共查询到20条相似文献，搜索用时 15 毫秒
1.
Sherilyn W. Driscoll Carolyn C. Geis Mikaela M. Raddatz Carolyn L. Kinney Lawrence R. Robinson 《PM & R》2018,10(12):1361-1365
Background
Maintenance of certification (MOC) in Physical Medicine and Rehabilitation is a process of lifelong learning that begins after successfully completing an Accreditation Council for Graduate Medical Education (ACGME)–accredited residency and passing the American Board of Physical Medicine and Rehabilitation (ABPMR) Part I and Part II Examinations. We seek to identify factors predictive of successful MOC Examination performance.Objective
To identify characteristics predictive of successful completion on the ABPMR MOC Examination.Design
Retrospective review.Setting
American Board of Physical Medicine and Rehabilitation database review.Participants
4,545 diplomates who completed the MOC Examination between January 2006 and December 2017.Methods
MOC Examination performance was the primary outcome variable. Performance on Part I and Part II Examinations were independent variables. Additional potential predictors evaluated included year of MOC cycle in which examination was taken, years of practice since residency completion, age, and subspecialty certification.Main Outcome Measures
Performance on MOC Examination.Results
Age at time of MOC Examination was inversely correlated with examination score (r = –0.14, P < .001). Similarly, as time since completion of residency training increased, MOC scores declined. Passing the Part I Examination on first attempt predicted a 98% MOC pass rate, compared to 90% for those who failed initially. MOC performance was highly correlated with Part I performance (r = 0.59, P < .001) and Part II performance (r = 0.32, P < .001). Although MOC performance was similar for those taking the examination in years 7 – 10 of their cycle (97% pass rate), those taking the examination after more than 10 years of the cycle had a significantly lower performance (85% pass rate, P < .01).Conclusions
Better performance on the MOC Examination is associated with better performance on Part I and Part II Examinations, taking the examination earlier in the 10 year cycle, younger age, and less time since completion of training. Diplomates who are at higher risk for failing the examination may need to prepare differently for MOC Exam than those who are more likely to pass.Level of Evidence
III 相似文献2.
3.
Julie K. Silver Saurabha Bhatnagar Cheri A. Blauwet Ross D. Zafonte Nicole L. Mazwi Chloe S. Slocum Jeffrey C. Schneider Adam S. Tenforde 《PM & R》2017,9(10):976-984
Background
Medical specialty societies are important resources for physicians in advancing their careers. There is a gap in the literature regarding gender disparities within these societies. This study assesses one area where disparities may exist: recognition awards.Objective
To determine whether female physicians are underrepresented among recognition award recipients by the American Academy of Physical Medicine and Rehabilitation (AAPM&R).Design
Surveillance study.Setting and Methods
A published online list of national award recipients from the AAPM&R was analyzed. Forty-eight years of data were included, as the list contained all major recognition award recipients from 1968 to 2015. All awards that were given exclusively to physicians were included. There were eight award categories listed online; seven met this criterion, with a total of 264 individual awards presented. One award category was excluded because it focused on distinguished public service and included both physician and nonphysician (eg, public official) recipients. Awards that were not published online were also excluded.Main Outcome Measures
Total awards given to female versus male physicians from 1968 to 2015, with awards given over the past decade (2006-2015) assessed independently. Lectureships were also analyzed as a set. For awards given to groups of physician recipients, analysis included gender composition of the group (eg, male only versus female only versus mixed-gender physician groups). To assess the proportion of female versus male physiatrists over time, physician gender and specialty data from 3 sources were used: the American Medical Association (AMA), the Association of American Medical Colleges (AAMC), and the AAPM&R.Results
Over the past 48 years, the AAPM&R presented 264 recognition awards to physicians. Award recipients were overwhelmingly male (n = 222; 84.1%). Females received 15.9% (n = 42) of the total awards, although there was an upward trend in female physician recipients to 26.8% (n = 26) from 2006 to 2015. Lectureships were given to 8 female physicians (n = 8 of 77, 10.4%). These results were lower than the proportion of female physicians in the field of physiatry (35% in 2013). Female physicians were more likely to receive awards if they were part of a group and less likely to be recognized if the award was given to only 1 recipient each year or involved a lectureship with a speaking opportunity at a national meeting.Conclusions
To our knowledge, this is the first study in medicine to assess whether female physicians are underrepresented among recipients of recognition awards presented by a national medical society. For nearly half a century, female physicians have been underrepresented in awards presented by the AAPM&R. Although it is encouraging that the proportion of female physicians receiving awards is increasing, further research is needed to understand why underrepresentation remains.Level of Evidence
Not applicable. 相似文献4.
