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1.

Objective

To determine relationships between pain sites and pain intensity/interference in people with lower limb amputations (LLAs).

Design

Cross-sectional survey.

Setting

Community.

Participants

Lower limb prosthesis users with unilateral or bilateral amputations (N=1296; mean time since amputation, 14.1y).

Interventions

Not applicable.

Main Outcome Measures

Patient-Reported Outcomes Measurement Information System (PROMIS) pain intensity (1 item to assess average pain), PROMIS pain interference (4-item short form to assess the consequences of pain in desired activities), and questions that asked participants to rate the extent to which each of the following were a problem: residual limb pain (RLP), phantom limb pain (PLP), knee pain on the nonamputated side, back pain, and shoulder pain.

Results

Nearly three quarters (72.1%) of participants reported problematic pain in 1 or more of the listed sites. Problematic PLP, back pain, and RLP were reported by 48.1%, 39.2%, and 35.1% of participants, respectively. Knee pain and shoulder pain were less commonly identified as problems (27.9% and 21.7%, respectively). Participants also reported significantly (P<.0001) higher pain interference (T-score ± SD, 54.7±9.0) than the normative sample based on the U.S. population (T-score ± SD, 50.0±10.0). Participants with LLAs rated their pain intensity on average ± SD at 3.3±2.4 on a 0-to-10 scale. Pain interference (ρ=.564, P<.0001) and intensity (ρ=.603, P<.0001) were positively and significantly correlated with number of pain sites reported.

Conclusions

Problematic pain symptoms, especially RLP, PLP, and back pain, affect most prosthetic limb users and have the potential to greatly restrict participation in life activities.  相似文献   

2.

Objective

To determine whether patient-reported measures would be clinically sensitive and useful for identifying functional change within an intensive chronic pain program setting by examining 2 patient-reported measures administered as part of physical and occupational therapy for chronic pain.

Design

A retrospective data analysis of children and adolescents with chronic pain treated over a single calendar year. Paired t tests evaluated change in perceived function measures and pain over time. Standardized residual change scores were used in subsequent regression to assess associations between change scores.

Setting

An interdisciplinary pediatric pain rehabilitation program that supports children and adolescents with chronic pain by increasing strength, flexibility, and endurance; facilitating a return to daily life activities; and using appropriate self-directed coping and pain management skills.

Participants

Children and adolescents (N=109; age range, 8–19y; 83% girls) with various chronic pain diagnoses who were admitted to a 3- to 4-week intensive pain rehabilitation program.

Interventions

Participants were involved in physical and occupational therapy for 3 hours daily, as well as recreation therapy, psychology, school, aquatics, art therapy, and music therapy for a total of 8 hours daily. Parents were involved in parent education with therapists from all disciplines in conjunction with their child's programming.

Main Outcome Measures

Lower Extremity Functional Scale (LEFS), Upper Extremity Functional Index (UEFI), and self-reported pain severity rating on 0-to-10 numerical rating scale.

Results

Data demonstrated significant gains in LEFS and UEFI during the program. Improvement in perceived functioning was significantly correlated with a reduction in pain.

Conclusions

The LEFS and UEFI provide a meaningful way to track progress in chronic pain rehabilitation. Using self-perceived measures, children and adolescents noted significant functional improvement, associated with less pain intensity. These findings increase our understanding of the rehabilitation process and point to goals for clinical improvement.  相似文献   

3.

Objective

To determine the association between the amplitude of vastus medialis (VM) Hoffmann reflex (H-reflex) and pain level, self-reported physical function, and chronicity of pain in women with patellofemoral pain (PFP).

Design

Cross-sectional study.

Setting

Laboratory of biomechanics and motor control.

Participants

Women diagnosed with PFP (N=15) aged 18 to 35 years.

Interventions

Not applicable.

Main Outcome Measures

Data on worst pain level during the previous month, self-reported physical function, and symptom duration (chronicity) were collected from the participants. Maximum evoked responses were obtained by electrical stimulation applied to the femoral nerve and peak-to-peak amplitudes of normalized maximal H-reflexes (maximal Hoffmann reflex/maximal motor wave ratios) of the VM were calculated. A Pearson product-moment correlation matrix (r) was used to explore the relations between the amplitude of VM H-reflex and worst pain during the previous month, self-reported function, and chronicity of pain.

