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1.
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Extracorporeal shockwave therapy (ESWT) is a technology that was first introduced into clinical practice in 1982 for urologic conditions. Subsequent clinical applications in musculoskeletal conditions have been described in treatment of plantar fasciopathy, both upper and lower extremity tendinopathies, greater trochanteric pain syndrome, medial tibial stress syndrome, management of nonunion fractures, and joint disease including avascular necrosis. The aim of this review is to summarize the current understanding of treatment of musculoskeletal conditions with ESWT, accounting for differences in treatment protocol and energy levels. Complications from ESWT are rare but include 2 reported cases of injury to bone and Achilles tendon rupture in older adults using focused shockwave. Collectively, studies suggest ESWT is generally well-tolerated treatment strategy for multiple musculoskeletal conditions commonly seen in clinical practice.
Level of Evidence
III 相似文献3.
Pregnancy is a risk factor for stroke in young women, but the effect of delivery on recovery and rehabilitation after stroke has not been elucidated in pregnant patients with stroke. This case report presents a pregnant patient with stroke who recovered successfully after cesarean delivery during rehabilitation. The possible effect of oxytocin is discussed as a factor promoting recovery from stroke.
Level of Evidence
V 相似文献4.
Donna Bergman Lynnette Rasmussen Kate Wan-Chu Chang Lynda J-S. Yang Virginia S. Nelson 《PM & R》2018,10(1):64-71
Background
The term self-determination refers to decision-making, goal setting, and perseverance to achieve those goals. Numerous studies have established the importance of self-determination to enhance learning and improve postschool outcomes. However, most studies evaluate students with learning disabilities, cognitive impairment, or behavioral disabilities. There is an absence of research on self-determination for adolescents with physical disabilities.Objective
To assess self-determination of adolescents with neonatal brachial plexus palsy (NBPP) compared with their typically developing peers via self-reported measures of function.Design
Case-control study.Setting
Brachial plexus clinic.Participants
Twenty adolescents with NBPP (aged 10-17 years) and their parents and 20 age/gender-matched typically developing adolescents and their parents were recruited. Non–English-speaking participants and those with other physical impairments were excluded from study.Methods
Participants completed demographic and American Institutes for Research (AIR) self-determination surveys. One of two designated occupational therapists evaluated participant physical function.Main Outcome Measurements
A demographic survey and AIR self-determination assessment were administered, and active range of motion measurements in shoulder forward flexion, elbow flexion, elbow extension, forearm pronation, and supination were obtained. Grip/pinch strength, MRC muscle strength, 9-Hole Peg Test, and Mallet scale scores also were evaluated.Results
Despite physical differences, adolescents with NBPP presented similar self-determination levels as their typically developing peers. Adolescents with NBPP rated their opportunities to engage in self-determined behaviors at school significantly lower than at home. Both adolescents with NBPP and those in the control group rated their opportunities to engage in self-determined behaviors at school significantly lower than at home.Conclusions
Adolescents with NBPP presented similar self-determination scores as their age/gender-matched typically developing peers. These results could be a reflection of our program’s patient- and family-centered care approach. Therefore, caregivers and providers should encourage personal development and fulfillment in adolescents with NBPP. Teachers and schools should be aware that opportunities for acquiring self-determination skills might be more limited at school than at home in this age group.Level of Evidence
III 相似文献5.
Left ventricular assist devices (LVADs) are used in patients with progressive heart failure symptoms to provide circulatory support. Patients with LVADs are referred to inpatient cardiac rehabilitation to prevent postoperative complications and improve aerobic capacity and quality of life. Preoperative exercise therapy for cardiac patients is an emerging treatment modality, and several studies have reported that it improves postoperative outcomes, such as length of hospital stay and postoperative complications. This case report describes the benefits of preoperative cognitive behavioral and exercise therapy in a Korean patient undergoing LVAD implantation.
Level of Evidence
V 相似文献6.
