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Braun R, Han K, Arata J, Gourab K, Gonzalez-Fernandez M. Establishing a Clinical Care Pathway to Expedite Rehabilitation Transitions for Stroke Patients With Dysphagia and Enteral Feeding Needs. Am J Phys Med Rehabil 2024; 103:390-394. [PMID: 38112750 PMCID: PMC11031280 DOI: 10.1097/phm.0000000000002387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2023]
Abstract
OBJECTIVE The aim of the study is to evaluate the safety and efficacy of a physiatrist-led clinical pathway to expedite rehabilitation transitions for stroke patients with dysphagia requiring nasogastric tube or percutaneous endoscopic gastrostomy. DESIGN This is a retrospective single-center observational study in 426 adults with stroke and dysphagia admitted to the acute hospital. Physican Medicine and Rehabilitation (PM&R) was consulted to determine dysphagia prognosis and candidacy for rehabilitation admission with nasogastric tube or percutaneous endoscopic gastrostomy. The proportion of patients accepted with nasogastric tube versus percutaneous endoscopic gastrostomy, progression to total oral diet during rehabilitation, and lengths of stay were tracked. RESULTS The rate of recovery to total oral diet for patients accepted with nasogastric tube was 38/44 = 86.3% versus 29/75 = 38.6% with percutaneous endoscopic gastrostomy. There was a significant difference in mean time to total oral diet with nasogastric tube (20.37 days) versus percutaneous endoscopic gastrostomy (34.46 days): t (43) = 4.49, P < 0.001. The acute hospital length of stay was significantly shorter with nasogastric tube (12.9 days) versus percutaneous endoscopic gastrostomy (20.4 days): t (117) = 4.16, P < 0.001. Rehabilitation length of stay did not differ significantly between groups (26.9 vs. 32.0 days). CONCLUSION Physiatrist-led initiatives to evaluate stroke patients with dysphagia can expedite rehabilitation transitions, prevent unnecessary invasive procedures, and reduce acute hospital length of stay.
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Affiliation(s)
- Robynne Braun
- University of Maryland School of Medicine, Department of Neurology, Baltimore, MD
| | - Kenneth Han
- Midstate Medical Center, Hartford Healthcare, Meriden CT
| | - Jodi Arata
- University of Maryland Rehabilitation and Orthopedic Institute, Baltimore, MD
| | - Krishnaj Gourab
- University of Maryland Rehabilitation and Orthopedic Institute, Baltimore, MD
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Yeh JC, Ambady L, Lewis R, Mehta AK, Asher A, Raj VS, Engle JP. Palliative Care Education in US Physical Medicine and Rehabilitation Residency Programs: Current Practices, Perceived Needs, and Barriers. J Palliat Med 2023; 26:1128-1132. [PMID: 37335750 DOI: 10.1089/jpm.2022.0606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Background: Physical medicine and rehabilitation (PM&R) clinicians commonly care for patients with serious illness/injury and would benefit from primary palliative care (PC) training. Objective: To assess current practices, attitudes, and barriers toward PC education among U.S. PM&R residencies. Design: This is a cross-sectional study utilizing an electronic 23-question survey. Setting/Subjects: Subjects were program leaders from U.S. PM&R residency programs. Results: Twenty-one programs responded (23% response). Only 14 (67%) offered PC education through lectures, elective rotations, or self-directed reading. Pain management, communication, and nonpain symptom management were identified as the most important PC domains for residents. Nineteen respondents (91%) felt residents would benefit from more PC education, but only five (24%) reported undergoing curricular change. Lack of faculty availability/expertise and teaching time were the most endorsed barriers. Conclusion: PC education is heterogeneous across PM&R programs despite its perceived value. PC and PM&R educators can collaborate to build faculty expertise and integrate PC principles into existing curricula.
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Affiliation(s)
- Jonathan C Yeh
- Section of Palliative Care, Division of General Medicine and Primary Care, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | - Leena Ambady
- Harvard Medical School, Boston, Massachusetts, USA
| | - Ryan Lewis
- Mayo Clinic Center for Palliative Medicine, Rochester, Minnesota, USA
| | - Ambereen K Mehta
- Palliative Care Program, Department of Medicine, Johns Hopkins Bayview Medical Center, Baltimore, Maryland, USA
| | - Arash Asher
- Patient and Family Support Program at the Samuel Oschin Comprehensive Cancer Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
| | - Vishwa S Raj
- Department of Physical Medicine and Rehabilitation, Carolinas Rehabilitation, Charlotte, North Carolina, USA
- Department of Supportive Care, Levine Cancer Institute, Charlotte, North Carolina, USA
| | - Jessica P Engle
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Alwashmi AH. Assessment of the Study Habits of Residents in Physical Medicine and Rehabilitation Programs in Saudi Arabia: A Cross-Sectional Study. Adv Med Educ Pract 2023; 14:615-625. [PMID: 37350931 PMCID: PMC10284300 DOI: 10.2147/amep.s411225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2023] [Accepted: 06/10/2023] [Indexed: 06/24/2023]
Abstract
Background Residents in training must employ a variety of study strategies, as they not only participate in academic studies but also interact with patients. This study aimed to evaluate the study practices and factors affecting those practices among Saudi Arabian physical medicine and rehabilitation residents during their residency program. Methods In this cross-sectional study, a previously used questionnaire was distributed to Saudi Arabian physiatry residents from July 1 to August 15, 2022, via a social media platform and completed using a Google Forms survey. A Microsoft Excel spreadsheet was used to collect, clean, and import the data before IBM SPSS Statistics for Windows, version 22.0 was utilized for statistical analysis. Results The data of 94.91% of respondents were included in the analysis. Individuals who were female, unmarried or divorced, and without children predominated. Only 17.9% (n = 10) of the residents believed that their training program effectively prepared them to pass the board examination, which was the most strongly motivating factor for studying for 85.7% of respondents. Over two-thirds of the residents mentioned that they regularly exercise. Residents who studied more than 11 hours per week had a significantly lower score in the category of factors that negatively affect examination performance (M = 12.33 ± 2.82, F = 2.794, P < 0.05). Females, final-year residents, and Riyadh residents studied more than their counterparts. Conclusion Our study is the first to investigate how Saudi physiatrists study, with the finding that current physiatry residents employ a combination of traditional and contemporary learning strategies. This information can help stakeholders to understand current training challenges, improve the quality of training for physiatry residents, and create an ideal learning environment.