Implementation science is an evolving part of translating evidence into clinical practice and public health policy. This report describes how a social media strategy for the journal PM&R using metrics, including alternative metrics, contributes to the dissemination of research and other information in the field of physical medicine and rehabilitation. The primary goal of the strategy was to disseminate information about rehabilitation medicine, including but not limited to new research published in the journal, to health care professionals. Several different types of metrics were studied, including alternative metrics that are increasingly being used to demonstrate impact in academic medicine. A secondary goal was to encourage diversity and inclusion of the physiatric workforce—enhancing the reputations of all physiatrists by highlighting their research, lectures, awards, and other accomplishments with attention to those who may be underrepresented. A third goal was to educate the public so that they are more aware of the field and how to access care. This report describes the early results following initiation of PM&R’s coordinated social media strategy. Through a network of social media efforts that are strategically integrated, physiatrists and their associated institutions have an opportunity to advance their research and clinical agendas, support the diverse physiatric workforce, and educate the public about the field to enhance patient awareness and access to care. 相似文献
5.
6.
Background
Growing numbers of allogeneic stem cell transplants and improved posttransplant care have led to an increase of individuals with chronic graft-versus-host disease (cGVHD). Although cGVHD leads to functional impairment for many, there is limited literature regarding the benefits of acute inpatient rehabilitation for patients with cGVHD.Objective
To assess Functional Independence Measure (FIM) outcomes of patients with cGVHD during acute inpatient rehabilitation and to compare inpatient rehabilitation outcomes with patients with burn injuries, a rehabilitation patient population with similar comorbidities.Design
Retrospective chart review.Setting
Acute rehabilitation center at a large academic medical center.Patients (or Participants)
A total of 37 adult patients with cGVHD and 30 with burn injuries admitted to inpatient rehabilitation from 2010 to 2015.Methods or Interventions
Linear regression analysis to evaluate group (cGVHD versus burn) differences in functional gains. Effect size and minimal detectable change at the 90% confidence level (MDC90) were used to evaluate change in FIM outcomes.Main Outcome Measurements
Total FIM gain, motor FIM gain, and FIM efficiency.Results
Patients with cGVHD had statistically significant lower functional gains than patients with burn injuries, with an average of 11.66 fewer total FIM points (P ≤ .001), 10.54 fewer motor FIM points (P = .01), and 2.45 units less of FIM efficiency (P = .01). At the time of discharge, 7 (18%) patients with cGVHD exceeded the MDC90 values for total FIM gain versus 9 (30%) patients with burn injuries (P = .26). Eight (21%) patients with cGVHD exceeded the MDC90 for motor FIM gain versus 13 (43%) patients with burn injuries (P = .048). Effect sizes for patients with cGVHD and with burn injury were moderate to large, respectively, with patients with burn injuries having nearly twice the magnitude of gains as patients with cGVHD.Conclusions
Despite achieving more modest functional gains than patients with burn injuries, patients with cGVHD improved in function after acute inpatient rehabilitation. If replicated in larger studies, patients with functional impairment from cGVHD can be considered for inpatient rehabilitation. Future work should also determine minimal clinically important differences in function gain from inpatient rehabilitation for patients with cGVHD.Level of Evidence
II 相似文献7.
