PM&R最新文献

{"title":"Epidemiology of traumatic spinal cord injury and traumatic brain injury treated in emergency departments in the United States: 2006 to 2020.","authors":"Axler Jean Paul, Elsa Alvarez, Julian Marcet, McKenna Hamm, Kelly Gartner, Darryl Kaelin, Castillo Camillo, Beatrice Ugiliweneza","doi":"10.1002/pmrj.13440","DOIUrl":"https://doi.org/10.1002/pmrj.13440","url":null,"abstract":"<p><strong>Background: </strong>Traumatic spinal cord injury (TSCI) and traumatic brain injury (TBI) remain health challenges with devastating biopsychological and socioeconomic consequences. The occurrence of dual diagnosis is a significant but poorly reported issue in U.S. emergency departments (EDs).</p><p><strong>Objective: </strong>To evaluate the trend, demographic, and socioeconomic aspects of dual diagnosis compared to isolated TSCI and TBI.</p><p><strong>Design: </strong>Observational cross-sectional study.</p><p><strong>Setting: </strong>Nationwide Emergency Departments Sample, 2006-2020.</p><p><strong>Participants: </strong>Data were extracted on number of ED visits nationwide by patients over 18 years of age with TBI, TSCI, and dual diagnoses based on International Classification of Diseases, Ninth Revision, Clinical Modification and Tenth Revision, Clinical Modification codes. From 2006 to 2020, there were 23,826,719 TBI and TSCI related visits to EDs nationwide. Of these, 68,578 were dual diagnoses (TSCI+TBI), 23,579,060 were isolated TBIs, and 356,562 were isolated TSCIs.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Trend analysis of dual diagnoses, TBI (mild, moderate, severe), and TSCI (cervical, thoracic, lumbar/sacral/cauda equina). Demographics including gender, age, income quartile, comorbidities, and hospital characteristics were compared between TSCI+TBI, TBI alone, and TSCI alone.</p><p><strong>Results: </strong>There was an increase of 201 dual diagnosis ED visits per year from 2012 onwards and an increase of 465 TSCI ED visits per year from 2017. However, TBIs declined from 2014 onwards, following the Centers for Disease Control and Prevention's reclassification of unspecified TBI. Patients with dual diagnosis had a median age of 50 years and were predominantly male. Private insurance (TSCI+TBI: 39%; TBI: 32%; TSCI: 27%) was the most used by patients with dual diagnosis, although 29% (vs. TBI: 27%; TSCI: 32%) were in the lowest income quartiles. Most reported ED visits were in the southern United States, and most were at university hospitals. Importantly, patients treated at level 1 trauma hospitals were primarily dual diagnosis (48%).</p><p><strong>Conclusion: </strong>TSCI alone and dual diagnosis visits are rising nationally in EDs; these patients have higher morbidity rates and may require more specialized care. These patients are among the most vulnerable socioeconomically. The increase in ED visits among these populations underscores the need for adequate and sufficient outpatient care to support their ongoing treatment and recovery.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754100","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Neuromusculoskeletal ultrasound examination in Nicolau syndrome.","authors":"Beytullah Yazar, Abdullah Emre Uğur, Mustafa Güngör Albayrak, Levent Özçakar","doi":"10.1002/pmrj.13452","DOIUrl":"https://doi.org/10.1002/pmrj.13452","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-31","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144754101","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Ultrasound: A key tool in the diagnosis of common peroneal neuropathy.","authors":"Berkay Yalçınkaya, Ahmet Furkan Çolak, Alp Çetin","doi":"10.1002/pmrj.70002","DOIUrl":"https://doi.org/10.1002/pmrj.70002","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.8,"publicationDate":"2025-07-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144732938","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Response to letter to the editor Re: Advancements in large language model accuracy for answering physical medicine and rehabilitation board review questions.","authors":"Jason Bitterman, Alexander D'Angelo, Alexandra Holachek, James E Eubanks","doi":"10.1002/pmrj.13451","DOIUrl":"https://doi.org/10.1002/pmrj.13451","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708567","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Comparative efficacy and acceptability of different intensity levels of extracorporeal shock wave therapy in adults with plantar heel pain: A systematic review and network meta-analysis.","authors":"Peng Zhao, Yuwei He, Meng Li, Jialin Wang, Ruirui Wang, Xinwen Cui","doi":"10.1002/pmrj.13417","DOIUrl":"https://doi.org/10.1002/pmrj.13417","url":null,"abstract":"<p><strong>Objective: </strong>To estimate the comparative clinical efficacy and acceptability of different intensity levels of extracorporeal shock wave therapy (ESWT) in adults with plantar heel pain (PHP). TYPE: Systematic review and network meta-analysis.</p><p><strong>Literature survey: </strong>PubMed, EMBASE, Cochrane Library electronic databases and Web of Science for randomized controlled trials from inception to March 2024.</p><p><strong>Methodology: </strong>We included placebo-controlled and head-to-head trials of different intensity levels of ESWT used to treat adults with PHP. Data were extracted following a predefined hierarchy. We assessed the studies' risk of bias in according to the Cochrane risk of bias tool, and the certainty of the evidence using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. Primary outcomes were efficacy (success rate) and acceptability (all-course discontinuation rate). Secondary outcomes were pain and function scores changes. All interventions were ranked using the surface under the cumulative ranking curve to determine the hierarchy of treatment.