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Affiliation(s)
- Ahmad H Alwashmi
- Department of Orthopedic Surgery, College of Medicine, Qassim University, Buraydah, 52571, Saudi Arabia
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Goldman JG, Merkitch D, Brewington D, Peirce H, Rho M, Jayabalan P, Curran J, Brennan K. Patient experiences receiving rehabilitation care via telehealth: Identifying opportunities for remote care. Front Rehabil Sci 2023; 4:1049554. [PMID: 36817717 PMCID: PMC9932031 DOI: 10.3389/fresc.2023.1049554] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 01/11/2023] [Indexed: 02/05/2023]
Abstract
Use of telehealth has grown substantially in recent times due to the COVID-19 pandemic. Remote care services may greatly benefit patients with disabilities; chronic conditions; and neurological, musculoskeletal, and pain disorders, thereby allowing continuity of rehabilitation care, reducing barriers such as transportation, and minimizing COVID-19 exposure. In March 2020, our rehabilitation hospital, Shirley Ryan AbilityLab, launched a HIPAA-compliant telemedicine program for outpatient and day rehabilitation clinics and telerehabilitation therapy programs. The objective of this study was to examine patients' experiences and satisfaction with telemedicine in the rehabilitation physician practice, including novel virtual multidisciplinary evaluations. The present study examines survey data collected from 157 patients receiving telemedicine services at Shirley Ryan AbilityLab from December 2020-August 2021. Respondents were 61.8% female, predominantly White (82.2%) with ages ranging across the lifespan (69.4% over age 50 years). Diagnostic categories of the respondents included: musculoskeletal conditions 28%, chronic pain 22.3%, localized pain 10.2%, neurological conditions 26.8%, and Parkinson's and movement disorders 12.7%. Survey responses indicate that the telemedicine experiences were positive and well received. The majority of participants found these services easy to use, effective, and safe, and were overall satisfied with the attention and care they received from the providers-even for those who had not previously used telehealth. Respondents identified a variety of benefits, including alleviating financial and travel-related burdens. There were no significant differences in telehealth experiences or satisfaction across the different clinical diagnostic groups. Respondents viewed the integrated physician and rehabilitation therapist telehealth multidisciplinary model favorably, citing positive feedback regarding receiving multiple perspectives and recommendations, feeling like an integrated member of their healthcare team, and having a comprehensive, holistic team approach along with effective communication. These findings support that telemedicine can provide an effective care model in physiatry (physical medicine and rehabilitation) clinics, across different neurological, musculoskeletal, and pain conditions and in multidisciplinary team care settings. The insights provided by the present study expand our understanding of patient experiences with remote care frameworks for rehabilitation care, while controlling for institutional variation, and ultimately will help provide guidance regarding longer term integration of telemedicine in physiatry and multidisciplinary care models.
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Affiliation(s)
- Jennifer G. Goldman
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States,Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Department of Neurology, Northwestern University Feinberg School of Medicine, Chicago, IL, United States,Correspondence: Jennifer G. Goldman
| | - Douglas Merkitch
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - David Brewington
- Information Systems, Enterprise Data Warehouse, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Hannah Peirce
- Parkinson's Disease and Movement Disorders, Shirley Ryan AbilityLab, Chicago, IL, United States
| | - Monica Rho
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Prakash Jayabalan
- Department of Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Chicago, IL, United States
| | - Jessica Curran
- Outpatient Physical Therapy, Shirley Ryan AbilityLab, Chicago, IL, United States
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Torres JA, Griffin T, Rogenmoser WD. Interdisciplinary Care Provided in a Rural Setting to Patient with Below-Knee Amputation. Cureus 2023; 15:e34700. [PMID: 36909103 PMCID: PMC9995249 DOI: 10.7759/cureus.34700] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2023] [Indexed: 02/09/2023] Open
Abstract
As a result of severe injury, limb amputation remains a pivotal procedure to preserve residual function of an injured extremity. Complications following amputation can impact successful rehabilitation. This case report aims to highlight the clinical importance of interdisciplinary care demonstrated by a 65-year-old Caucasian male below-knee amputee (BKA) who presented to an amputee clinic with complaints of right distal tibia pain. He reported that he was seen at a small rural clinic and was told he had "deterioration of his tibia". Physical exam revealed a well-healed below-knee amputation stump with tenderness to palpation of the right lateral distal residual fibula. Upon prosthetic modifications managed by our prosthetist, the patient's symptoms persisted. Further work up by Physical Medicine and Rehabilitation (PM&R) revealed a sharp edge to the distal fibula and the need for surgical revision by plastic surgery. Conditions resulting from the initial operation left this patient with factors that significantly impacted the process of restoring function to this BKA. Management of care for amputees commonly involves a variety of healthcare provider consisting of, but not limited to, primary care, physiatrists, prosthetists, plastic surgeons, and physical and occupational therapists. The aim of this case report is to illustrate how the fundamental collaboration rooted in interdisciplinary care is paramount to ensure that comprehensive care is delivered to this complex patient population that reside in rural areas.
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Affiliation(s)
- Joshua A Torres
- Physical Medicine and Rehabilitation, Edward Via College of Osteopathic Medicine, Monroe, USA
| | - Thomas Griffin
- Orthotics & Prosthetics, Snell's Orthotics & Prosthetics, Alexandria, USA
| | - William D Rogenmoser
- Physical Medicine and Rehabilitation, CHRISTUS St. Frances Cabrini Hospital, Alexandria, USA
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Pinto LV, Gouveia FC, Ramalho JF, Silva SR, Silva JR. Horseback Riding-Related Injuries in Portugal and Prevention Strategies. J Sport Rehabil 2023;:1-6. [PMID: 36689993 DOI: 10.1123/jsr.2022-0101] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2022] [Revised: 11/28/2022] [Accepted: 12/01/2022] [Indexed: 01/24/2023]
Abstract
CONTEXT Horse riding (HR) has gain popularity in Portugal, thereby increasing the number of related injuries. This study identifies frequently occurring injuries in Portuguese riders, the conditions under which they occur, and preventive measures. DESIGN A retrospective cohort study. METHODS We included 216 Portuguese riders practicing HR at the time of the study with ≥1 year of experience. Data were obtained from a questionnaire that characterized first and second rider injuries; we opted for a systematic method to assess the riders' injuries, in a temporal order. Questions regarding demographic data, sports-related background, systematic training workload, number and characteristics of the first 2 injuries, and the need for treatment were included in the questionnaire. RESULTS Most first and second injuries were musculoskeletal, occurred from falling off the horse during training, and primarily affected the lower limb. Rehabilitation was required in almost 50% of all cases. The occurrence of injury was significantly associated with the number of days of training per week, years of experience, height and weight of the rider, and practice of another sport. Riding different horses was also significantly associated with the number of injuries. CONCLUSIONS The most frequently occurring injuries during HR are musculoskeletal and in the extremities. Injury prevention is essential in HR, as most riders have at least one injury while practicing. Rehabilitation should involve a physiatrist and core strengthening exercises.
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Haque MZ, Ahmed F, Khandaker S, Syed S, Bazzy YA. Pediatric physical medicine and rehabilitation: Fellowship website content comprehensiveness evaluation. J Pediatr Rehabil Med 2023; 16:493-496. [PMID: 37694317 DOI: 10.3233/prm-220139] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/12/2023] Open
Abstract
This cross-sectional analysis of Pediatric Rehabilitation Medicine (PRM) fellowship program websites in the United States assesses their comprehensiveness based on 43 variables commonly sought by applicants. The study found that 30% of programs had a direct link to the PRM fellowship page, with limited information on criteria such as education resources, research stipend, mentorship opportunities, and fellow wellness. The results underscore the need for improved accessibility, content expansion, and yearly link maintenance. These improvements could enhance the applicant experience, foster informed decisions, and streamline the application process. The findings offer a roadmap for PRM fellowships to better align their online platforms with applicant needs, reflecting the current shift toward virtual interactions in the post-pandemic era.
