American Journal of Physical Medicine & Rehabilitation

The current rehabilitation therapy protocols for management of individuals with spinal cord injury or disease (SCI/D) aim to maximize restoration of remaining function and minimize secondary health conditions. Also, several novel rehabilitation therapies for management of SCI/D have been reshaping the field over the past two decades. This scoping review analyzes the trends and features of the recently completed and ongoing clinical studies on the rehabilitation of individuals with spinal cord injury or disease (SCI/D) that were registered in the ClinicalTrials...

OBJECTIVES: Physical examinations are essential for in-person patient visits but remain difficult to replicate during virtual encounters. This work aims to identify gaps in the current state of telemedicine-based physical assessments (TelePA) by surveying physical medicine and rehabilitation (PM&R) physicians who perform physical examinations. DESIGN: A survey of 29 Likert-scale questions and 5 open-ended questions was distributed to practicing PM&R physicians...

OBJECTIVE: Characterize patient-reported signs and symptoms of urinary tract infections (UTI) in patients with neurogenic bladder (NB) to inform development of an intervention to improve the accuracy of UTI diagnosis. DESIGN: Retrospective cohort study, of adults with NB due to spinal cord injury/disorder (SCI/D), multiple sclerosis (MS), and/or Parkinson's Disease (PD) and UTI encounters at four medical centers between 2017-2018. Data were collected through medical record review and analyzed using descriptive statistics and unadjusted logistic regression...

OBJECTIVE: The aim of this umbrella review with meta-meta-analysis was to assess the effectiveness of orthopedic manual therapy in isolation on pain sensitization in patients with chronic musculoskeletal pain. DESIGN: A systematic search was performed in different databases including systematic reviews with or without meta-analysis. The outcome measures included were pressure pain threshold, temporal summation, and conditioned pain modulation. We statistically synthesized the results of the different reviews through a random-effect meta-analysis of all standardized mean differences and the corresponding 95% confidence interval reported by each study...

OBJECTIVE: To compare handrim wheelchair propulsion technique between individuals with spinal cord injury (SCI) with and without shoulder pain. DESIGN: A cross-sectional study including 38 experienced handrim wheelchair users with SCI. Participants were divided in a 'shoulder pain' (n = 15) and 'no-shoulder pain' (n = 23) group using the Local Musculoskeletal Discomfort scale. Kinetic and spatiotemporal aspects of handrim wheelchair propulsion during submaximal exercise on a motor-driven treadmill were analyzed...

Despite numerous first-line treatment interventions, adequately managing a patient's post-amputation pain (PAP) can be difficult. Peripheral nerve stimulation (PNS) has emerged as a safe neuromodulatory intervention that can be utilized for many etiologies of chronic pain. We performed a systemic review to appraise the evidence of PNS use for improvement in PAP. This was performed in Ovid, Cochrane databases, OVID, Scopus, Web of Science Core Collection, and PubMed. The primary outcome was improvement in PAP after use of PNS...

ChatGPT and other artificial intelligence (AI) word prediction large database models are now readily available to the public. Program directors should be aware of the general features of this technology and consider its effect in graduate medical education, including the preparation of materials such as personal statements. The authors provide a sample ChatGPT-generated personal statement and general considerations for program directors and other graduate medical education stakeholders. The authors advocate that programs and applicants will be best served by transparent expectations about how/if programs will accept application materials created using AI, starting with this application cycle...

The purposes of this study were to: 1) describe the level of functional independence of patients with Guillain-Barré Syndrome (GBS) before and after inpatient rehabilitation (IPR), 2) determine whether the level of functional independence increased in each functional domain during IPR, and 3) determine whether independence at the end of IPR differed significantly between domains. Data from patients with GBS discharged from IPR settings in 2019 were obtained from the Uniform Data System for Medical Rehabilitation® database...

OBJECTIVE: Although intra-articular corticosteroid (IACS) is injected locally, some systemic absorption occurs, potentially causing immunosuppression in recipients. This study examined odds of influenza in patients who received IACS compared to matched controls. DESIGN: Adults in our health system who received IACS from May 2012 through April 2018 were 1:1 matched to adults without IACS. The primary outcome was overall odds of influenza. Secondary analyses examined influenza odds by timing of IACS, joint size, and vaccination status...

OBJECTIVE: Spasticity in children with cerebral palsy (CP) can be managed by a spectrum of approaches, from conservative therapy to temporary botulinum toxin A (BoNT-A) injections, to permanent transection of sensory nerves with a selective dorsal rhizotomy (SDR). This pilot study investigated whether these three tone management approaches are associated with histological and biochemical properties of the medial gastrocnemius. DESIGN: A convenience sample of children with CP undergoing gastrocnemius lengthening surgery were enrolled...