Results

Strong negative correlations were found between the amplitude of VM H-reflex and worst pain in the previous month (r=?.71; P=.003) and chronicity (r=?.74; P=.001). A strong positive correlation was found between the amplitude of VM H-reflex and self-reported physical function (r=.62; P=.012).

Conclusions

The strong and significant relations reported in this study suggest that women with PFP showing greater VM H-reflex excitability tend to have lower pain, better physical function, and more recent symptoms. Therefore, rehabilitation strategies designed to increase the excitability of the monosynaptic stretch reflex should be considered in the treatment of women with PFP if their effectiveness is demonstrated in future studies.  相似文献   

4.

Objective

To explore the feasibility of a newly developed smartphone-based exercise program with an embedded self-classification algorithm for office workers with neck pain, by examining its effect on the pain intensity, functional disability, quality of life, fear avoidance, and cervical range of motion (ROM).

Design

Single-group, repeated-measures design.

Setting

The laboratory and participants' home and work environments.

Participants

Offices workers with neck pain (N=23; mean age ± SD, 28.13±2.97y; 13 men).

Intervention

Participants were classified as having 1 of 4 types of neck pain through a self-classification algorithm implemented as a smartphone application, and conducted corresponding exercise programs for 10 to 12min/d, 3d/wk, for 8 weeks.

Main Outcome Measures

The visual analog scale (VAS), Neck Disability Index (NDI), Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36), Fear-Avoidance Beliefs Questionnaire (FABQ), and cervical ROM were measured at baseline and postintervention.

Results

The VAS (P<.001) and NDI score (P<.001) indicated significant improvements in pain intensity and functional disability. Quality of life showed significant improvements in the physical functioning (P=.007), bodily pain (P=.018), general health (P=.022), vitality (P=.046), and physical component scores (P=.002) of the SF-36. The FABQ, cervical ROM, and mental component score of the SF-36 showed no significant improvements.

Conclusions

The smartphone-based exercise program with an embedded self-classification algorithm improves the pain intensity and perceived physical health of office workers with neck pain, although not enough to affect their mental and emotional states.  相似文献   

5.

Objective

To examine if a comorbid diagnosis of knee or hip osteoarthritis (OA) in older adults with new back pain visits is associated with long-term patient-reported outcomes and back-related health care use.

Design

Prospective cohort study.

Setting

Three integrated health systems forming the Back pain Outcomes using Longitudinal Data cohort.

Participants

Participants (N=5155) were older adults (≥65y) with a new visit for back pain and a complete electronic health record data.

Interventions

Not applicable; we obtained OA diagnoses using diagnostic codes in the electronic health record 12 months prior to the new back pain visit.

Main Outcome Measures

The Roland-Morris Disability Questionnaire (RDQ) and the EuroQol-5D (EQ-5D) were key patient-reported outcomes. Health care use, measured by relative-value units (RVUs), was summed for the 12 months after the initial visit. We used linear mixed-effects models to model patient-reported outcomes. We also used generalized linear models to test the association between comorbid knee or hip OA and total back-related RVUs.

Results

Of the 5155 participants, 368 (7.1%) had a comorbid knee OA diagnosis, and 94 (1.8%) had a hip OA diagnosis. Of the participants, 4711 (91.4%) had neither knee nor hip OA. In adjusted models, the 12-month RDQ score was 1.23 points higher (95% confidence interval [CI], 0.72–1.74) for patients with knee OA and 1.26 points higher (95% CI, 0.24–2.27) for those with hip OA than those without knee or hip OA, respectively. A lower EQ-5D score was found among participants with knee OA (.02 lower; 95% CI, ?.04 to ?.01) and hip OA diagnoses (.03 lower; 95% CI, ?.05 to ?.01) compared with those without knee or hip OA, respectively. Comorbid knee or hip OA was not significantly associated with total 12-month back-related resource use.