</p><p><strong>Synthesis: </strong>22 RCTs comprising 2299 participants met the inclusion criteria. In terms of efficacy, all intensity levels of ESWT were more effective than placebo, with ORs ranging from 2.29 (95% CI 1.39-3.76) for medium intensity M-ESWT (M-ESWT) to 5.50 (95% CI 1.00-30.29) for low intensity ESWT (L-ESWT). In terms of acceptability, there was no statistically significant difference between all intensity levels of ESWT and placebo, with ORs ranging from 0.83 (0.47-1.45) for M-ESWT to 1.42 (0.19-10.71) for L-ESWT. For pain relief, only M-ESWT and H-ESWT were superior to placebo (SMD -0.60, 95% CI -0.94 to -0.26; SMD -0.28, 95% CI -0.44 to -0.11), whereas there was no difference between them (p = .05). For function improved, there was no statistically significant difference between all intensity levels of ESWT and placebo (range of ORs 1.02-3.44). In contrast, there were no significant differences among the intensity levels in all outcomes. Of the 22 trials, 7 (32%) were assessed as high risk, and the rest (68%) were assessed as unclear risk. The certainty of evidence was low to very low.</p><p><strong>Conclusion: </strong>Compared to the placebo, all intensity levels of ESWT were more favorable in terms of efficacy, but there was no difference in terms of acceptability. In addition, M-ESWT appeared to provide additional benefits in pain and function for patients with PHP compared to the other intensity levels. The results provide an evidence-based basis for considering ESWT as an alternative for patients with PHP for whom conservative treatment is not effective, and also highlight future research priorities to providing more decision-making for the clinical management of PHP.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708566","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Access to assistive technology in pediatric brain injury care: Narrative perspectives of clinicians, vendors, and parents.","authors":"Debjani Mukherjee, Kaiulani S Shulman, Joseph J Fins","doi":"10.1002/pmrj.13444","DOIUrl":"https://doi.org/10.1002/pmrj.13444","url":null,"abstract":"<p><strong>Background: </strong>The critical need for assistive technology (AT) for children with brain injury is recognized. Despite its importance, there is scant literature on how delays and denials in the provision of AT affect recovery and rehabilitation.</p><p><strong>Objective: </strong>To examine the complex ecosystem of AT usage and barriers to access, drawing upon the perspectives of clinicians, vendors, and parents in an exploratory qualitative study.</p><p><strong>Design: </strong>This is a companion study to a quantitative retrospective medical chart review using grounded theory methods. Two focus groups with clinical staff, one focus group with vendors, and six interviews with parents of children with brain injury were conducted. The narrative data were combined to maximize the triangulation of themes.</p><p><strong>Setting: </strong>Pediatric rehabilitation hospital.</p><p><strong>Participants: </strong>Multidisciplinary rehabilitation clinicians, vendors who provide AT, and parents of children with brain injury.</p><p><strong>Results: </strong>Primary themes included coordinating with insurance, vendors, and funding; fostering age-appropriate independence; family's familiarity with AT; understanding the dynamic nature of development and recovery; impact on family relationships; costs/financial considerations; accepting role of AT; discovering new AT; accepting child's reality; and advocating for AT access.</p><p><strong>Conclusion: </strong>The ethical implications of delays in access to AT, particularly in children with maturing and recovering brains, are far reaching and bring to the forefront concerns about the potential impact of disability stigma, social justice, and access to devices and information and the importance of maximizing self-determination and enabling independence and autonomy. Delays in access to AT preclude both a child's rights and capabilities, adversely affecting their recovery and maturation and limiting their integration into society under disability law.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-25","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144708565","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Identification of factors related to pain from musculoskeletal injections.","authors":"Caitlin D Faust, Masaru Teramoto, Sarah T Pietruszka, Joy English, Nicholas E Monson, Christopher A Gee, Emily J Harold, Mark Sederberg, Daniel M Cushman","doi":"10.1002/pmrj.13437","DOIUrl":"https://doi.org/10.1002/pmrj.13437","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal injections are a common clinical procedure, often intended to reduce joint or muscular pain in patients. Further identification is warranted to identify additional clinical variables that may lead to increased or decreased pain perception with musculoskeletal injections.</p><p><strong>Objective: </strong>To examine clinical, demographic, and injection-related factors with patient-perceived pain during musculoskeletal injections, which expands upon prior studies.</p><p><strong>Design: </strong>Cross-sectional study.</p><p><strong>Setting: </strong>Retrospective study involving outpatient orthopedic clinics. Consecutive adult patients (age ≥ 18 years) undergoing musculoskeletal injections were reviewed.