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Affiliation(s)
- Mahfujul Z Haque
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Frass Ahmed
- Michigan State University College of Human Medicine, Grand Rapids, MI, USA
| | - Shaima Khandaker
- Department of Physical Medicine and Rehabilitation, Beaumont Hospitals, Royal Oak, MI, USA
| | - Sameer Syed
- Department of Physical Medicine and Rehabilitation, University of Toledo College of Medicine and Life Sciences, Toledo, OH, USA
| | - Yusef A Bazzy
- Rehabilitation Institute of Michigan, Detroit, MI, USA
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Pomeroy JML, Sanchez JO, Cai C, Garfinkel S, Côté P, Frontera WR, Gerber LH. Incorporating the Concept of Relevance in Clinical Rehabilitation Research and Its Reviews May Improve Uptake by Stakeholders. Am J Phys Med Rehabil 2022; 101:775-781. [PMID: 35533398 PMCID: PMC9301989 DOI: 10.1097/phm.0000000000002046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
ABSTRACT The "relevance" of research to stakeholders is an important factor in influencing the uptake of new knowledge into practice; however, this concept is neither well defined nor routinely incorporated in clinical rehabilitation research. Developing a uniform definition, measurement standards, stakeholder engagement strategies, and guiding frameworks that bolster relevance may help incorporate the concept as a key element in research planning and design. This article presents a conceptual argument for why relevance matters, proposes a working definition, and suggests strategies for operationalizing the construct in the context of clinical rehabilitation research. We place special emphasis on the importance of promoting relevance to patients, caregivers, and clinicians and provide preliminary frameworks and innovative study designs that can assist clinical rehabilitation researchers in doing so. We argue that researchers who include a direct statement regarding why and to whom a study is relevant and who incorporate considerations of relevance throughout all phases of study design produce more useful research for patients, caregivers, and clinicians, increasing its chance of uptake into practice. Consistent consideration of relevance, particularly to nonacademic audiences, during the conceptualization, study design, presentation, and dissemination of clinical rehabilitation research may promote the uptake of findings by patients, caregivers, and providers.
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Affiliation(s)
- J. Mary Louise Pomeroy
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Jonathan O. Sanchez
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Cindy Cai
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Steven Garfinkel
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Pierre Côté
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Walter R. Frontera
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
| | - Lynn H. Gerber
- From the College of Health and Human Services, Department of Health Administration and Policy, George Mason University, Fairfax, Virginia (JMLP, JOS, LHG); American Institutes for Research, Arlington, Virginia (CC); American Institutes for Research, Chapel Hill, North Carolina (SG); Ontario Tech University, Oshawa, Canada (PC); Department of Physiology, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF); and Department of Physical Medicine, Rehabilitation, and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico (WRF)
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Annaswamy TM, Rizzo JR, Schnappinger A, Morgenroth DC, Engkasan JP, Ilieva E, Arnold WD, Boninger ML, Bean AC, Cirstea CM, Dicianno BE, Fredericson M, Jayabalan P, Raghavan P, Sawaki L, Suri P, Suskauer SJ, Wang QM, Hosseini M, Case CM, Whyte J, Paganoni S. Evidence-Based Medicine Training in United States-Based Physiatry Residency Programs. Am J Phys Med Rehabil 2022; 101:S40-S44. [PMID: 33852491 PMCID: PMC9444380 DOI: 10.1097/phm.0000000000001752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
ABSTRACT Although the physiatric community increasingly embraces evidence-based medicine (EBM), the current state of EBM training for trainees in physiatry is unclear. The purposes of this article are to report the results of the Association of Academic Physiatrists' surveys of physiatry residency programs in the United States, to discuss the implications of their findings, and to better delineate the "baseline" upon which sound and clear recommendations for systematic EBM training can be made. The two Association of Academic Physiatrists surveys of US physiatry residency programs reveal that most survey respondents report that they include EBM training in their programs that covers the five recommended steps of EBM core competencies. However, although most respondents reported using traditional pedagogic methods of training such as journal club, very few reported that their EBM training used a structured and systematic approach. Future work is needed to support and facilitate physiatry residency programs interested in adopting structured EBM training curricula that include recommended EBM core competencies and the evaluation of their impact.
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Affiliation(s)
- Thiru M Annaswamy
- From the PM&R Service, VA North Texas Health Care System, Dallas, Texas (TMA); Department of PM&R, UT Southwestern Medical Center, Dallas, Texas (TMA); Departments of Rehabilitation Medicine and Neurology, New York University Langone Health, New York City, New York (J-RR); Association of Academic Physiatrists, Owings Mills, Maryland (AS); VA RR&D Center for Limb Loss and Mobility (CLiMB), VA Puget Sound Health Care System, Seattle, Washington (DCM); Department of Rehabilitation Medicine, University of Washington, Seattle, Washington (DCM, PS); Department of Rehabilitation Medicine, University of Malaya, Kuala Lumpur, Malaysia (JPE); Department of Physical and Rehabilitation Medicine, Medical University of Plovdiv, Plovdiv, Bulgaria (EI); Departments of Neurology, PM&R, Neuroscience, and Physiology and Cell Biology, The Ohio State University Wexner Medical Center, Columbus, Ohio (WDA); Department of PM&R, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (MLB, ACB, BED); Department of Physical Medicine & Rehabilitation, University of Missouri, Columbia, Missouri (CM Cirstea); Division of PM&R, Stanford University School of Medicine, Stanford, California (MF); Shirley Ryan AbilityLab, Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, Illinois (PJ); Johns Hopkins School of Medicine, Baltimore, Maryland (PR); Department of PM&R, University of Kentucky, Lexington, Kentucky (LS); Seattle Epidemiologic Research and Information Center and Division of Rehabilitation Care Services, VA Puget Sound Health Care System, Seattle, Washington (PS); Clinical Learning, Evidence, and Research Center, University of Washington, Seattle, Washington (PS); Departments of Physical Medicine & Rehabilitation and Pediatrics, Johns Hopkins University School of Medicine, Kennedy Krieger Institute, Baltimore, Maryland (SJS); Spaulding Rehabilitation Hospital, Harvard Medical School, Charlestown, Massachusetts (QMW, SP); Department of Physical Medicine and Rehabilitation, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York (MH); Creighton University, Omaha, Nebraska (CM Case); Moss Rehabilitation Research Institute, Elkins Park, Pennsylvania (JW); and Healey & AMG Center for ALS and Neurological Clinical Research Institute, Massachusetts General Hospital, Boston, Massachusetts (SP)
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Loy E, Scheidler A, Packham T, Dow H, Winston P. Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS. Can J Pain 2022; 6:77-84. [PMID: 35694140 PMCID: PMC9176228 DOI: 10.1080/24740527.2022.2063113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Background The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS). Aims The aim of this study was to perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis, and treatment of CRPS with prednisone are safe and effective. Methods An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS: PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pretreatment baseline) and at the time of survey (posttreatment). Results CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients' experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment. Conclusions This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS.