Samman Shahpar Alex W.K. Wong Susan Keeshin Sarah M. Eickmeyer Patrick Semik Masha Kocherginsky Stacy McCarty 《PM & R》2018,10(9):926-933
Background
Malignant brain tumors cause significant impairments in function because of the nature of the disease. Nevertheless, patients with malignant brain tumors can make functional gains equivalent to those with stroke and traumatic brain injury in the inpatient rehabilitation setting. However, the efficacy of outpatient rehabilitation in this population has received little study.Objective
To determine if an interdisciplinary outpatient rehabilitation program will improve functional outcomes in patients with malignant brain tumors.Design
Nonrandomized prospective longitudinal study.Setting
Six affiliated outpatient sites of one institution.Patients
Forty-nine adults with malignant brain tumors were enrolled.Methods
Patients received interdisciplinary therapy services, with duration determined by the therapist evaluations. The therapists scored the Day Rehabilitation Outcome Scale (DayROS) and Disability Rating Scale (DRS) on admission and discharge. The caregivers filled out the DRS at discharge, 1 month, and 3 months after discharge.Main Outcome Measurements
The primary study outcome measure was the DayROS, which is a functional measure similar to the Functional Independence Measure. DRS was another functional outcome measure assessing basic self-care, dependence on others, and psychosocial adaptability.Results
Forty-six of 49 enrolled patients (94%) completed the day rehabilitation program. The average length of stay was 76.9 days. There was a significant improvement in total DayROS (P < .001), mobility (P < .001), Activities of Daily Living ( P < .001), and communication (P < .001) DayROS subscores from admission to discharge. There were no significant changes over time in the DRS scores. Women had higher DayROS gains (P = .003) and better therapist DRS scores from admission to discharge than men (P = .010).Conclusions
Patients with malignant brain tumors can make functional gains in an interdisciplinary outpatient rehabilitation program. This level of care should be considered in this patient population.Level of Evidence
II 相似文献8.
Alexander J. Bajorek Chloe Slocum Richard Goldstein Jacqueline Mix Paulette Niewczyk Colleen M. Ryan Carla Tierney Hendricks Ross Zafonte Jeffrey C. Schneider 《PM & R》2017,9(1):1-7
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9.
Neuralgic amyotrophy (NA) is a neurologic syndrome of unknown etiology primarily affecting the brachial plexus. We are reporting an unusual case of acute bilateral NA that was possibly secondary to Lyme disease. The patient demonstrated significant functional gains and was discharged home after 2 weeks of inpatient rehabilitation, supporting the role of inpatient rehabilitation in acute NA. In this report, we discuss the diagnosis, electrodiagnostic progression, pain management, goals for inpatient rehabilitation, and overall prognosis of NA.
Level of Evidence
V 相似文献10.
Background
Prosthetic motor rehabilitation usually relies on the highly repetitive training of movements. Patients might drop out of training because the rehabilitation process is long and often discouraging. Game-based interventions provide a potentially useful alternative to standard myoelectric (electromyographic [EMG]) training and can increase engagement with training.Objective
To assess the short-term impact of a game-based rehabilitation protocol on parameters for EMG control, evaluate how game-based interventions affect patient motivation, performance, and effort, and compare the game-based intervention with a standard tool in rehabilitation (MyoBoy).Design
This randomized controlled trial included 2 patient groups and 1 control group. After establishing a baseline, the 2 patient groups received different interventions that were compared with each other and with the able-bodied control group.Setting
University hospital-based study.Participants
Fourteen patients with traumatic transradial or transhumeral upper extremity amputation and 10 able-bodied participants.Methods
For the game-based intervention, EMG proficiency was assessed before and after playing the games and 2 days later as follow-up to measure retention rate. EMG proficiency was measured using maximum voluntary contraction, proportional precision control, signal separation, and muscle endurance. Questionnaires for rating the game-based intervention and intrinsic motivation were provided after the intervention.Outcomes
Outcome measures for EMG proficiency were provisional maximum voluntary muscle contraction, precise proportional control, electrode separation, and muscle endurance. Quantitative outcome measures for participant experience were intrinsic motivation, enjoyment, pressure, exerted effort, and usefulness of the intervention. The qualitative outcome measure was the surveyed attitude toward the game-based intervention.Results
Results showed an overall improvement in EMG control, fine muscle activation, and electrode separation. Patients stated that racing games provided slightly more fun, but rhythm-based games were considered to provide better challenges for EMG control.Conclusion
Game-based interventions provide a useful addition to standard EMG training and can achieve better results in clinical outcome measures. The racing and music game genres provide solid starting points for interventions. Further studies can look at a wider range of genres and identify more specific game mechanics suitable for training.Level of Evidence
I 相似文献11.