Conclusions

Comorbid knee or hip OA in older adults with a new back pain visit was associated with modestly worse long-term disability and health-related quality of life.  相似文献   

6.

Objective

To determine whether multifidi size, intramuscular fat, or both, are associated with self-reported and performance-based physical function in older adults with and without chronic low back pain (LBP).

Design

Case-control study.

Setting

Individuals participated in a standardized evaluation in a clinical laboratory and underwent magnetic resonance imaging (MRI) of the lumbar spine at a nearby facility.

Participants

A volunteer sample of community-dwelling older adults (N=106), aged 60 to 85 years, with (n=57) and without (n=49) chronic LBP were included in this secondary data analysis.

Intervention

Average right-left L5 multifidi relative (ie, total) cross-sectional area (CSA), muscle-fat infiltration index (MFI) (ie, a measure of intramuscular fat), and relative muscle CSA (rmCSA) (ie, total CSA minus intramuscular fat CSA) were determined from MRIs. Linear regression modeling was performed with physical function measures as the dependent variables. Age, sex, and body mass index were entered as covariates. The main effects of L5 multifidi MFI and rmCSA, as well as their interaction with group assignment, were compared as independent variables.

Main Outcome Measures

Medical Outcomes Study 36-Item Short-Form Health Survey physical functioning subscale, timed Up and Go, gait speed, and fast stair descent performance.

Results

Interaction terms between L5 multifidi MFI and group assignment were found to be significant contributors to the variance explained in all physical function measures (P≤.012). Neither the main effect nor the interaction with group assignment for L5 multifidi rmCSA significantly contributed to the variance explained in any of the physical function measures (P>.012).

Conclusions

Among older adults with chronic LBP of at least moderate intensity, L5 multifidi muscle composition, but not size, may help to explain physical function.  相似文献   

7.

Objective

To determine the amplitude of the electromyographic activity of trunk muscles during Pilates exercises in women with and without chronic low back pain (LBP).

Design

Case-control study.

Setting

University physical therapy clinic.

Participants

Women (N=60) divided into an LBP group and a control group.

Interventions

Not applicable.

Main Outcome Measures

Amplitude of the electromyographic activity (root mean square values) of the gluteus maximus and external oblique muscles collected during 3 Pilates exercises: Shoulder Bridge performed on the mat, and Hip Roll and Breathing performed in equipment. Pain intensity was assessed in the LBP group.

Results

The amplitude of the electromyographic activity was similar between groups (P≥.05). For both groups, the amplitude of the gluteus maximus was higher in the Shoulder Bridge exercise compared with the Hip Roll with 2 springs (control group: mean difference [MD]=.18; 95% confidence interval [CI], .05–.41; LBP group: MD=.29; 95% CI, .16–.31) and the Breathing exercise (control group: MD=?.40; 95% CI, ?.55 to ?.26; LBP group: MD=?.36; 95% CI, ?.52 to ?.20). The amplitude of the external oblique muscle was higher in the Shoulder Bridge compared with the Hip Roll with 2 springs (control group: MD=.13; 95% CI, .05–.21; LBP group: MD=.18; 95% CI, .03–.33). Pain intensity increased after exercises, but this increase was lower for the mat exercises.

Conclusions

Similar muscle activation between groups was found. The findings suggest that mat exercises caused less pain and a greater difference in the amplitude of muscle activation compared with the equipment-based exercises.  相似文献   

8.

Objectives

To assess the association of physical activity measures, derived with an accelerometer and a self-reported questionnaire, with fear of movement in patients with chronic nonspecific low back pain (LBP) and to investigate the association between disability and fear of movement in this population.

Design

Cross-sectional study.

Setting

Outpatient physical therapy university clinics.

Participants

Patients (N=119) presenting with nonspecific LBP of >3 months' duration.

Interventions

Not applicable.

Main Outcome Measures

Physical activity levels measured objectively with an accelerometer (ie, counts per minute, time spent in moderate-to-vigorous and light physical activity per day, number of steps per day, and number of 10-minute bouts of moderate-to-vigorous physical activity per day) and subjectively with a self-reported questionnaire (Baecke Physical Activity Questionnaire); fear of movement (Tampa Scale of Kinesiophobia); pain (11-point numerical rating scale); disability (Roland Morris Disability Questionnaire); and depression (Beck Depression Inventory). The associations were examined with correlational, univariate, and multivariable linear regression analyses.