Background
Spinal cord injury (SCI) results in increased accumulation of visceral adipose tissue (VAT). Anthropometrics may provide an alternative to estimate VAT cross-section area (CSA) compared to magnetic resonance imaging (MRI).Objective
To validate the use of anthropometrics, including abdominal circumference and skinfold thickness (SFT) measurements against MRI to predict subcutaneous adipose tissue (SAT) and VAT cross-sectional areas in persons with SCI.Design
Cross-sectional.Setting
Clinical research centerParticipant
Twenty-two men with motor complete SCIMethods
Anthropometric measurements and MRI were taken during a single visit. Abdominal circumference and SFT were used to derive prediction equations for subcutaneous adipose tissue (SATAnthro-CSA) and VAT (VATAnthro-CSA). Three-axial MRI at the level of umbilicus was used to establish the prediction equations. VATAnthro-CSA was compared against body mass index (BMI), waist circumference, and SFT. Bland-Altman plots were used to determine limits of agreement between prediction equations and MRI.Main Outcome Measurements
SAT and VAT cross-sectional areas.Results
SATAnthro-CSA explained 76% of the variance in SAT cross-sectional area (r2 = 0.76, standard error of the estimate [SEE] = 49.5 cm2, P <.001). VATAnthro-CSA explained 72% of VAT cross-sectional area (r2 = 0.72, SEE = 45.8 cm2, P <.001). Compared to VATAnthro-CSA, BMI, waist circumference, and SFT explained only 37%, 63%, and 31%, respectively, in the variance of VAT MRI.Conclusion
Abdominal circumference and SFT demonstrated an alternative way to predict VAT CSA. VATAnthro-CSA estimated VATMRI more accurately than BMI, waist circumference, and SFT in individuals with chronic SCI.Level of Evidence
I 相似文献7.
Background
A variety of tests have been proposed to measure the performance of neck flexor muscles, but head-to-head comparisons hardly have been documented.Objective
To compare reliability indexes, construct validity, and ability to discriminate between individuals with and without neck pain of 4 muscle tests (deep neck flexors endurance test [DNFET]; 2 variations of the craniocervical flexion test [CCFT1 and CCFT2]; and dynamometry).Design
Reliability and validity study.Setting
General community.Participants
A total of 66 participants, 33 with chronic idiopathic neck pain (mean ± standard deviation pain intensity: 3.2 ± 1.9) and 33 without neck pain, from the general population.Methods/Main Outcome
Neck muscle functioning was assessed with the CCFT1, the CCFT2, the DNFET, and dynamometry on 2 separate sessions. Participants with neck pain also were assessed for pain intensity, disability, pain catastrophizing, and fear of movement.Results
Relative reliability of all tests was at least moderate (intraclass correlation coefficient ≥ 0.62), whereas measurement error was high, particularly for the DNFET (95% minimum detectable change ≥ 23.00 seconds). All tests showed moderate correlation (r ≥ 0.3) with at least 2 pain-related measures and moderate-to-strong correlations with each other. Principal component analysis retained 2 factors explaining 68%-73% of the variance of the 4 muscle tests. Significant differences between groups were found for the DNFET and dynamometry (P < .05).Conclusion
The reliability indexes suggest that the DNFET and the CCFT may be more appropriate for group comparisons than for individual comparisons. The 4 tests seem to have construct validity, but they also seem to measure slightly different constructs.Level of Evidence
III 相似文献8.
Ashraf S. Gorgey Gary J. Farkas David R. Dolbow Refka E. Khalil David R. Gater 《PM & R》2018,10(4):338-348
Background
Increase in visceral adipose tissue (VAT) is an independent risk for mortality and other health-related comorbidities.Objective
To examine the gender differences in VAT and subcutaneous adipose tissue (SAT) cross-sectional areas (CSA) between men and women with chronic spinal cord injury (SCI). The differences in the distribution of central adiposity were used to determine the association of VAT and SAT to metabolic dysfunction after SCI.Design
Cross-sectional design.Setting
Hospital-based study.Participants
Sixteen individuals (8 men and 8 women) with motor complete SCI were matched based on age, time since injury, and level of injury.Methods
Anthropometrics, dual x-ray absorptiometry (DXA), and magnetic resonance imaging were captured to measure lean mass, fat mass (FM), percentage FM, VAT, and SAT CSAs. Basal metabolic rate was measured, and intravenous glucose tolerance test and lipid panel were performed.Main Outcome Measurements
VAT, SAT, and metabolic profile.Results
SAT CSA was 1.6 -1.75 times greater in the upper and lower trunks in women compared to men with SCI (P < .05). VAT CSA was 1.8-2.6 times greater in the upper and lower trunks in men compared to women with SCI (P < .05). VAT adjusted to body weight was greater in men compared to women with SCI. High-density lipoprotein cholesterol (HDL-C) was positively related to SAT and negatively related to VAT. Glucose effectiveness was negatively related to lower trunk SAT (r = ?0.60, P = .02). HDL-C ratio and triglycerides were positively related to upper VAT, lower VAT, and VAT:SAT ratio.Conclusion
Magnetic resonance imaging demonstrated that there is a gender dimorphism in central adiposity in persons with chronic SCI. This gender dimorphism in central adipose tissue distribution may explain the higher prevalence of metabolic dysfunction in men with SCI, especially, the decrease in the HDL-C profile.Level of Evidence
IV 相似文献9.