12.
Courtney Frengopoulos Michael W.C. Payne Jeffrey D. Holmes Ricardo Viana Susan W. Hunter 《PM & R》2018,10(10):1012-1019
Background
Gait is a complex process that involves coordinating motor and sensory systems through higher-order cognitive processes. Walking with a prosthesis after lower extremity amputation challenges these processes. However, the factors that influence the cognitive-motor interaction in gait among lower extremity amputees has not been evaluated. To assess the interaction of cognition and mobility, individuals must be evaluated using the dual-task paradigm.Objective
To investigate the effect of etiology and time with prosthesis on dual-task performance in those with lower extremity amputations.Design
Cross-sectional study.Setting
Outpatient and inpatient amputee clinics at an academic rehabilitation hospital.Participants
Sixty-four individuals (aged 58.20±12.27 years; 74.5% male) were stratified into 3 groups; 1 group of new prosthetic ambulators with transtibial amputations (NewPA) and 2 groups of established ambulators: transtibial amputations of vascular etiology (TTA-vas), transtibial amputations of nonvascular etiology (TTA-nonvas).Interventions
Not applicable.Main Outcome Measures
Time to complete the L Test measured functional mobility under single and dual-task conditions. A serial arithmetic task (subtraction by 3s) was paired with the L Test to create the dual-task test condition. Single-task performance on the cognitive arithmetic task was also recorded. Dual-task costs (DTCs) were calculated for performance on the cognitive and gait tasks. Analysis of variance determined differences between groups. A performance-resource operating characteristic (POC) graph was used to graphically display DTCs.Results
Gait performance was worse under dual-task conditions for all groups. Gait was significantly slower under dual-task conditions for the TTA-vas (P < .001), TTA-nonvas (P < .001), and NewPA groups (P < .001). However, there was no between-group difference for gait DTC. The 3 groups tested did not differ in the amount of cognitive DTC (DTCcog). Dual-task conditions also had a negative impact on cognitive task performance for the TTA-nonvas (P = .02) and NewPA groups (P < .001). The TTA-vas group had a slight improvement during dual-task conditions and has a positive DTCcog as a result (P = .04). However, no between-group differences were seen for DTCcog. The POC graph demonstrated that many individuals had a decrease in performance on both tasks; however, the gait task was prioritized for the majority (56.2%) of participants.Conclusions
Cognitive distractions while walking pose challenges to individuals regardless of etiology, level of amputation, or time with the prosthesis. These findings highlight that individuals are at risk for adverse events when performing multiple tasks while walking.Level of Evidence
II 相似文献13.
