TBI). Outcomes included complications, discharge disposition, and 30-day mortality. Survival analysis was performed using Kaplan-Meier plots. Results A total of 102 patients (physiatry 51; no physiatry 51) were matched. Median age was 38 (28-55) years, and median ISS was 25.5 (17-35); 82.4% (n = 84) were male, and 77.5% (n = 79) were bluntly injured. Rates of in-hospital complications were similar between groups. Physiatry involvement was associated with increased odds of discharge to inpatient rehabilitation (odds ratio, 4.6; 95% CI, 2-11.6; p < .001). There was a significant survival benefit seen with physiatry involvement at 30 days (92.6% vs. 78.6%, p = .004) that correlated with a decreased risk of mortality (hazard ratio, 0.2; 95% CI, 0.03-0.7; p = .01). Conclusion Incorporating physiatry into the management of patients with ATSCI is associated with improved survival and greater odds of discharge to rehabilitation. In this population, physiatry should be incorporated into the trauma care team to optimize patient outcomes.
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Affiliation(s)
- Brett M Tracy
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Erin Hoover
- Department of Surgery, The Ohio State University Wexner Medical Center, Columbus, Ohio
| | - Nikki Jones
- Department of Surgery, Morehouse School of Medicine at Grady Memorial Hospital, Atlanta, Georgia
| | - Mark J Hinrichs
- Department of Rehabilitation Medicine, Emory University School of Medicine at Grady Memorial Hospital, Atlanta, Georgia
| | - Rondi B Gelbard
- Department of Surgery, University of Alabama at Birmingham, Birmingham, Alabama
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Venkatachalam AM, Rabroker A, Stone S, Manchi MR, Sengupta S, Ifejika NL. Effect of an Interdisciplinary Stroke Consult Service on the Transition to Post-Acute Rehabilitation. Arch Phys Med Rehabil 2022; 103:1338-1344. [DOI: 10.1016/j.apmr.2022.03.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2021] [Revised: 03/08/2022] [Accepted: 03/20/2022] [Indexed: 11/27/2022]
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Weppner JL, Linsenmeyer MA, Wagner AK. Effects of an acute care brain injury medicine continuity consultation service on health care utilization and rehabilitation outcomes. PM R 2021; 13:1227-1236. [PMID: 33527710 DOI: 10.1002/pmrj.12563] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Revised: 12/29/2020] [Accepted: 01/15/2021] [Indexed: 11/09/2022]
Abstract
INTRODUCTION Although general physiatry acute-care consultation services are commonplace and improve length of stay (LOS), the benefits of a subspecialty physiatric continuity consultation service targeting patients with severe brain injury have not been reported. OBJECTIVES Our primary objective was to characterize patient care recommendations from a Brain Injury Medicine (BIM) Continuity Consult Service, and to investigate the effects on acute-care LOS relative to brain injury patients receiving General Physical Medicine & Rehabilitation (PM&R) Consult Services. Our secondary objectives were to examine inpatient rehabilitation (IPR) health care utilization metrics and costs between groups and evaluate clinical improvements during IPR and discharge disposition. DESIGN Retrospective cohort comparison study. SETTING Academic medical center with level 1 trauma center. PARTICIPANTS Adults with severe brain injury admitted to a single-site acute-care facility and subsequently admitted to a single inpatient brain injury rehabilitation unit over the same time period. PHYSIATRIC CARE MODELS BIM Continuity Consult Service versus General PM&R Consult Service. MAIN OUTCOME MEASURES Acute-care LOS; unplanned discharges to acute-care. RESULTS Despite no major demographic or clinical group differences, the BIM Consult Service had more patient comorbidities than General PM&R Consult Service (17.5±5.3 versus 16±5.1;P = .04). BIM Consult Service patients spent fewer days in acute care (30±11.8 versus 36±22.8; P = .008), and early BIM consult (≤7 days after admission) was associated with shorter acute-care LOS (P < .002). IPR LOS was similar between groups when considering unplanned transfers. Unplanned transfers among General PM&R Consult Service patients occurred twice as frequently as in BIM Consult Service patients; average readmission costs were $2778 per patient on the BIM Consult Service and $6702 per patient on the General PM&R Consult Service. More BIM Consult Service (85.7%) than General PM&R Consult Service (27.3%) patients emerged from disorders of consciousness during IPR (P = .02). CONCLUSIONS BIM Continuity Consultation Services were associated with shorter acute-care LOS, fewer unplanned acute-care transfers, and an increased likelihood of emerging from a minimally conscious state during IPR.