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Affiliation(s)
- Emma Loy
- Faculty of Medicine, University of British Columbia, Vancouver, BritishColumbia, Canada
| | - Anna Scheidler
- Faculty of Medicine, Dalhousie University, Halifax, Nova Scotia, Canada
| | - Tara Packham
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Heather Dow
- Canadian Association of Physical Medicine and Rehabilitation, Kingston, Ontario, Canada
| | - Paul Winston
- Division of Physical Medicine and Rehabilitation, University of British Columbia, Vancouver, BritishColumbia, Canada,CONTACT Dr. Paul Winston Division of Physical Medicine and Rehabilitation, University of British Columbia, 1 Hospital Way, Victoria General Hospital, Victoria, BCV8Z 6R5, Canada
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11
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Haque M, Khan S, Sandhu A, Armstrong K. Social media and the practice of pediatric physical medicine and rehabilitation in the COVID-19 pandemic: A new era in patient-care. J Pediatr Rehabil Med 2022; 15:413-416. [PMID: 36031919 DOI: 10.3233/prm-220050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Social media represents a significant source of health information for the public, especially during the COVID-19 pandemic where gatherings are limited. It is important for pediatric physical medicine and rehabilitation physicians to understand how their patients use these platforms in order to educate the public and provide sound medical advice on social media. Given the lack of current guidelines on medical education through social media, the purpose of this paper is to provide an overview of various online social media platforms and describe how they can be utilized to enhance pediatric patient education. It is necessary to understand the different educational functions and limitations of the various social media platforms. This text provides a comprehensive overview of different social media platforms, their educational uses, limitations, and sample accounts. Relevant to the COVID-19 pandemic, social media can improve the efficiency of educational delivery and clinic workflow. Although social media is not meant to replace physician-patient relationships, it can be used as a surrogate for health information and improve- even start- physician-patient relationships. Despite the benefits of social media, pediatric physiatrists may be hesitant to utilize these platforms for several reasons. This text provides an overview of common barriers to social media usage by physicians and recommendations to overcome them. Given that the pandemic has led to increased social media usage, physicians should be aware of its implications on patient care and how they can be used to enhance the practice of pediatric physical medicine and rehabilitation. As social media usage by both patients and physicians grows, more research is needed to create recommendations on how pediatric physiatrists can best utilize social media to educate the public in an enjoyable manner while maintaining a professional image.
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Affiliation(s)
- Mahfujul Haque
- Michigan State University College of Human Medicine, East Lansing, MI, USA.,Department of Physical Medicine and Rehabilitation, Mary Free Bed Hospital, Grand Rapids, MI, USA
| | - Shahrin Khan
- Wayne State University School of Medicine, Detroit, MI, USA
| | - Amar Sandhu
- Michigan State University College of Osteopathic Medicine, Detroit, MI, USA
| | - Kelly Armstrong
- Michigan State University College of Human Medicine, East Lansing, MI, USA.,Department of Physical Medicine and Rehabilitation, Mary Free Bed Hospital, Grand Rapids, MI, USA
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Conic RRZ, Geis C, Vincent HK. Social Determinants of Health in Physiatry: Challenges and Opportunities for Clinical Decision Making and Improving Treatment Precision. Front Public Health 2021; 9:738253. [PMID: 34858922 PMCID: PMC8632538 DOI: 10.3389/fpubh.2021.738253] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2021] [Accepted: 10/11/2021] [Indexed: 11/15/2022] Open
Abstract
Physiatry is a medical specialty focused on improving functional outcomes in patients with a variety of medical conditions that affect the brain, spinal cord, peripheral nerves, muscles, bones, joints, ligaments, and tendons. Social determinants of health (SDH) play a key role in determining therapeutic process and patient functional outcomes. Big data and precision medicine have been used in other fields and to some extent in physiatry to predict patient outcomes, however many challenges remain. The interplay between SDH and physiatry outcomes is highly variable depending on different phases of care, and more favorable patient profiles in acute care may be less favorable in the outpatient setting. Furthermore, SDH influence which treatments or interventional procedures are accessible to the patient and thus determine outcomes. This opinion paper describes utility of existing datasets in combination with novel data such as movement, gait patterning and patient perceived outcomes could be analyzed with artificial intelligence methods to determine the best treatment plan for individual patients in order to achieve maximal functional capacity.
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Affiliation(s)
- Rosalynn R Z Conic
- Department of Family Medicine and Public Health, University of California, San Diego, San Diego, CA, United States
| | - Carolyn Geis
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
| | - Heather K Vincent
- Department of Physical Medicine and Rehabilitation, University of Florida, Gainesville, FL, United States
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Maltser S, Trovato E, Fusco HN, Sison CP, Ambrose AF, Herrera J, Murphy S, Kirshblum S, Bartels MN, Bagay L, Oh-Park M, Stein AB, Cuccurullo S, Nori P, Donovan J, Dams-O’Connor K, Amorapanth P, Barbuto SA, Bloom O, Escalon MX. Challenges and Lessons Learned for Acute Inpatient Rehabilitation of Persons With COVID-19: Clinical Presentation, Assessment, Needs, and Services Utilization. Am J Phys Med Rehabil 2021; 100:1115-1123. [PMID: 34793372 PMCID: PMC8594401 DOI: 10.1097/phm.0000000000001887] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE The aim of the study was to present: (1) physiatric care delivery amid the SARS-CoV-2 pandemic, (2) challenges, (3) data from the first cohort of post-COVID-19 inpatient rehabilitation facility patients, and (4) lessons learned by a research consortium of New York and New Jersey rehabilitation institutions. DESIGN For this clinical descriptive retrospective study, data were extracted from post-COVID-19 patient records treated at a research consortium of New York and New Jersey rehabilitation inpatient rehabilitation facilities (May 1-June 30, 2020) to characterize admission criteria, physical space, precautions, bed numbers, staffing, employee wellness, leadership, and family communication. For comparison, data from the Uniform Data System and eRehabData databases were analyzed. The research consortium of New York and New Jersey rehabilitation members discussed experiences and lessons learned. RESULTS The COVID-19 patients (N = 320) were treated during the study period. Most patients were male, average age of 61.9 yrs, and 40.9% were White. The average acute care length of stay before inpatient rehabilitation facility admission was 24.5 days; mean length of stay at inpatient rehabilitation facilities was 15.2 days. The rehabilitation research consortium of New York and New Jersey rehabilitation institutions reported a greater proportion of COVID-19 patients discharged to home compared with prepandemic data. Some institutions reported higher changes in functional scores during rehabilitation admission, compared with prepandemic data. CONCLUSIONS The COVID-19 pandemic acutely affected patient care and overall institutional operations. The research consortium of New York and New Jersey rehabilitation institutions responded dynamically to bed expansions/contractions, staff deployment, and innovations that facilitated safe and effective patient care.
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Patel N, Steinberg C, Patel R, Chomali C, Doulatani G, Lindsay L, Jaywant A. Description and Functional Outcomes of a Novel Interdisciplinary Rehabilitation Program for Hospitalized Patients With COVID-19. Am J Phys Med Rehabil 2021; 100:1124-32. [PMID: 34596096 DOI: 10.1097/PHM.0000000000001897] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES The aims of the study were to describe an interdisciplinary inpatient rehabilitation program for patients recovering from COVID-19 and to evaluate functional outcomes. DESIGN This is an analysis of retrospective data captured from the electronic health record of COVID-19 patients admitted to the rehabilitation unit (N = 106). Rehabilitation approaches are described narratively. Functional gain was evaluated using the Activity Measure for Postacute Care 6 Clicks, basic mobility and daily activities. RESULTS Interdisciplinary approaches were implemented to address the medical, physical, communication, cognitive, and psychosocial needs of COVID-19 patients. COVID-19 patients exhibited significant improvements in basic mobility (Activity Measure for Postacute Care for basic mobility, P < 0.001, Cohen d = 1.35) and daily activities (Activity Measure for Postacute Care for daily activities, P < 0.001, Cohen d = 1.06) from admission to discharge. There was an increase in ambulatory distance as well as the percentage of the patients who were able to breathe on room air. At discharge, fewer patients required supplemental oxygen on exertion. Eighty percent of the patients were discharged home after an average length of stay of 17 days. Greater functional improvement was associated with younger age, longer intubation duration, and participation in psychotherapy, but not a history of delirium during hospitalization. CONCLUSIONS Early rehabilitation is associated with improved mobility and independence in activities of daily living after COVID-19.