Results

None of the objective physical activity measures were associated with fear of movement. The apparent association of self-reported physical activity levels with fear of movement (correlational analyses: r=?.18; P<.05; univariate regression analyses: β=?.04; 95% confidence interval [CI], ?.07 to ?.01; P=.04) was not confirmed in multivariable analyses. Fear of movement was consistently associated with disability in both correlational (r=.42; P<.01) and multivariable (β=.21; 95% CI, .11–.31; P<.001) analyses.

Conclusions

Our data support one aspect of the fear-avoidance model—that higher fear of movement is associated with more disability—but not the aspect of the model linking fear of movement with inactivity.  相似文献   

9.

Objective

To review the current literature regarding methods and effects of real-time biofeedback used as a method for gait retraining to reduce knee adduction moment (KAM), with intended application for patients with knee osteoarthritis (KOA).

Data Sources

Searches were conducted in MEDLINE, Embase, CINAHL, SPORTDiscus, Web of Science, and Cochrane Central Register of Controlled Trials with the keywords gait, feedback, and knee osteoarthritis from inception to May 2015.

Study Selection

Titles and abstracts were screened by 1 individual for studies aiming to reduce KAM. Full-text articles were assessed by 2 individuals against predefined criteria.

Data Extraction

Data were extracted by 1 individual according to a predefined list, including participant demographics and training methods and effects.

Data Synthesis

Electronic searches resulted in 190 potentially eligible studies, from which 12 met all inclusion criteria. Within-group standardized mean differences (SMDs) for reduction of KAM in healthy controls ranged from .44 to 2.47 and from .29 to .37 in patients with KOA. In patients with KOA, improvements were reported in pain and function, with SMDs ranging from .55 to 1.16. Methods of implementation of biofeedback training varied between studies, but in healthy controls increased KAM reduction was noted with implicit, rather than explicit, instructions.

Conclusions

This review suggests that biofeedback gait training is effective primarily for reducing KAM but also for reducing pain and improving function in patients with KOA. The review was limited by the small number of studies featuring patients with KOA and the lack of controlled studies. The results suggest there is value and a need in further researching biofeedback training for reducing KAM. Future studies should include larger cohorts of patients, long-term follow-up, and controlled trials.  相似文献   

10.

Background

Chronic low back pain (LBP) is a common musculoskeletal impairment in people with lower limb amputation. Given the multifactorial nature of LBP, exploring the factors influencing the presence and intensity of LBP is warranted.

Objective

To investigate which physical, personal, and amputee-specific factors predicted the presence and intensity of LBP in persons with nondysvascular transfemoral amputation (TFA) and transtibial amputation (TTA).

Design

A retrospective cross-sectional survey.

Setting

A national random sample of people with nondysvascular TFA and TTA.

Participants

Participants (N = 526) with unilateral TFA and TTA due to nondysvascular etiology (ie, trauma, tumors, and congenital causes) and a minimum prosthesis use of 1 year since amputation were invited to participate in the survey. The data from 208 participants (43.4% response rate) were used for multivariate regression analysis.

Methods (Independent Variables)

Personal (ie, age, body mass, gender, work status, and presence of comorbid conditions), amputee-specific (ie, level of amputation, years of prosthesis use, presence of phantom-limb pain, residual-limb problems, and nonamputated limb pain), and physical factors (ie, pain-provoking postures including standing, bending, lifting, walking, sitting, sit-to-stand, and climbing stairs).

Main Outcome Measures (Dependent Variables)

LBP presence and intensity.

