PM&R最新文献

{"title":"Lower-extremity asymmetry and patellofemoral pain in young female dancers: A 2-year follow-up.","authors":"Nili Steinberg, Yael Sitton, Michal Shenhar, Itzhak Siev-Ner","doi":"10.1002/pmrj.13393","DOIUrl":"https://doi.org/10.1002/pmrj.13393","url":null,"abstract":"<p><strong>Background: </strong>Patellofemoral pain (PFP) is a prevalent injury in young dancers, with low recovery rates. This study aimed to assess PFP in young female dancers over a 2-year period while examining associations between lower-limb asymmetry and PFP.</p><p><strong>Methods: </strong>Thirty-two female dancers (aged 13.6 ± 2.9 years) were clinically examined for PFP at the baseline, 12 months later (first follow-up), and 24 months later (second follow-up). Dancers were also assessed for anthropometric measurements, joint range of movement (ROM), and muscle strength.</p><p><strong>Results: </strong>PFP was identified in 46.9%, 53.1%, and 46.9% of the dancers at the three time points, respectively. When comparing the baseline to the second follow-up, 21.9% of the dancers had recovered, 21.9% had developed PFP, and 25.0% had remained with PFP. Only 31.3% had remained healthy throughout this period. Examining muscle-strength-asymmetry in the four groups of dancers, significant interactions (time × group) were found for ankle plantar-flexor, knee extensor, hip abductor, and hip extensor muscle strength (p < .001), indicating that dancers in the developed-PFP or remained-PFP groups had greater muscle-strength-asymmetry at baseline than the recovered or healthy groups. Significant differences in the prevalence of asymmetry between the four groups were found for joint ROM (ankle en-pointe, hip abduction, hip external rotation, and hip internal rotation) (p < .05); and significant differences in the prevalence of asymmetry between the three time points were found for joint ROM (ankle en-pointe, ankle dorsiflexion, hip extension, hip abduction, and hip external rotation) (p = .05).</p><p><strong>Discussion: </strong>A high prevalence of dancers had PFP, with a limited prevalence of recovery. Dancers who developed PFP or remained with PFP had greater muscle strength and joint ROM asymmetry than their healthy or recovered counterparts.</p><p><strong>Conclusion: </strong>Screening for and addressing asymmetries in strength measures may modify the risk for PFP in dancers.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-16","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144078801","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":"Exercise improves stair climbing performance after stroke: A systematic review of randomized trials with meta-analysis.","authors":"Lucas Rodrigues Nascimento, Amanda Marcele de Souza Oliveira, Grazyelle Maria Silva Pereira de Moraes, Augusto Boening, Kênia Kiefer Parreiras de Menezes, Estephane Mendes de Souza, Guilherme Silva Nunes, Stella Maris Michaelsen","doi":"10.1002/pmrj.13373","DOIUrl":"https://doi.org/10.1002/pmrj.13373","url":null,"abstract":"<p><strong>Background: </strong>Exercises have been used to improve outcomes after stroke.</p><p><strong>Objective: </strong>To examine the effects of planned, structured, and repetitive exercises of the paretic lower limb for improving stair climbing performance after stroke.</p><p><strong>Data sources: </strong>MEDLINE, EMBASE, Cochrane Library, Allied and Complementary Medicine Database, and Physiotherapy Evidence Database (PEDro).</p><p><strong>Review methods: </strong>Only randomized clinical trials were included. Participants in the reviewed studies were adults at any time after stroke. The experimental intervention consisted of exercises for the paretic lower limb in comparison with no intervention/placebo. Outcome data related to stair climbing performance were extracted from the eligible trials and combined in meta-analysis. The quality of included trials was assessed by the PEDro scores. The quality of evidence was determined according to the Grading of Recommendations Assessment, Development, and Evaluation system.</p><p><strong>Results: </strong>Nine trials, involving 314 participants, were included. The examined interventions were strength training, task-oriented training, or a combination of strength training with aerobic or task-oriented training. A random-effect meta-analysis provided very low-quality evidence that exercises improved stair climbing performance by standardized mean difference 0.4 (95% confidence interval [CI], 0-0.8). When only trials that reported the time to ascent/descent stairs were pooled, exercise improved stair climbing performance by 3.4 seconds (95% CI, 0.4-6.5). No trials examined the maintenance of benefits beyond the intervention period.</p><p><strong>Conclusion: </strong>This systematic review provided very-low-quality evidence that 6 weeks of planned, structured, and repetitive exercises, performed during 50 minutes, four times per week, improve stair climbing performance of moderately disabled individuals with chronic stroke.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143990887","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":"Effects of kilohertz versus low-frequency electrical stimulation of the wrist extensors in patients after stroke: A randomized crossover trial.","authors":"Sarah Tenberg, Jonas Weinig, Daniel Niederer, Lutz Vogt, Markus Leisse, Steffen Müller","doi":"10.1002/pmrj.13368","DOIUrl":"https://doi.org/10.1002/pmrj.13368","url":null,"abstract":"<p><strong>Background: </strong>Electrical stimulation is an effective treatment method for improving motor function after stroke, but the optimal current type for patients with stroke and arm paresis remains unclear.