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Alwashmi AH, Alkhamees AA. Burnout and the Psychological Impact among Physiatrists in Saudi Arabia during COVID-19. Int J Environ Res Public Health 2021; 18:ijerph18189621. [PMID: 34574546 PMCID: PMC8472589 DOI: 10.3390/ijerph18189621] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2021] [Revised: 09/07/2021] [Accepted: 09/08/2021] [Indexed: 11/16/2022]
Abstract
Background: Burnout is an emerging critical issue facing specialists and trainees in all disciplines and not particularly studied among physiatry specialists and trainees in Saudi Arabia during the COVID-19 pandemic. Objective: To assess physiatrist burnout, depression, anxiety, and stress during the current COVID-19 pandemic crisis in Saudi Arabia. Design: Cross-sectional study. Setting: By distributing an electronic survey, the researcher assessed burnout using the Maslach Burnout Inventory (MBI) Human Services Survey (HSS) in the midst of the curfew that Saudi authorities imposed. Participants: One hundred one participating trainees, specialists, and consultants. Results: Of the 101 study participants, the majority (73.3%) were between the ages of 24 and 34 years old, with the rest distributed within the age group ranging from 35 to 65 years old. Junior residents represented 34.7%, senior residents 22.8%, physiatrist specialists 26.7%, and consultants 15.8%. The sample included 55.4% males and 44.6% females; 64.4% of the participants were married, 29.7% were still single, and 5.9% were divorced. Among the total group participating, 25.7% were handling COVID-19 patients. In the total participant sample, 80.2% reported experiencing burnout, 10.9% experienced stress, and 22.8% and 6.9% experienced anxiety and depression, respectively. Conclusion: Burnout in Saudi Arabia exists among more than two-thirds of practicing physiatrists in Physical Medicine & Rehabilitation (PM&R), and that did not appear to have a statistically significant influence on stress, anxiety, or depression (p > 0.05). The current COVID-19 global pandemic might escalate burnout and influence mental health outcomes. The healthcare authority and administration should take the lead in identifying the challenges, overcoming the obstacles, and optimizing clinician well-being, delivering up-to-date solutions, and promptly checking their effectiveness.
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Affiliation(s)
- Ahmad H. Alwashmi
- Department of Orthopedic Surgery, College of Medicine, Qassim University, Buraydah 52571, Saudi Arabia
- Correspondence:
| | - Abdulmajeed A. Alkhamees
- Department of Medicine, Unaizah College of Medicine and Medical Sciences, Qassim University, Buraydah 52571, Saudi Arabia;
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Hreha K, Weden K, Perea J, Roberts P, Rizzo JR. A Model for Vision Rehabilitation and the Role of the Physiatrist on the Interdisciplinary Team. Am J Phys Med Rehabil 2021; 100:e80-e81. [PMID: 32701638 PMCID: PMC9704747 DOI: 10.1097/phm.0000000000001544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Journeay WS, Robinson LR, Titman R, Macdonald SL. Characteristics and outcomes of COVID-19-Positive Individuals Admitted for Inpatient Rehabilitation in Toronto, Canada. J Rehabil Med Clin Commun 2021; 4:1000053. [PMID: 33884155 PMCID: PMC8054744 DOI: 10.2340/20030711-1000053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/02/2021] [Indexed: 05/08/2023]
Abstract
OBJECTIVE To describe the sociodemographic features, impairments, and functional changes of COVID-19-positive individuals who underwent inpatient rehabilitation at three rehabilitation hospitals in Toronto, Canada. DESIGN Retrospective chart review of patients admitted to three COVID-19 rehabilitation units between 20 April 2020 and 3 June 2020. Sociodemographic factors, impairments, length of stay, and Functional Independence Measure data were reported. RESULTS A total of 41 patients were included in this study, including 22 males and 19 females. The median age was 75 years. Thirty-six percent of patients were admitted to the intensive care unit during their acute stay. The most commonly affected body functions were: neuromusculoskeletal (73.2%); combined cardiovascular, haematological, immunological, and respiratory (65.9%); and mental functions (29.3%). Median total Functional Independence Measure score was 85 at admission and 108.5 at discharge. CONCLUSION This study represents some of the first data on the characteristics and outcomes of COVID-19-positive individuals admitted to inpatient rehabilitation in Toronto, Canada early in the COVID-19 pandemic.
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Affiliation(s)
- W Shane Journeay
- Providence Healthcare, Unity Health Toronto, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - Lawrence R Robinson
- St John's Rehabilitation, Sunnybrook Health Sciences Centre, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - Rebecca Titman
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
| | - Shannon L Macdonald
- Bridgepoint Active Healthcare, Sinai Health, Toronto, Canada
- Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Canada
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Genovese TJ, Carayannopoulos A, Parziale JR. Physical Medicine and Rehabilitation in Rhode Island during the COVID-19 Pandemic. R I Med J (2013) 2020; 103:47-50. [PMID: 33261236] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
The COVID-19 pandemic has transformed the practice of medicine. We interviewed Physical Medicine and Rehabilitation (PM&R) specialist physicians providing rehabilitation services throughout Rhode Island to organize a narrative assessing the pandemic's impact on the state's rehabilitation community and the responses of its leaders. Almost half of rehabilitation providers needed to suspend their services during the initial peak of the pandemic. Most experienced reductions in the size of their practices, as well as personnel issues that contributed to burnout. All physicians used telemedicine to connect with patients. Many reported issues with accessing personal protective equipment and providing clinical opportunities for trainees. Inpatient rehabilitation policies and practices helped to maintain access for COVID-positive and negative patients, yet challenges were faced when configuring physical space to abide by CDC social distancing guidelines and providing care without patient visitors. Despite setbacks, the pandemic outlined opportunities for improvement of healthcare organization and delivery.