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Affiliation(s)
- Justin L Weppner
- Department of Physical Medicine and Rehabilitation, University of Virginia, Charlottesville, Virginia, USA.,Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Mark A Linsenmeyer
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Physical Medicine and Rehabilitation, Sunnyview Rehabilitation Hospital, Schenectady, New York, USA.,Sunnyview Research Institute, St. Peter's Health Partners, Albany, New York, USA
| | - Amy K Wagner
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Department of Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Clinical and Translational Science Institute, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Safar Center for Resuscitation Research, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.,Center for Neuroscience, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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An Evaluation of Age-Based Differences in the Demographic Features and Clinical Outcomes of Trauma Rehabilitation Patients. Am J Phys Med Rehabil 2020; 99:999-1003. [PMID: 32379073 DOI: 10.1097/phm.0000000000001458] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aims of the study were to describe potential age-related differences in injury type and mechanism, comorbidities, and physical medicine and rehabilitation-relevant complications in patients admitted after major trauma and to examine whether functional outcomes vary by age group after traumatic injury. DESIGN This is a subanalysis of a pre-post study. Individuals admitted to a level 1 trauma center who sustained major trauma were divided into three age groups (young, middle age, and elderly). The demographic, acute care, and rehabilitation factors for these patients were then compared across the three age groups. RESULTS Based on an age distribution plot, the age categories were defined as follows: young, 18-39 yrs (n = 120); middle age, 40-64 yrs (n = 124); and elderly, 65 yrs or older (n = 85). Patients 65 yrs or older demonstrated a greater frequency of comorbidities (P < 0.001) and complications (P < 0.001). For individuals admitted to inpatient rehabilitation, admission and discharge functional independence measure scores were lower for the elderly individuals, but functional independence measure change was not significantly different between groups. CONCLUSIONS Although the elderly trauma patient demonstrates important differences from the younger one, capacity for improvement with rehabilitation seems similar.
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Hitzig SL, Gotlib Conn L, Guilcher SJT, Cimino SR, Robinson LR. Understanding the role of the physiatrist and how to improve the continuum of care for trauma patients: a qualitative study. Disabil Rehabil 2020; 43:2846-2853. [DOI: 10.1080/09638288.2020.1719215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Sander L. Hitzig
- St. John’s Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Department of Occupational Science & Occupational Therapy, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lesley Gotlib Conn
- Tory Trauma Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Department of Anthropology, Faculty of Arts and Science, University of Toronto, Toronto, Canada
- Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | - Sara J. T. Guilcher
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Leslie Dan Faculty of Pharmacy, University of Toronto, Toronto, Canada
- ICES, Toronto, Canada
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Stephanie R. Cimino
- St. John’s Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Lawrence R. Robinson
- St. John’s Rehab Research Program, Evaluative Clinical Sciences, Sunnybrook Research Institute, Toronto, Canada
- Rehabilitation Sciences Institute, Faculty of Medicine, University of Toronto, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Faculty of Medicine, University of Toronto, Toronto, Canada
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Geddes AT, Stathopoulou T, Viscasillas J, Lafuente P. Opioid‐free anaesthesia (OFA) in a springer spaniel sustaining a lateral humeral condylar fracture undergoing surgical repair. VETERINARY RECORD CASE REPORTS 2019. [DOI: 10.1136/vetreccr-2018-000681] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Affiliation(s)
- Alexander Thomas Geddes
- Department of Surgical SciencesUniversity of Wisconsin Madison School of Veterinary MedicineMadisonWisconsinUSA
| | | | - Jaime Viscasillas
- Clinical Sciences and ServicesThe Royal Veterinary CollegeHatfieldUK
| | - Pilar Lafuente
- Clinical Sciences and ServicesThe Royal Veterinary CollegeHatfieldUK
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