Virtual reality and active video games (VR/AVGs) are promising rehabilitation tools because of their potential to facilitate abundant, motivating, and feedback-rich practice. However, clinical adoption remains low despite a growing evidence base and the recent development of clinically accessible and rehabilitation-specific VR/AVG systems. Given clinicians’ eagerness for resources to support VR/AVG use, a critical need exists for knowledge translation (KT) interventions to facilitate VR/AVG integration into clinical practice. KT interventions have the potential to support adoption by targeting known barriers to, and facilitators of, change. This scoping review of the VR/AVG literature uses the Theoretical Domains Framework (TDF) to (1) structure an overview of known barriers and facilitators to clinical uptake of VR/AVGs for rehabilitation; (2) identify KT strategies to target these factors to facilitate adoption; and (3) report the results of these strategies. Barriers/facilitators and evaluated or proposed KT interventions spanned all but 1 and 2 TDF domains, respectively. Most frequently cited barriers/facilitators were found in the TDF domains of Knowledge, Skills, Beliefs About Capabilities, Beliefs About Consequences, Intentions, Goals, Environmental Context and Resources, and Social Influences. Few studies empirically evaluated KT interventions to support adoption; measured change in VR/AVG use did not accompany improvements in self-reported skills, attitudes, and knowledge. Recommendations to target frequently identified barriers include technology development to meet end-user needs more effectively, competency development for end-users, and facilitated VR/AVG implementation in clinical settings. Subsequent research can address knowledge gaps in both clinical and VR/AVG implementation research, including on KT intervention effectiveness and unexamined TDF domain barriers.
Level of Evidence
IV 相似文献10.
Hyun-Mi Oh Geun-Young Park Young Min Choi Hyung Jung Koo Yongjun Jang Sun Im 《PM & R》2018,10(8):789-797
Background
There are no guidelines on the ideal time to inject botulinum toxin type A (BT-A) for lower leg spasticity in stroke patients. An early injection may produce unwanted weakness, interfering with gait recovery.Objective
To evaluate whether the outcomes after BT-A injection for plantarflexion spasticity can be different according to stroke chronicity.Design
A secondary analysis study from a double-blinded, randomized trial with group reclassification according to stroke chronicity.Setting
Two rehabilitation centers.Participants
Stroke participants (n = 40) with plantar flexor spasticity, treated with BT-A (200 units) into the gastrocnemius muscle.Methods
Outcome parameters were reanalyzed serially using 2-way repeated measures of analysis of variance (ANOVA), at baseline and 2, 4, and 8 weeks postinjection. Subjects were reclassified into 3 groups: early, within 6 months (n = 12); middle, between 6 months and 1 year (n = 14); and late, between 1 and 2 years from stroke onset (n = 12).Main Outcome Measures
The Modified Ashworth Scale, clonus scale, 10-m walking test, ABILOCO, and the Functional Ambulation Category.Results
The 2-way repeated measures of ANOVA showed improvement in gait and spasticity after injection in the 3 groups. Significant improvement in the Modified Ashworth Scale (P < .001) was observed, starting from the post–2 week injection period. Improvement of gait as assessed by the functional measurement ABILOCO and the Functional Ambulation Category (P < .001) were observed in all 3 groups, mostly at the post–8 week injection period.Conclusions
Our serial measurements of the outcome parameters indicated that BT-A could be expected to lead to consistent improvement in both the muscle tone and gait quality in those with plantar flexor spasticity regardless of stroke chronicity, including those injected as early as within the first 6 months.Level of Evidence
I 相似文献11.
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
12.
Chronic daily headaches (CDHs) are common, disabling, and difficult to treat. We report a case of a patient with a complex medical history experiencing multifactorial CDH referred for and eventually enrolled in an interdisciplinary chronic pain program. Focusing on enhancing the patient’s function while minimizing the use of medications and invasive procedures, this comprehensive rehabilitation intervention consists of diverse treatment approaches, including cognitive-behavioral therapy, physical and occupational therapy, and medical interventions. Despite the patient’s challenges with implementation of strategies learned in the program, positive results were seen, including decreased symptomatology, decreased opioid use, and attainment of employment. Although time-intensive, interdisciplinary chronic pain programs may result in a greater likelihood for sustained functional improvements and prevention of disability for patients with CDH, even in the most complex.
Level of Evidence
IV 相似文献13.
14.