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19
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Mardinger C, Steve AK, Yeung JK. A Multidisciplinary Hand Clinic Using Physiatrists for the Evaluation of Non-Operative Pathologies. Plast Surg (Oakv) 2020; 29:128-131. [PMID: 34026677 DOI: 10.1177/2292550320967399] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Purpose The purpose of this study was to describe the impact of using a multidisciplinary hand clinic on (1) hand clinic waitlists for urgent operative pathologies and (2) the volume of urgent operative referrals seen by plastic surgery. Methods A retrospective data analysis of all new referrals to the Peter Lougheed Centre hand clinic in Calgary, Alberta, was performed. Data were collected from 6 months before and after the introduction of the multidisciplinary model (ie, between January 2017 and January 2018). Demographics for all new referrals were collected from the clinic database, including wait times, triage type, and volume of referrals triaged to each discipline. Results Prior to using a multidisciplinary model, 81% (n = 591) of new patient referrals were triaged directly to plastic surgery, 4% (n = 28) to physiotherapy, and 6% (n = 43) to minor surgery (N = 728). However, following the addition of physiatry to the clinic, 62% (n = 451) of new patient referrals were triaged directly to plastic surgery, 24% (n = 173) to physiatry, 2% (n = 17) to physiotherapy, and 4% (n = 31) to minor surgery (N = 730). Overall, the number of urgent operative referrals triaged to plastic surgery proportionally increased by 7%, from 67% to 74%. Mean wait times for urgent referrals to plastic surgery decreased by 1.7 ± 1.0 months (P = .09). Conclusion Applying a multidisciplinary model to a hand clinic can allow non-operative cases to be triaged directly to physiotherapy and physiatry, allowing plastic surgeons to manage a higher volume of urgent and operative referrals. Implementing a multidisciplinary hand clinic can, therefore, decrease waitlist volumes and shorten the time to assessment by a plastic surgeon. Type of Study Level II Prognostic Study.
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Affiliation(s)
- Cynthia Mardinger
- University of Calgary, Cumming School of Medicine, Health Sciences Centre, Calgary, Alberta, Canada
| | - Anna K Steve
- Division of Plastic Surgery, Department of Surgery, Cumming School of Medicine, University of Calgary, Foothills Medical Centre, Calgary, Alberta, Canada
| | - Justin K Yeung
- Reconstructive & Cosmetic Plastic Surgery, Calgary, Alberta, Canada
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Ranza E, Mammi P, Rampello A, Annamaria S, Brianti R. Botulinum toxin therapy during the COVID-19 outbreak: Experience of an Italian multidisciplinary team. Eur J Neurol 2020; 28:e71-e72. [PMID: 33012098 PMCID: PMC7675437 DOI: 10.1111/ene.14569] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2020] [Accepted: 09/30/2020] [Indexed: 12/01/2022]
Affiliation(s)
- Elena Ranza
- Rehabilitation Medicine Unit, Geriatric and Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Patrizia Mammi
- Rehabilitation Medicine Unit, Geriatric and Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Anais Rampello
- Rehabilitation Medicine Unit, Geriatric and Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Salghetti Annamaria
- Rehabilitation Medicine Unit, Geriatric and Rehabilitation Department, University Hospital of Parma, Parma, Italy
| | - Rodolfo Brianti
- Rehabilitation Medicine Unit, Geriatric and Rehabilitation Department, University Hospital of Parma, Parma, Italy
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21
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Le B, Parziale JR. Pre-clinical Medical Students' Attitudes Toward Physical Medicine and Rehabilitation. R I Med J (2013) 2019; 102:26-28. [PMID: 30943668] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
We explored pre-clinical medical students' awareness, attitudes, and understanding of Physical Medicine and Rehabilitation (PM&R). We conducted a survey of Brown University medical students within the first 18 months of training to determine their level of familiarity with the field of PM&R. Of the respondents, 53% understood the acronym "PM&R." Sixty-one percent either disagreed or strongly disagreed that they understood the patient population that PM&R serves. Thirty-four percent strongly disagreed and 44% disagreed that they would know a PM&R physician to contact either at or external to their medical school. Pre-clinical medical students may have limited exposure to PM&R compared to most other specialties, resulting in a lack of understanding and/or potential misconceptions of the field, which may influence future career choice and referral patterns. Our data suggests that medical students may have limited exposure to PM&R in the preclinical years.
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Affiliation(s)
- Bryan Le
- Warren Alpert Medical School of Brown University, Providence, RI
| | - John R Parziale
- Warren Alpert Medical School of Brown University, Providence, RI
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22
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Silver JK, Stout NL, Fu JB, Pratt-Chapman M, Haylock PJ, Sharma R. The State of Cancer Rehabilitation in the United States. J Cancer Rehabil 2018; 1:1-8. [PMID: 30882090 PMCID: PMC6415687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
The field of cancer rehabilitation and prehabilitation has grown significantly over the past decade. Advancements in early detection and treatment have resulted in a growing number of cancer survivors in the United States (US), expected to reach 26 million by 2040.1 Health care professional graduate education is trying to catch up with anticipated clinical demand by increasing the number of cancer rehabilitation fellowship training programs and introducing rehabilitation/prehabilitation concepts earlier in training. Numerous national organizations have issued guidelines for cancer rehabilitation research and posttreatment cancer health care. As treatment modalities evolve, so too must research on side-effects and multisystem management over the continuum of care. Current research strategies address different cancer types with a broad focus on timing of interventions, cost effectiveness, efficacy of rehabilitation, and improving screening and assessment tools. A collaborative, interdisciplinary research model is paramount to deepen impact and broaden reach. Policy supports could advance cancer survivorship and rehabilitative care. Funding to advance evidence-based practices for distress screening, psychosocial support, survivorship care planning, and rehabilitation services remains critical. Current social policies and health care access protections must be expanded to best serve the growing number of cancer survivors in the US. Equitable health care access, health care experience and health care outcomes remain a critical area for research and policy supports. The cost of cancer treatment requires significant reform to ensure access to all. Rehabilitation services are elements of standards of care for many neurological, cardiovascular and orthopedic diagnoses, but currently are not standard for actual or potential dysfunctions among cancer survivors. Both the disease process and the variety of therapeutic modalities increase risks of dysfunction, impairments, poor survival, and diminished quality of life. Rehabilitation focuses on optimizing quality of life and maximizing function throughout the continuum of cancer care. Health care professionals are urged to integrate high quality interdisciplinary care to promote collaboration and dissemination of knowledge which will yield better care for cancer survivors. Prehabilitation has the potential to play key roles in reducing or eliminating many cancer-related impairments and disabilities.
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Affiliation(s)
- Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Massachusetts General Hospital; and Brigham and Women's Hospital, Boston, Massachusetts, USA
| | - Nicole L Stout
- Office of Strategic Research, Department of Rehabilitation Medicine, National Institutes of Health, Bethesda, Maryland, USA
| | - Jack B Fu
- Associate Professor Department of Palliative, Rehabilitation & Integrative Medicine, University of Texas M.D. Anderson Cancer Center, 1515 Holcombe Boulevard, Unit 1414, Houston, Texas 77030, USA
| | - Mandi Pratt-Chapman
- George Washington University School of Medicine and Health Sciences, George Washington Cancer Center, Institute for Patient-Centered Initiatives & Health Equity, Washington, D.C., USA
| | - Pamela J Haylock
- Cancer Care Consultant & Nurse Educator, Medina, Texas, USA, Adjunct Faculty, Sul Ross State University, Alpine, Texas, USA
| | - Raman Sharma
- Administrative Chief ResidentDepartment of Physical Medicine and Rehabilitation, Burke Rehabilitation Hospital, White Plains, NY, USA
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Abstract
Pakistan is one of the three countries in South East Asia that has an active postgraduate physical medicine and rehabilitation (PM&R) training program. College of Physicians and Surgeons Pakistan (CPSP) offers a four-year structured training program in PM&R. It consists of clinical teaching, lectures, rotations in other specialties, and writing a research dissertation. The aim of this survey was to provide an objective analysis of the current PM&R training program, including the facilities available for training, the participation of residents in academic activities, and their participation in different PM&R procedures. Hospital ethics committee approval was obtained. The questionnaire had sections on informed consent; basic demographics; the different components of residency training; and self-assessement of competence in different procedural skills. It was approved by the dean of PM&R at CPSP. There are six accredited training centers in Pakistan. Twelve residents are undergoing residency training at four different centers (Dec 2015). Key persons were nominated at each center to facilitate data collection. All residents (100% response rate) completed the survey. Almost all had read the CPSP training manual. Most had submitted the research dissertation. Training facilities varied across different centers, with the military center being the best equipped. The self-assessed competence of residents in different PM&R procedures varied among different centers, but overall it conformed to the competency levels specified in the training manual. Overall PM&R residency training in Pakistan is satisfactory, but there is a need to strengthen the weak areas and standardize the training across all centers in the country.