Eduard Alentorn-Geli Nathan R. Wanderman Andrew T. Assenmacher Bassem T. Elhassan Joaquín Sánchez-Sotelo Robert H. Cofield John W. Sperling 《PM & R》2017,9(10):1006-1012
Background
Theoretically, patients with only one functional arm secondary to contralateral amputation or paralysis will subject their only functional upper extremity to increased loads. This could become an issue after reverse shoulder arthroplasty (RSA). However, there are no reported data on the implant survival or function for patients with a nonfunctional contralateral upper extremity.Objective
To report the outcomes of RSA in patients with contralateral upper extremity amputation or paralysis.Design
Retrospective case series.Setting
Tertiary university hospital.Patients
All patients who underwent RSA between January 2004 and December 2013.Methods
Of 1335 RSA procedures performed, 5 patients had a minimum 2-year follow-up and nonfunctional contralateral upper extremity. There were 3 men and 2 women, with a mean (standard deviation) age and length of follow-up of 72.4 (7.5) years and 56.4 (24-132) months. Two of the patients had a contralateral upper extremity amputation, and the other 3 had contralateral upper extremity paralysis as a result of stroke, traumatic brain injury, and traumatic brachial plexus injury at birth.Main Outcomes
Pain, range of motion, functional scores (Simple Shoulder Test, American Shoulder and Elbow Society and Quick-Disability of the Arm, Shoulder and Hand), satisfaction, complications/reoperations, and radiographic loosening.Results
RSA resulted in substantial improvement in pain (P = .008), forward flexion (P = .02), and external range of motion (P = .01). The mean (standard deviation) Simple Shoulder Test, American Shoulder and Elbow Society, and Quick-Disability of the Arm, Shoulder, and Hand scores were 9.8 (1.3), 82 (13), and 17.8 (13.4), respectively. The results were excellent in 3, satisfactory in 1, and unsatisfactory in 1 patient (due only to external rotation limited to 10°). Subjectively, all 5 patients felt greatly improved and stated they would undergo RSA again. There were no complications or reoperations. There were no shoulders with component loosening.Conclusions
RSA seems to be a safe, effective, and successful surgical procedure for patients with a nonfunctional contralateral upper extremity. Studies with larger sample sizes and longer follow-up will hopefully validate the present findings.Level of Evidence
IV 相似文献14.
Progressive supranuclear palsy (PSP) is a progressive neurodegenerative disorder caused by the deposition of abnormal proteins in neurons of the basal ganglia that limit motor ability, resulting in disability and reduced quality of life. So far, no pharmacologic therapy has been developed, and the treatment remains symptomatic. The aim of the present study is to perform a systematic investigation of the literature, and to determine the types and effects of rehabilitative interventions used for PSP. A search of all studies was conducted in MEDLINE/PubMed, the Cochrane Central Register of Controlled Trials, CINAHL, and EMBASE. Twelve studies were identified, including 6 case reports, 3 case series, one case-control study, one quasi?randomized trial (i.e. not truly random) with crossover design, and one randomized controlled trial, with 88 patients investigated overall. Rehabilitative interventions varied in type, number, frequency, and duration of sessions. The most commonly used clinical measures were the Progressive Supranuclear Palsy Rating Scale (PSPRS) and Unified Parkinson's Disease Rating Scale (UPDRS). Physical exercises were the main rehabilitative strategy but were associated with other interventions and rehabilitative devices, in particular treadmill and robot-assisted gait training. All studies showed an improvement in balance and gait impairment with a reduction of falls after rehabilitation treatment. Because of poor methodological quality and the variety of rehabilitative approaches including different and variable strategies, there was insufficient evidence of the effectiveness of any specific rehabilitation intervention in PSP. Despite this finding, rehabilitation might improve balance and gait, thereby reducing falls in PSP patients.
Level of Evidence
IV 相似文献15.
Background
Isometric assessment of muscular function using a handheld dynamometer (HHD) is frequently used in clinic environments. However, there is controversy in terms of the validity of isometric assessment to monitor changes in dynamic performance. One repetition maximum (1RM) is considered the gold standard for evaluating dynamic strength, though clinicians do not often use 1RM testing, preferring to be cautious with clients who have preexisting impairments. If strength testing using an HHD could be used to predict 1RM, this may have significant implications for the use of isometric testing to prescribe exercise in clinical environments.Objective
To establish the relationship and agreement between 1RM and isometric strength scores measured using HHD for the biceps and quadriceps muscle groups and to determine if HHD measurements can be used to predict 1RM.Design
Criterion standard comparison.Setting
Tertiary institution gymnasium.Participants
Convenience sample of 50 healthy adults (26 women) aged 19-33 years (mean 23.38 ± 3.11 years).Methods
Muscle strength of the biceps and quadriceps muscle groups measured by 1RM and isometric maximal voluntary contraction measured using an HHD.Main Outcome Measures
Statistical analysis of the relation between the measures of strength was established using Pearson correlation and a Bland-Altman plot. A linear regression analysis with included covariates (gender, age, resistance training history, and body mass index) was used to derive the prediction equations.Results
A significant correlation was found between 1RM and HHD scores for the biceps (r = .83, P < .001) and quadriceps muscle groups (r = .82, P < .001). However, strength scores were not in agreement. Linear regression analysis found significance in predicting 1RM from all HHD scores (P < .001). Gender as a covariate significantly influenced the prediction of 1RM for the biceps (P = .005) and quadriceps (P = .003) muscle groups.Conclusions
There is a significant relationship between 1RM and HHD measures of strength, and measures taken using an HHD can be used to predict 1RM in the biceps and quadriceps muscle groups. The use of an HHD may therefore provide a more accessible alternative to 1RM for muscle strength assessments. Further research is warranted to determine if results are applicable in clinical populations.Level of Evidence
NA 相似文献16.