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OBJECTIVE: Investigate 1) what physical and physiological parameters are most important for Frame Running (FR) capacity, a parasport for individuals with ambulatory difficulties, and 2) determine if FR capacity can be predicted in athletes with cerebral palsy (CP). DESIGN: Athletes with CP (n = 62, GMFCS I-V; 2/26/11/21/2) completed a 6-minute FR test (6-MFRT). Before the 6-MFRT, muscle thickness, passive range of motion (hip, knee, ankle), selective motor control, and spasticity (hip, knee, ankle) were measured in both legs...

Blinding in research is important and the field of PM&R poses special consideration due to the patient populations and treatment methodologies used. Historically, blinding has been increasingly relevant to conducting good quality research. The main reason to blind is to reduce bias. There are several strategies to blinding. At times, when blinding is not possible, alternatives to blinding include sham control and description of study and control groups. Illustrative examples of blinding used in PM&R research are described in this article along with how to assess success and fidelity of blinding...

OBJECTIVE: To determine and compare the treatment efficacy of subacromial steroid injections and dextrose prolotherapy (DPT) for chronic subacromial bursitis patients. DESIGN: 54 patients with chronic subacromial bursitis were enrolled in this double-blind randomized controlled trial. Shoulder pain and disability index (SPADI) and visual analog scale (VAS) were the primary outcomes. RESULTS: The steroid group (n = 26) exhibited significant VAS score improvements comparing to baseline at weeks 2, 6, and 12; the DPT group (n = 28) exhibited VAS score improvements at weeks 6, and 12...

Frailty, a geriatric syndrome of growing importance in recent years, has been shown to be associated with increased risk of disability, adverse health and socio-economic outcomes. Therefore, there is a need for new educational strategies for Physical Medicine and Rehabilitation (PMR) residents to promote greater geriatric competencies, with a focus on developing customized evaluation and management plans. With this paper, we aimed at offering a quick reference tool summarizing the latest evidence on the rehabilitative management of frailty...

Acute and long-term morbidity and mortality rates have not changed in the United States for people with high level spinal cord injury in 40 years, neither has the conventional invasive respiratory management for these patients. This is despite a 2006 challenge to institutions for a paradigm shift to avoid or decannulate patients of tracheostomy tubes. Centers in Portugal, Japan, Mexico, and South Korea decannulate high level patients to up to continuous noninvasive ventilatory support and use mechanical insufflation exsufflation, as we have done and reported since 1990, but there has been no such paradigm shift in U...

OBJECTIVE: Chronic Low Back Pain (CLBP) is the leading cause of disability worldwide, and several factors have been proposed as potential causes or co-factors. We aimed to explore their direct and indirect relations to understand CLBP and identify relevant rehabilitation targets. METHODS: 119 CLBP patients and 117 chronic-pain free individuals were assessed. A network analysis approach was employed to explore the complexity of CLBP by assessing the relations between pain intensity, disability, functionality (physical, social and psychological), age, body mass index, and education level...

A high-school-aged right-handed male presented with a 5-month history of persistent proximal right arm weakness and numbness after an American football stinger injury without a documented history of a shoulder dislocation or humeral fracture. He developed diffuse deltoid muscle atrophy, persistent shoulder abduction weakness, and reduced pinprick sensation confined to the axillary distribution over 5 months. Needle electromyography demonstrated dense fibrillation potentials and no voluntary activation in all three deltoid muscle heads, indicating a severe posttraumatic ruptured axillary mononeuropathy...

OBJECTIVE: To examine the effect of adding weight shift training to a weight loss program on the risk of falling, fear of falling, overall stability, anteroposterior stability, mediolateral stability, and isometric knee torque in young obese women. DESIGN: A single-blinded, randomized controlled study was performed. Sixty females, 18-46 years, were randomly assigned either to the study or the control groups. The participants in the study group were given weight-shifting training plus a weight reduction program; the control group received only a weight-reduction program...

OBJECTIVE: This study investigated the moderating role of baseline depressive symptoms on the association between baseline pain severity and time to recovery in individuals with acute grade I-II whiplash-associated disorders (WAD). DESIGN: This is a secondary analysis of a randomised controlled trial investigating the effectiveness of a government-regulated rehabilitation guideline for the management of grade I-II WAD. Participants who completed baseline questionnaires for neck pain intensity and depressive symptoms and follow-up questionnaire on self-reported recovery were included in the analysis...