Results

A multivariate logistic regression model showed that the presence of 2 or more comorbid conditions (prevalence odds ratio [POR] = 4.34, P = .01), residual-limb problems (POR = 3.76, P < .01), and phantom-limb pain (POR = 2.46, P = .01) influenced the presence of LBP. Given the high LBP prevalence (63%) in the study, there is a tendency for overestimation of POR, and the results must be interpreted with caution. In those with LBP, the presence of residual-limb problems (β = 0.21, P = .01) and experiencing LBP symptoms during sit-to-stand task (β = 0.22, P = .03) were positively associated with LBP intensity, whereas being employed demonstrated a negative association (β = ?0.18, P = .03) in the multivariate linear regression model.

Conclusions

Rehabilitation professionals should be cognizant of the influence that comorbid conditions, residual-limb problems, and phantom pain have on the presence of LBP in people with nondysvascular lower limb amputation. Further prospective studies could investigate the underlying causal mechanisms of LBP.

Level of Evidence

II  相似文献   

11.

Background

Pain management in the emergency department (ED) remains suboptimal. Nursing staff protocols could improve this, but studies show divergent results.

Objective

Our aim was to evaluate a nurse-initiated pain-management protocol in adult patients with traumatic injuries in the short and in the long term, utilizing fentanyl for severe pain.

Methods

In this pre–post implementation study, ED patients were included during three periods. The protocol allowed nurses to administer acetaminophen, non-steroidal anti-inflammatory drugs, or fentanyl autonomously, based on Numeric Rating Scale pain scores. Primary outcome was frequency of analgesic administration at 6 and 18 months after implementation. Secondary outcomes were pain awareness, occurrence of adverse events, and pain treatment after discharge.

Results

Five hundred and twelve patients before implementation were compared with 507 and 468 patients at 6 and 18 months after implementation, respectively. Analgesic administration increased significantly at 18 months (from 29% to 36%; p = 0.016), not at 6 months (33%; p = 0.19) after implementation. Pain awareness increased from 30% to 51% (p = 0.00) at 6 months and to 56% (p = 0.00) at 18 months, due to a significant increase in pain assessment: 3% to 30% (p = 0.00) and 32% (p = 0.00), respectively. Post-discharge pain treatment increased significantly at 18 months compared to baseline (from 25% to 33%; p = 0.016) and to 6 months (from 24% to 33%; p = 0.004). No adverse events were recorded.

Conclusions

Implementation of a nurse-initiated pain-management protocol only increases analgesic administration in adult patients with traumatic injuries in the long term. Auditing might have promoted adherence. Pain awareness increases significantly in the short and the long term.  相似文献   

12.

Objectives

To evaluate the extent of variability in functional responses in participants in the Lifestyle Interventions and Independence for Elders (LIFE) study and to identify the relative contributions of intervention adherence, physical activity, and demographic and health characteristics to this variability.

Design

Secondary analysis.

Setting

Multicenter institutions.

Participants

A volunteer sample (N=1635) of sedentary men and women aged 70 to 89 years who were able to walk 400m but had physical limitations, defined as a Short Physical Performance Battery (SPPB) score of ≤9.

Interventions

Moderate-intensity physical activity (n=818) consisting of aerobic, resistance, and flexibility exercises performed both center-based (2times/wk) and home-based (3–4times/wk) sessions or health education program (n=817) consisting of weekly to monthly workshops covering relevant health information.

Main Outcome Measures

Physical function (gait speed over 400m) and lower extremity function (SPPB score) assessed at baseline and 6, 12, and 24 months.

Results

Greater baseline physical function (gait speed, SPPB score) was negatively associated with change in gait speed (regression coefficient β=?.185; P<.001) and change in SPPB score (β=?.365; P<.001), whereas higher number of steps per day measured by accelerometry was positively associated with change in gait speed (β=.035; P<.001) and change in SPPB score (β=.525; P<.001). Other baseline factors associated with positive change in gait speed and/or SPPB score include younger age (P<.001), lower body mass index (P<.001), and higher self-reported physical activity (P=.002).

Conclusions

Several demographic and physical activity–related factors were associated with the extent of change in functional outcomes in participants in the LIFE study. These factors should be considered when designing interventions for improving physical function in older adults with limited mobility.  相似文献   

13.