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Affiliation(s)
- Farooq A Rathore
- Department of Rehabilitation Medicine, PNS Shifa Hospital, DHA II, Karachi 75500, Pakistan ; Department of Rehabilitation Medicine, Bahria University Medical and Dental College, Bahria University, DHA -II, Karachi ; Department of Rehabilitation Medicine, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
| | - Aamir W Butt
- Department of Rehabilitation Medicine, AFIRM, Rawalpindi, Pakistan
| | - Nabila Soomro
- Director, Institute of Physical Medicine and Rehabilitation, Dow University of Health Sciences (DUHS), Karachi, Pakistan
| | - Noreen Akhtar
- Department of Rehabilitation Medicine, Combined Military Hospital, Abbottabad, Khyber Pakhtunkhwa, Pakistan
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Kane H, Teixeira-Poit S, Halpern MT, Keating M, Olmsted M. Factors influencing the desire to provide MS patient care in clinical practice among physiatrists. NeuroRehabilitation 2016; 38:1-6. [PMID: 26889792 DOI: 10.3233/nre-151289] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Rehabilitation care is an important part of care for individuals with multiple sclerosis (MS). Little is known about factors influencing physiatrists' desire to provide MS care. OBJECTIVE This study examines factors associated with physiatrists' attitudes towards providing MS care. METHODS We collaborated with the American Academy of Physical Medicine and Rehabilitation to survey a sample of 300 U.S. physiatrists. Analyses examined the association of exposure to MS care resources during residency, physician demographic and practice characteristics with attitudes toward providing MS care. RESULTS Physiatrists indicating negative factors limiting the number of MS patients seen in clinical practice were more likely to practice in a setting other than a major city and less likely to have interacted with MS specialists during residency. Physiatrists indicating factors having a positive influence on providing MS patient care were more likely to practice within a major city, see one or more MS patients per week, and serve as the primary physiatrist directing care for one or more MS patients. CONCLUSIONS Physiatrists indicated positive and negative attitudes towards MS care. Increasing exposure to MS patients, providing resources for MS care, and participating in continuing education on MS, may encourage physiatrists to provide MS patient care.
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Puffer RC, Clifton WE, Mallory GW, Clarke MJ. Delayed cervical palsy following cervical spine fusion leads to an increase in hospital-related costs. J Neurosurg Spine 2014; 22:11-4. [PMID: 25360529 DOI: 10.3171/2014.9.spine14166] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Delayed cervical palsy (DCP) is a known complication following cervical spine surgery. While most DCPs eventually improve, they can result in significant temporary disability. Postoperative complications affect hospital length of stay (LOS) as well as overall hospital cost. The authors sought to determine the hospital cost of DCP after cervical spine fusion operations. METHODS A retrospective review of patients undergoing cervical fusion for degenerative disease at the Mayo Clinic from 2008 to 2012 was performed. Patients who developed DCPs not attributable to intraoperative trauma were included. All nonoperative-related costs were compared with similar costs in a control group matched according to age, sex, and surgical approach. All costs and services were reflective of the standard costs for the current year. Raw cost data were presented using ratios due to institutional policy against publishing cost data. RESULTS There were 27 patients (18 men, 9 women) who underwent fusion and developed a DCP over the study period. These patients were compared with 24 controls (15 men, 9 women) undergoing fusion in the same time period. There was no difference between patients and controls in mean age (62.4 ± 3.1 years vs. 63.8 ± 2.5 years, respectively; p = 0.74), LOS (4.2 ± 3.3 days vs 3.8 ± 4.5 days, respectively; p = 0.43), or operating room-related costs (1.08 ± 0.09 vs. 1.0 ± 0.07, respectively; p = 0.58). There was a significant difference in nonoperative hospital-related costs between patients and controls (1.67 ± 0.15 vs 1.0 ± 0.09, respectively; p = 0.04). There was a significantly higher utilization of postoperative imaging (CT or MRI) in the DCP group (14/27, 52%) when compared with the matched cohort (4/24, 17%; p = 0.018), and a significantly higher utilization of physiatry services (24/27 [89%] vs 15/24 [63%], respectively; p = 0.046). CONCLUSIONS While DCPs did not significantly prolong the length of hospitalization, they did increase hospital-related costs. This method could be further extrapolated to model costs of other complications as well.
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Affiliation(s)
- Ross C Puffer
- Department of Neurosurgery, Mayo Clinic, Rochester, Minnesota; and
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Kane H, Halpern MT, Teixeira-Poit S, Frost C, Keating M, Olmsted M, Johnson S. Factors influencing interest in providing MS patient care among physiatry residents. NeuroRehabilitation 2014; 35:89-95. [PMID: 24990004 DOI: 10.3233/nre-141095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
BACKGROUND Rehabilitation care is an important part of comprehensive care for MS patients. Little is known about the number of physiatry residents who are interested in providing care to individuals with multiple sclerosis [MS]. OBJECTIVE This study examines factors that influence physiatry residents' interest in providing care to MS patients. METHODS We randomly sampled half of all Accreditation Council for Graduate Medical Education-certified physical medicine and rehabilitation residency programs in the continental United States and Puerto Rico. Surveys were received from 74% of programs (Stage 1 response rate) and from 221 residents (45% Stage 2 response rate). RESULTS Residents expressing interest in providing MS care were more likely to be female, Asian, and to select statements emphasizing multidisciplinary care approaches and a community of dedicated professional colleagues as positive features of MS patient care. Residents interested in teaching and with more education debt were marginally more likely to express interest in MS care. CONCLUSIONS Medical education should emphasize the need for physical medicine and rehabilitative care among individuals with MS, the ability of physiatrists to improve the functional status and quality of life for MS patients, and the team-based nature of MS care.