Se Won Lee Ratnakar Veeramachaneni Ibrahim Abou Saleh Karen Morice Timothy Tiu Yungtai Lo Kevin Frison Matthew N. Bartels 《PM & R》2018,10(8):836-842
Background
Home-based therapy optimizing biomechanics and neuromuscular control is increasingly recognized as a treatment option for chronic nonspecific low back pain (CNSLBP). However, its impact on pain, function, and gait is limited among patients in a metropolitan area.Objective
To evaluate the change of pain, function, and gait parameters with home-based therapy with the use of footwear-generated biomechanical manipulation and perturbation training in a population with CNSLBP in a metropolitan area.Design
Prospective observational study.Setting
Outpatient rehabilitation clinic at an academic teaching hospital.Participants
One hundred sixteen patients with CNSLBP for more than 6 months.Intervention
Six months of home-based therapy with a biomechanical device using 4 modular elements attached to a foot-worn platform.Main Outcome Measures
Instrumental gait analysis (gait velocity, step length, single limb support phase % of gait cycle), Numeric Rating Scale for pain, and Oswestry Disability Questionnaire Index for pain and function.Results
Only 43 patients (37.1%) completed the study. Among 43 patients, mean gait velocity increased from 86.6 ± 20.7 to 99.7 ± 22.1 cm/s (P < .0001) in 6 months. Mean left step length increased from 51.1 ± 8.4 to 54.8 ± 9.8 cm (P < .0001). Mean right step length increased from 51.0 ± 7.9 to 55.4 ± 9.0 cm (P < .0001). Mean single limb support increased from 36.4 ± 2.8 to 37.2 ± 2.5%, (P = .208) in the right side and from 36.6 ± 3.0 to 37.8 ± 4.4%, (P = .019) in the left side. Median Oswestry Disability Questionnaire Index score improved from 28 (18-44; interquartile range) to 17 (10-35) (P = .045). Mean Numeric Rating Scale for back pain improved from 7.7 ± 1.8 to 3.3 ± 3.1 (P < .0001).Conclusion
At 6 months, patients with CNSLBP undergoing home-based therapy with footwear-generated biomechanical manipulation and perturbation training demonstrated significant improvement of objective gait parameters, pain, and function.Level of Evidence
IV 相似文献17.