Background

Pain is one of the most common reasons for emergency department (ED) visits in the United States. Ketamine is a sedative with N-methyl-D-aspartate (NMDA) receptor antagonism. Recent literature has suggested that the use of subdissociative dose ketamine (SDDK) may be safe and effective for acute pain.

Objective

The objective of our study was to evaluate ketamine in subdissociative doses as an adjunct for acute pain in the ED.

Methods

This was a single-center, prospective, randomized, double-blind, placebo-controlled trial that evaluated the use of SDDK in adult patients who presented to the ED with acute pain. Patients received ketamine 0.3 mg/kg via intravenous piggyback over 15 min or placebo. Morphine 0.1 mg/kg intravenous push was administered with the study interventions. The primary outcome was the patient's pain score 15 min after initiation of the intervention. Secondary outcomes included adverse events, consumption of rescue analgesia, patient's length of stay, and patient satisfaction with treatment.

Results

Thirty patients were enrolled in each group. Median pain scores in patients who received ketamine were lower than in controls at 15 min (3.5 [interquartile range {IQR} 1.0–7.3 vs. 6.0 [IQR 4.0–9.0], respectively; p = 0.018). No serious adverse events occurred. No difference was detected in the amount of rescue analgesia used or in length of stay. Patients who received ketamine reported a higher mean satisfaction score with their pain management (8.57 [standard deviation {SD} 2.1]) than patients who received placebo (6.05 [SD 2.6]; p = 0.01).

Conclusion

When used as an adjunct, SDDK administered at 0.3 mg/kg over 15 min resulted in safe and effective analgesia for ≤30 min in patients who presented with acute pain in the ED.  相似文献   

14.

Objectives

To provide reference data for the Cumberland Ankle Instability Tool (CAIT) and to investigate the prevalence and correlates of perceived ankle instability in a large healthy population.

Design

Cross-sectional observational study.

Setting

University laboratory.

Participants

Self-reported healthy individuals (N=900; age range, 8–101y, stratified by age and sex) from the 1000 Norms Project.

Interventions

Not applicable.

Main Outcome Measures

Participants completed the CAIT (age range, 18–101y) or CAIT-Youth (age range, 8–17y). Sociodemographic factors, anthropometric measures, hypermobility, foot alignment, toes strength, lower limb alignment, and ankle strength and range of motion were analyzed.

Results

Of the 900 individuals aged 8 to 101 years, 203 (23%) had bilateral and 73 (8%) had unilateral perceived ankle instability. The odds of bilateral ankle instability were 2.6 (95% confidence interval [CI], 1.7–3.8; P<.001) times higher for female individuals, decreased by 2% (95% CI, 1%–3%; P=.001) for each year of increasing age, increased by 3% (95% CI, 0%–6%; P=.041) for each degree of ankle dorsiflexion tightness, and increased by 4% (95% CI, 2%–6%, P<.001) for each centimeter of increased waist circumference.

Conclusions

Perceived ankle instability was common, with almost a quarter of the sample reporting bilateral instability. Female sex, younger age, increased abdominal adiposity, and decreased ankle dorsiflexion range of motion were independently associated with perceived ankle instability.  相似文献   

15.

Background

As our population ages, neurogenic claudication (NC) from central canal stenosis of the lumbar spine is becoming an increasingly common condition. Studies have been undertaken to assess the efficacy of caudal, interlaminar, or unilateral transforaminal epidural injections, but bilateral transforaminal epidural injections (BTESIs) have not been evaluated to date.

Objective

To assess the therapeutic value and long-term effects of fluoroscope-guided BTESIs in patients with NC from degenerative lumbar spinal stenosis (DLSS) of the central spinal canal.

Design

Case series.

Setting

Single institution spine clinic.

Patients

Twenty-six adults between the ages of 40 and 90 years with a diagnosis of DLSS and a history of subacute or chronic NC.

Methods/Interventions

Patients meeting inclusion criteria received fluoroscope-guided BTESI of local anesthetic and steroid at the level immediately below the most stenotic level. Patient self-reported pain level, activity level, and overall satisfaction were recorded by telephone interview at 1, 3, and 6 months after injection by an independent observer.

Main Outcome Measures

Pain score and Swiss Spinal Stenosis score at baseline, 1, 3, and 6 months.