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Affiliation(s)
- Heather Kane
- RTI International, Research Triangle Park, N.C. and Washington, DC, USA
| | - Michael T Halpern
- RTI International, Research Triangle Park, N.C. and Washington, DC, USA
| | | | - Corey Frost
- RTI International, Research Triangle Park, N.C. and Washington, DC, USA
| | - Michael Keating
- RTI International, Research Triangle Park, N.C. and Washington, DC, USA
| | - Murrey Olmsted
- RTI International, Research Triangle Park, N.C. and Washington, DC, USA
| | - Shana Johnson
- Department of Rehabilitation Medicine, University of Washington Medical Center, Seattle, WA, USA
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DiFazio RL, Harris M, Vessey JA, Glader L, Shanske S. Opportunities lost and found: experiences of patients with cerebral palsy and their parents transitioning from pediatric to adult healthcare. J Pediatr Rehabil Med 2014; 7:17-31. [PMID: 24919935 DOI: 10.3233/prm-140276] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
PURPOSE To describe and define the experiences of adults with cerebral palsy (CP) and parents of adults with CP who have been involved in a transfer of physiatry care from pediatric to adult healthcare and to explore their experiences more generally in the transition from pediatric to adult services. METHODS A qualitative research approach was used. Semi-structured focus group interviews were conducted with adults with CP (n=5) and parents of adults with CP (n=8) to explore the health care transition (HCT) process from pediatric to adult healthcare. Four key content domains were used to facilitate the focus groups; 1) Transition Planning, 2) Accessibility of Services, 3) Experience with Adult Providers, and 4) Recommendations for Improving the Transition Process. Conventional content analysis was used to analyze the data. RESULTS Four themes emerged from the focus groups; Lost in Transition, Roadmap to Care, List of None, and One Stop Shopping. Participants felt lost in the HCT process, requested a transparent transition plan, expressed concern regarding access to adult healthcare, and made recommendations for improvements. CONCLUSION Challenges in transitioning from pediatric to adult health care were identified by all participants and several strategies were recommended for improvement.
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Affiliation(s)
| | | | - Judith A Vessey
- Boston Children's Hospital, Boston, MA, USA Boston College, Chestnut Hill, MA, USA
| | - Laurie Glader
- Boston Children's Hospital, Boston, MA, USA Harvard Medical School, Boston, MA, USA
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Silver JK, Baima J, Mayer RS. Impairment-driven cancer rehabilitation: an essential component of quality care and survivorship. CA Cancer J Clin 2013; 63:295-317. [PMID: 23856764 DOI: 10.3322/caac.21186] [Citation(s) in RCA: 242] [Impact Index Per Article: 22.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/29/2013] [Revised: 03/18/2013] [Accepted: 03/18/2013] [Indexed: 02/06/2023] Open
Abstract
Adult cancer survivors suffer an extremely diverse and complex set of impairments, affecting virtually every organ system. Both physical and psychological impairments may contribute to a decreased health-related quality of life and should be identified throughout the care continuum. Recent evidence suggests that more cancer survivors have a reduced health-related quality of life as a result of physical impairments than due to psychological ones. Research has also demonstrated that the majority of cancer survivors will have significant impairments and that these often go undetected and/or untreated, and consequently may result in disability. Furthermore, physical disability is a leading cause of distress in this population. The scientific literature has shown that rehabilitation improves pain, function, and quality of life in cancer survivors. In fact, rehabilitation efforts can ameliorate physical (including cognitive) impairments at every stage along the course of treatment. This includes prehabilitation before cancer treatment commences and multimodal interdisciplinary rehabilitation during and after acute cancer treatment. Rehabilitation appears to be cost-effective and may reduce both direct and indirect health care costs, thereby reducing the enormous financial burden of cancer. Therefore, it is critical that survivors are screened for both psychological and physical impairments and then referred appropriately to trained rehabilitation health care professionals. This review suggests an impairment-driven cancer rehabilitation model that includes screening and treating impairments all along the care continuum in order to minimize disability and maximize quality of life.
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Affiliation(s)
- Julie K Silver
- Associate Professor, Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA
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Siddiq MAB, Hasan SA, Das G, Khan AUA. Interventional pain management in rheumatological diseases - a three years physiatric experience in a tertiary medical college hospital in bangladesh. Korean J Pain 2012; 24:205-15. [PMID: 22220242 PMCID: PMC3248584 DOI: 10.3344/kjp.2011.24.4.205] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 09/02/2011] [Accepted: 09/02/2011] [Indexed: 11/24/2022] Open
Abstract
Background Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. Methods A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. Results The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. Conclusions All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.
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Abstract
BACKGROUND/OBJECTIVE Applying practice-based evidence research methodology to spinal cord injury (SCI) rehabilitation requires taxonomy (typology or classification) of rehabilitation interventions provided by every discipline contributing to SCI rehabilitation. The rehabilitation field currently lacks such taxonomy. METHODS SCIRehab project researchers and clinicians representing 7 rehabilitation disciplines from 6 US inpatient SCI rehabilitation facilities worked in discipline groups during 2 face-to-face meetings and weekly discipline-specific teleconferences for 9 months to identify key contributions of each discipline to SCI rehabilitation and to develop a classification of treatment interventions used by each discipline. These clinician groups were charged with designing documentation systems that collected enough details to describe treatment adequately while not imposing an unrealistic data collection burden on clinicians. Completed documentation systems were programmed onto handheld personal digital assistants (PDAs) to facilitate data entry by clinicians at the point of care. RESULTS Seven discipline-specific SCI rehabilitation taxonomies were developed that describe and quantify intervention activities (major categories of treatment offered by the discipline) and the activity-specific details (variables deemed important to fully describe the interventional process). Much treatment information is unique to each discipline; some is common across disciplines. CONCLUSIONS The taxonomies provide a format with which clinicians document actual interventions performed with or for patients. The SCIRehab project has developed the first comprehensive multidisciplinary taxonomy for describing the details of the SCI rehabilitation process and designed a PDA-based documentation system based on that taxonomy that allows clinicians to describe the specifics of their interactions with their patients.
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Affiliation(s)
- Julie Gassaway
- Institute for Clinical Outcomes Research, Salt Lake City, UT 84102, USA.
| | - Gale Whiteneck
- 1Institute for Clinical Outcomes Research, Salt Lake City, Utah; 2Craig Hospital, Englewood, Colorado; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
| | - Marcel Dijkers
- 1Institute for Clinical Outcomes Research, Salt Lake City, Utah; 2Craig Hospital, Englewood, Colorado; 3Mt. Sinai School of Medicine, Department of Rehabilitation Medicine, New York, New York
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Abstract
BACKGROUND/OBJECTIVE Upper-extremity reconstruction for people with tetraplegia is underused, and we felt that physicians' beliefs could be contributing to this phenomenon. This research sought to determine whether (a) physicians underestimate the importance of upper-extremity function for people with tetraplegia, (b) physiatrists and hand surgeons disagree on the quality of life of those with tetraplegia, (c) surgeons believe that social issues make people with tetraplegia poor surgical candidates, and (d) the 2 specialties disagree on the benefits of upper-extremity reconstruction. METHODS A self-administered questionnaire was mailed to a national sample of 384 physiatrists and 379 hand surgeons. The data were analyzed with bivariate statistics. RESULTS The response rate was 62%. 65% of surgeons and 49% of physiatrists (P < 0.001) ranked upper-extremity function as the most important rehabilitative goal for people with tetraplegia. Both specialties believed the quality of life with tetraplegia was low (less than 60 on a scale of 0 to 100, with 100 representing perfect health). The 2 specialties have significantly different opinions regarding patient compliance, social support, and the effectiveness of surgery. CONCLUSIONS The majority of physicians believe that upper-extremity function is a rehabilitative priority for people with tetraplegia. However, physiatrists and hand surgeons have significantly different views about people with tetraplegia and the benefits of reconstructive surgery. Physician preconceptions and interdisciplinary divergence may be contributing to the underuse of these procedures, and these issues should be considered when designing programs to improve access to these procedures.
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