Rhabdomyosarcoma (RMS) represents the most common sarcoma in childhood yet is extremely rare in adults, with only a handful of cases reported. Here we present a case of intraspinal spindle cell RMS in an adult who presented as a typical case of spinal stenosis. To our knowledge, this is the first reported case of lumbar intraspinal spindle cell RMS in an adult patient. Furthermore, RMS phenotypically presents more aggressively in adults compared with children.
Level of Evidence
V 相似文献15.
Leticia Amaral Corrêa Luciano Teixeira dos Santos Edmur Nelson Nogueira Paranhos Alfredo Ignacio Minetti Albertini Patrícia do Carmo Silva Parreira Leandro Alberto Calazans Nogueira 《PM & R》2018,10(9):942-950
Objective
To identify the prevalence and risk factors for musculoskeletal pain in keyboard musicians.Design
Systematic reviewMethods
A systematic review was conducted according to the MOOSE recommendations and it was registered with the PROSPERO database under registration number CRD42016042913. We included observational studies through the electronic databases PubMed, Scopus, ScienceDirect, Web of Science, Répertoire International de Littérature Musicale (RILM), Retrospective Index to Music Periodicals (RIPM), Scielo, and Google Scholar, with combinations of the keywords pianists, keyboard players, musculoskeletal pain, muscular disease, tendinitis, tendinopathy, observational, case-control, prevalence, and risk factors. Data from population, information about pain, and risk factors were extracted from studies that fulfilled the eligibility criteria. The methodological quality of the studies was classified through the Newcastle-Ottawa Scale. The risk of bias and quality of evidence was assessed using the GRADE system.Results
Twelve articles (case-controls) were included for the qualitative synthesis. The quality of the studies was classified as fair (n = 6) and good (n = 6). Prevalence was observed between 25.8% and 77.0% of musculoskeletal pain among keyboard musicians, with a higher prevalence in wrists and hands (13.8%-65.8%), neck (9.8%-64.2%), and shoulders (9.8%-59.8%). The only consistent risk factor found in the 4 studies was being female, with OR ranging from 1.05-1.90. Age greater than 18 years; weekly training more than 20 hours; training for more than 60 minutes without a rest break; not having a habit of practicing sports; and playing despite the pain were also described as risks factors for musculoskeletal pain. It was not possible to perform the meta-analysis due to the heterogeneity of the studies.Conclusion
Keyboard musicians presented a high prevalence of musculoskeletal pain, especially in the upper extremity regions of the body. Female, ageing, playing behaviors, and sedentary lifestyle showed an increased likelihood to report musculoskeletal pain.Level of Evidence
II 相似文献16.
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17.
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18.
Aisia Azus Hsiang-Ling Teng Lauren Tufts Daniel Wu C. Benjamin Ma Richard B. Souza Xiaojuan Li 《PM & R》2018,10(1):56-63
Background
Few studies have investigated the associations between patient-reported outcome and gait in patients with anterior cruciate ligament (ACL) injury and reconstruction over time. Because there is an association between ACL rupture and the presence of osteoarthritis later in life, a better understanding of these relationships will help to elucidate how patients’ gait pattern may affect pain and symptoms, potentially leading to better treatment for or preventing the development of knee OA.Objective
To evaluate the associations between gait characteristics and self-reported pain and symptoms before, 6 months after, and 1 year after anterior cruciate ligament reconstruction.Design
Prospective cohort study.Setting
The Human Performance Center at the Orthopedic Institute at the University of California, San Francisco.Patients
Patients with full unilateral ACL tears were enrolled. A total of 43 patients were included at 12 months postsurgery.Methods
The independent variable in this study comprised specific gait variables in patients who had undergone ACL reconstruction. At each time point, 3-dimensional motion analysis was performed. Participants also completed the Knee Osteoarthritis Outcome Score (KOOS) questionnaire.Main Outcomes Measurements
The primary study outcome measurement was the KOOS and was planned before data collection began. Partial correlations were used to examine cross-sectional associations between gait characteristics and KOOS pain and symptom scores at all time points. In addition, partial correlations were performed to examine the associations between change in postoperative KOOS from 6 months to 1 year and gait characteristics at baseline and 6 months.Results
Significant associations between KOOS and gait characteristics were found at all time points, including an association between peak medial ground reaction force and pain (r = ?0.344, P = .02) and symptoms (r = ?0.407, P = .007) at baseline.Conclusions
Specific gait variables may be predictive of greater pain and symptoms and less improvement over time postreconstruction. This could help to inform rehabilitation exercises post injury and pre reconstruction.Level of Evidence
IV 相似文献19.
20.
Samman Shahpar Alex W.K. Wong Susan Keeshin Sarah M. Eickmeyer Patrick Semik Masha Kocherginsky Stacy McCarty 《PM & R》2018,10(9):926-933