Results

Of the 22 participants eligible for analysis, 20, 19, and 18 had follow-up data available at 1, 3, and 6 months, respectively. Reduction in numeric pain scale score of at least 50% was noted in 30% of participants at 1 month, 53% at 3 months, and 44% at 6 months. Swiss Spinal Stenosis subscale scores indicated a significant reduction in the proportion of participants reporting the presence of severe pain in the back, buttocks, and legs (particularly the back or buttocks) at 1, 3, and 6 months of follow-up compared with baseline (P < .05). The proportion of participants reporting severe weakness in the legs or feet also decreased after injection and was statistically significant at 3 months of follow-up (P = .04).

Conclusions

Fluoroscope-guided BTESI was moderately effective in reducing pain, improving function, and achieving patient satisfaction in patients with NC from DLSS at the central spinal canal in this clinical case series.

Level of Evidence

IV  相似文献   

16.

Background

Patients have expressed concern about undergoing procedures involving trainees, even with direct attending physician supervision. Little literature has examined the effect of trainee involvement on patient outcomes.

Objective

We aimed to evaluate the effect of trainee involvement on patient complications, immediate pain reduction, and fluoroscopic time for different fluoroscopic injection types.

Design

Retrospective review.

Setting

Four academic outpatient institutions with Accreditation Council for Graduate Medical Education (ACGME)?accredited residency (physical medicine and rehabilitation, or anesthesiology) or fellowship (sports medicine or pain medicine) programs from 2000 to 2015.

Patients

All patients receiving fluoroscopically guided hip (HI), sacroiliac joint (SIJI), transforaminal epidural (TFEI), and/or interlaminar epidural injections (ILEI, performed at only 1 institution).

Methods

Outcome measures were examined based on the presence or absence of a trainee during the procedure.

Main Outcome Measurements

The primary outcome was the number of immediate complications, with secondary outcomes being fluoroscopic time per injection (FTPI) and immediate numeric rating scale percentage improvement.

Results

Trainees were involved in 67.0% of all injections (N = 7,833). Complication rates or improvements in numeric rating scale scores showed no significant differences with trainee involvement for any injection type (P > .05). Trainee involvement was associated with increased FTPI for ILEIs (18.2 ± 10.1 seconds with trainees versus 15.1 ± 8.5 seconds without trainees, P < .001), but not for HIs (P = .60) or SIJIs (P = .51). Trainee involvement with TFEIs was dependent on institution for outcome with respect to FTPI (P < .001), with 28.1 ± 17.9 seconds with trainees and 32.1 ± 22.1 seconds without trainees (P = 0.51).

Conclusions

This large multicenter study of academic institutions demonstrates that trainee involvement in fluoroscopically guided injections does not affect immediate patient complications or pain improvement. Trainee involvement does not increase fluoroscopic time for most injections, although there is an institutional difference seen. This study supports the notion that appropriate trainee supervision likely does not compromise patient safety for fluoroscopically guided injections.

Level of Evidence

II  相似文献   

17.

Background

Intractable bone pain is a notorious adverse effect of granulocyte-colony stimulating factors (G-CSFs), such as pegfilgrastim and filgrastim, which are given to help prevent neutropenia in patients who are undergoing chemotherapy. G-CSF–induced bone pain is surprisingly common and often refractory to treatment with conventional analgesics.

Case Report

This article describes an emergency department case of opiate and nonsteroidal anti-inflammatory drug–resistant pegfilgrastim-induced bone pain that was successfully alleviated with 10 mg of oral loratadine, allowing for discharge home.

Why Should an Emergency Physician Be Aware of This?

This case suggests that loratadine may be an easy to implement, safe, and effective therapy in the emergency department management of intractable bone pain caused by G-CSF use. Emergency physicians should be aware that loratadine may successfully relieve otherwise intractable G-CSF–induced bone pain and allow for discharge home.  相似文献   

18.

Background

Stroke is a primary cause of death and disability in upper-middle–income countries such as Colombia. Given the lack of comprehensive rehabilitation for stroke patients in Colombia, there is a need to assess longitudinal mental health problems poststroke in this region.