Sayed E. Wahezi Edward Alexeev John S. Georgy Nogah Haramati Stephen A. Erosa Jay M. Shah Sherry Downie 《PM & R》2018,10(6):616-622
Background
Lumbar facet arthropathy is a common cause of low back pain. Literature supports treatment with radiofrequency ablation (RFA) of associated nerves that innervate lumbar facets when alternative conservative therapies have failed. Diagnostic local anesthetic blocks precede therapeutic ablation, but have a false-positive rate of 27%-63%, and some authors have questioned their utility in predicting therapeutic response to RFA. The authors of the current study believe that injectate volume may be a contributing factor to false positivity.Objective
To evaluate the difference in volume dispersion between 0.25 mL and 0.5 mL of injectate when performing lumbar medial branch blocks. We hypothesized that injection volumes greater than 0.25 mL during lumbar medial branch blocks would affect the distal branches of the adjacent medial branches, thus decreasing the specificity of the procedure. Thus, we attempted to demonstrate that injection volumes greater than 0.25 mL during lumbar medial branch blocks would affect the distal branches of the adjacent medial branches, which might increase false positivity of the blocks.Study Design
Cadaveric investigation.Setting
Tertiary care center.Participants
Not applicable.Outcome Measurements
To demonstrate that the spread of lumbar medial branch blocks using commonly injected volume coats adjacent structures that are not affected by radiofrequency ablation.Methods
Six cadavers were chosen with nondissected lumbar spines. Fluoroscopically guided medial branch injections were performed bilaterally using the posterior oblique approach. A volume of 0.25 mL or 0.50 mL of a 9:1 solution of Omnipaque 240 and 1% medical grade methylene blue were delivered to the left and right sides, respectively. Postinjection computed tomographic imaging was performed, followed by dissection.Results
Both volumes adequately coated the medial branches, but in the 0.5-mL injectate cohort there was consistent spread dorsally to the superficial muscles and distal segments of the dorsal branches distant to the target nerves, whereas in the 0.25-mL injectate cohort the spread was contained in the deep and intermediate muscular lumbar layers, close to the intended target.Conclusion
We suggest that a 0.5-mL injectate volume in clinical practice may produce an adjacent-level nerve block in addition to the intended injection level, thus decreasing the specificity of a targeted lumbar medial branch block. A 0.25-mL quantity of injectate reliably contacted the lumbar medial branches without extensive extravasation. Presumably, this means that 0.25 mL total volume for a lumbar medial branch block may provide greater specificity for RFA planning.Level of Evidence
NA 相似文献18.
19.
Eduard Alentorn-Geli Nathan R. Wanderman Andrew T. Assenmacher Joaquín Sánchez-Sotelo Robert H. Cofield John W. Sperling 《PM & R》2018,10(6):607-615
Background
Wheelchair-dependent patients rely on their upper extremities for mobility and transfers. This entails the heavy use of upper extremities as weight-bearing joints, leading to shoulder overuse with increased prevalence of rotator cuff–related disorders and ultimately to challenging cases for shoulder surgeons when a joint replacement is needed.Objective
To report the outcomes of reverse shoulder arthroplasty (RSA) in wheelchair-dependent patients with arthritis and rotator cuff tears.Design
Retrospective case series/cross-sectional study.Setting
Tertiary university hospital.Patient (participants)
All wheelchair-dependent patients undergoing RSA between 2004 and 2013.Methods/Interventions
Of the 22 wheelchair-dependent patients undergoing RSA, 18 of them had a minimum follow-up of 2 years. There were 9 men and 9 women, with a mean (standard deviation) age and length of follow-up of 68 (8.5) years and 36 (24-63) months. A retrospective chart review and cross-sectional phone calls were conducted to obtain all data.Outcomes
Pain, range of motion, functional scores (Neer scale, simple shoulder test, and American Shoulder and Elbow Society), satisfaction, complications/reoperations, radiographic loosening, and 90-day mortality/morbidity.Results
RSA resulted in a significant improvement in pain (P = .02) and nonsignificant improvements in forward flexion (P = .3) and external rotation (P = .07). There were 3 (16%) excellent, 12 (63%) satisfactory, and 4 (21%) unsatisfactory results. The mean (standard deviation) postoperative American Shoulder and Elbow Society score was 56.5 (16.5). All patients stated that they would undergo RSA again. There were no surgically related complications or reoperations. The 90-day mortality and morbidity rates were 0% and 26%, respectively.Conclusions
RSA is a safe and effective procedure in wheelchair-dependent patients who use their shoulders for weight-bearing purposes. Although functional scores are not optimal and medical complications are not uncommon, 79% of patients had an excellent or satisfactory result.Level of Evidence
III 相似文献20.
Shannon D. Sullivan Mark S. Nash Eshetu Tefara Emily Tinsley Suzanne Groah 《PM & R》2018,10(4):373-381