</p><p><strong>Patients: </strong>A total of 1371 injections from 935 patients were eligible for the analysis. Exclusion criteria included cognitive disability, non-English-speaking patients, and aphasia.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Main outcome measures: </strong>Patients reported their pre-, intra-, and postprocedural pain on a numerical scale from 0 to 10. Pain scores, demographics, and injection specifics were analyzed after retrospective chart review for their effect on intraprocedural pain.</p><p><strong>Results: </strong>A total of 1371 injections (62.4% female, mean age 58.6 ± 16.1 years, body mass index 29.6 ± 7.3 kg/m²) were included for analysis. The median intraprocedure pain score was 2. According to the multivariate linear regression model, female gender (B = 0.42; 95% confidence interval [CI] = 0.15-0.69; p < .01), ultrasound image guidance (B = 0.66; 95% CI = 0.22-1.10; p < .01), presence of a trainee (B = 0.44; 95% CI = 0.15-0.73 p < .01), and body mass index (B = 0.04; 95% CI = 0.01-0.06; p < .01) were significantly associated with greater intraprocedure pain score, whereas use of sodium bicarbonate (B = -0.68; 95% CI = -1.01 to -0.35; p < .01), age (B = -0.01; 95% CI = -0.02 to -0.01; p = .04), and injectate volume (B = -0.06; 95% CI = -0.13 to -0.01; p = .04) had significant, inverse associations with intraprocedure pain score. The logistic regression model showed the significant association of presence of trainee (odds ratio = 1.86; 95% CI = 1.23-2.83; p < .01) to intraprocedure pain score of ≥1 (vs. 0).</p><p><strong>Conclusions: </strong>This study identified clinical and demographic variables associated with worsened injection pain that may improve the counseling and expectations of patients and ideally lead to reduction in experienced procedural pain. Lower pain scores were associated with use of sodium bicarbonate, absence of a trainee, palpation guidance, and male gender of the patient.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691327","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Impact of COVID-19 positive status on outcome for individuals with stroke treated in acute inpatient rehabilitation.","authors":"Amy Ziems, Christopher J McLouth, Nicholas Elwert, Elissa Charbonneau, Joseph Stillo, Susan McDowell","doi":"10.1002/pmrj.13435","DOIUrl":"https://doi.org/10.1002/pmrj.13435","url":null,"abstract":"<p><strong>Background: </strong>Stroke, whether or not accompanied by concurrent COVID-19 infection, has been associated with varying acute care outcomes, with patients who are COVID-19 positive typically faring worse. This study aims to explore the functional outcomes of patients with stroke -with and without simultaneous COVID-19 infection-who survived their acute care stay and progressed to acute inpatient rehabilitation (IRF).</p><p><strong>Objectives: </strong>To identify differences in sociodemographic factors, medical complexity, and rehabilitation outcomes from an IRF stay between patients with stroke with concurrent COVID-19 and those without.</p><p><strong>Design: </strong>A retrospective, observational cohort study using electronic medical records (EMR) data.</p><p><strong>Setting: </strong>EMR data from 138 IRFs across 34 states of the United States and Puerto Rico involving 40,282 individuals following stroke discharged between April 1, 2020 and May 31, 2021 of whom 1483 (3.7%) were COVID-19 positive.</p><p><strong>Participants: </strong>NA.</p><p><strong>Interventions: </strong>NA.</p><p><strong>Main outcome measures: </strong>Variables collected included sociodemographic and medical complexity along with outcome variable categories included functional complexity, process outcomes, and functional abilities.</p><p><strong>Results: </strong>Significant differences were found between the two groups using standardized effect sizes >0.2. COVID-19 positive patients with stroke had more comorbidities (94.1% vs. 51.8%, standardized effect = 1.1), lower admission mobility (26 vs. 30, standardized effect = 0.27), lower discharge mobility scores (56 vs. 65, standardized effect = 0.27), and a longer IRF stay (17 days vs. 14 days, standardized effect = 0.30). They also were less likely to return to the community (65.5% vs. 78.3%) but had a higher acute care transfer rate (19.1% vs. 10.6%). Logistic regression showed that Hispanic COVID-positive individuals and those with higher mobility scores were more likely to be discharged to the community.</p><p><strong>Conclusions: </strong>There are meaningful differences in rehabilitation outcomes between COVID-19 positive and negative individuals with stroke that clinicians can use to better understand, anticipate and mitigate outcome challenges facing the COVID-19 positive population with stroke.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144691328","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Use of musculoskeletal ultrasound to diagnose fascial dehiscence.","authors":"Emily Andrews, Danielle Carey, Alberto Giardini","doi":"10.1002/pmrj.13438","DOIUrl":"https://doi.org/10.1002/pmrj.13438","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609188","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Demystifying sinus tarsi syndrome using ultrasonography: A subtalar joint synovial cyst.","authors":"Vincenzo Ricci, Arianna Pesaresi, Levent Özçakar","doi":"10.1002/pmrj.13446","DOIUrl":"https://doi.org/10.1002/pmrj.13446","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-07-11","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144609185","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}