Objective

To compare the course of mental health in stroke patients to healthy controls over the first year poststroke in Ibague, Colombia.

Design

Cross-sectional study.

Setting

The Psychological Attention Center of Antonio Nariño University in Ibague, Colombia.

Participants

Stroke patients (n = 50) and age- and gender-matched healthy controls (n = 50).

Methods

Patients and controls completed self-report Spanish versions of demographic information, injury-related characteristics, and mental health questionnaires

Main Outcome Measurements

Outcomes assessed included mental health (depression, anxiety, and stress) at 3, 6, and 12 months poststroke.

Results

Hierarchical linear models suggested that stroke patients had worse depression and anxiety over time than controls (P < .001). Among patients, depression and anxiety decreased over time (P < .001), whereas stress increased over time (P < .01). The findings suggest that although anxiety and depression improved over time in stroke patients, their mental health remained significantly lower than that of controls.

Conclusions

This is the first study to examine the course of mental health over the first year poststroke in Latin America, specifically in Ibague, Colombia. Despite the improvements in anxiety and depression over the first year poststroke, patient anxiety and depression were still worse in comparison to those in healthy controls. The current findings indicate a need for rehabilitation services in Colombia, especially targeting mental health issues.

Level of Evidence

I  相似文献   

19.

Background

Ideally, high-stakes examinations assess 1 dimension of medical knowledge to produce precise estimates of a candidate’s performance. It has not been reported whether the American Board of Physical Medicine and Rehabilitation Part 1 Certification Examination (ABPMR-CE-1) is unidimensional or not.

Objective

To examine the ABPMR-CE-1 to measure how many dimensions it assesses.

Design

Retrospective observational study.

Setting

We assessed examination results from the 2015 ABPMR-CE-1.

Participants

A total of 489 deidentified candidates taking the 2015 ABPMR-CE-1.

Methods

A 1-parameter Item Response Theory (IRT) measurement model was utilized. A Principal Components Analysis (PCA) of standardized residual correlations was used to detect multidimensionality.

Main Outcome Measure

Number of primary dimensions reflected in the 325 test questions.

Results

The results of the dimensionality analysis indicated that the ABPMR-CE-1 examination is highly unidimensional from a psychometric perspective. Expert content review of the substantive content of small contrasting clusters of questions provided additional assurance of the unidimensional nature of the examination.

Conclusions

The ABPMR-CE-1 appears indeed to measure a single construct, which suggests a sound structure of the examination. It closely approximates the assumption of statistical unidimensionality.

Level of Evidence

Not applicable.  相似文献   

20.

Background

A significant proportion of burn injury patients are admitted to inpatient rehabilitation facilities (IRFs). There is increasing interest in the use of functional variables, such as cognition, in predicting IRF outcomes. Cognitive impairment is an important cause of disability in the burn injury population, yet its relationship to IRF outcomes has not been studied.

Objective

To assess how cognitive function affects rehabilitation outcomes in the burn injury population.

Design

Retrospective study.

Setting

Inpatient rehabilitation facilities in the United States.

Participants

A total of 5347 adults admitted to an IRF with burn injury between 2002 and 2011.

Methods or Interventions

Multivariable regression was used to model rehabilitation outcome measures, using the cognitive domain of the Functional Independence Measure (FIM) instrument as the independent variable and controlling for demographic, medical, and facility covariates.

Main Outcome Measurements

FIM total gain, readmission to an acute care setting at any time during inpatient rehabilitation, readmission to an acute care setting in the first 3 days of IRF admission, rate of discharge to the community setting, and length of stay efficiency.

Results

Cognitive FIM total at admission was a significant predictor of FIM total gain, length of stay efficiency, and acute readmission at 3 days (P < .05). Cognitive FIM total scores did not have an impact on acute care readmission rate or discharge to the community setting.

Conclusions

Cognitive status may be an important predictor of rehabilitation outcomes in the burn injury population. Future work is needed to further examine the impact of specific cognitive interventions on rehabilitation outcomes in this population.

Level of Evidence

II  相似文献   

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