</p><p><strong>Objective: </strong>To compare the effects of kilohertz frequency with low-frequency current on stimulation efficiency, electrically induced force, discomfort, and muscle fatigue in patients with stroke.</p><p><strong>Design: </strong>A randomized crossover study.</p><p><strong>Setting: </strong>Neurological inpatient rehabilitation clinic in Germany.</p><p><strong>Participants: </strong>A total of 23 patients with arm paresis after stroke within the last 6 months were recruited, 21 were enrolled, and 20 completed the study (7 females; mean ± SD: 66 ± 12 years; 176 ± 11 cm; 90 ± 19 kg; 57 ± 34 days since stroke).</p><p><strong>Intervention: </strong>All patients underwent both kilohertz and low-frequency stimulation in a randomized order on 2 days (48-hour washout). Each day included a step protocol with a gradual increase in stimulation intensity, starting at the first measurable force (up to 12 steps, 1 mA increments, 8 seconds stimulation, 60 second rest) and a fatigue protocol (30 repetitions, 8 second stimulation, 3 second rest).</p><p><strong>Main outcome measure: </strong>Primary outcome was stimulation efficiency (electrically induced force/stimulation intensity) [N/mA], measured during each step of the stepwise increase in current intensity protocol.</p><p><strong>Results: </strong>Linear-mixed-effects models showed significantly higher stimulation efficiency for low-frequency stimulation (mean difference 0.14 [95% confidence interval, 0.01-0.27 N/mA], p = .031). However, current type did not significantly affect electrically induced force, level of discomfort, or muscle fatigue (p > .05).</p><p><strong>Conclusion: </strong>The findings suggest that low-frequency stimulation is more efficient than kilohertz-frequency stimulation. However, both current types yield similar effects on force, discomfort, and fatigue, making them both viable options for wrist extensor stimulation in patients after stroke. Considering the variability among individuals, customizing the current type based on electrically induced force and perceived discomfort may enhance therapeutic outcomes. Further research on the long-term treatment effects of both current types is warranted.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-13","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008882","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-guided injections for the retrotrochanteric region: A cadaveric investigation.","authors":"Kamal Mezian, Vincenzo Ricci, Ke-Vin Chang, Nimish Mittal, Jan Vacek, Ondřej Naňka, Levent Özçakar","doi":"10.1002/pmrj.13381","DOIUrl":"https://doi.org/10.1002/pmrj.13381","url":null,"abstract":"<p><strong>Background: </strong>Injections for the piriformis and triceps coxae tendons/bursae have not been described and validated.</p><p><strong>Objective: </strong>To investigate the deep retrotrochanteric anatomy and validate an ultrasound (US)-guided injection technique.</p><p><strong>Methods: </strong>Fifteen sides of the pelvic half/lower limb of formalin-fixed cadaveric specimens were dissected to investigate the deep retrotrochanteric region. An US-guided superficial/peritendinous green latex dye injection was performed on both sides of a single full body cadaver. Next, seven sides of another four full body cadavers were injected using a deep/intrabursal technique. The cadavers were dissected to observe the dye's location.</p><p><strong>Results: </strong>In the anatomical part of the study, we observed a consistent fusion of the piriformis tendon (PT) with the triceps coxae tendon (TCT) (15/15), and with the gluteus medius tendon in 93% (14/15). A bursa of piriformis was identified in 80% (12/15) of the cases, and a subtendinous bursa of obturator internus was found in 73% (11/15). A fat pad overlying the PT-TCT was present in 93% (14/15) of the cases. Regarding the US-guided injections, success rate for superficial/peritendinous injection was 0% (0/2), with the latex dye being identified in the fat pad covering the PT-TCT in both cases. For the deep/intrabursal injection, the success rate was 86% (6/7).</p><p><strong>Conclusions: </strong>The results indicated a satisfactory success rate for the deep/intrabursal injection of PT-TCT in retrotrochanteric pain syndrome. This technique holds promise for the treatment of bursa and tendon pathologies in relevant patients.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-12","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144020006","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":"Comparison of baseline PROMIS-10 scores of mental and physical health of patients with low back pain evaluated by physiatrists and orthopedic spine surgeons.","authors":"Rachel Rothman, Glolabo Sokunbi, G Ross Malik, Ellen Casey, Jonathan Kirschner, Carlo Milani, Harvinder Sandhu, Jennifer Cheng, Heidi Prather","doi":"10.1002/pmrj.13378","DOIUrl":"https://doi.org/10.1002/pmrj.13378","url":null,"abstract":"<p><strong>Background: </strong>Enabling spine patients to access appropriate spine providers based on their course of care can enhance care outcomes. Physiatrists are trained to provide care throughout the continuum of low-back pain (LBP) symptoms and structural conditions that do not require urgent/emergent spine structural intervention.</p><p><strong>Objective: </strong>To assess if patients triaged to a physiatrist for LBP based on where they are in their continuum of spine care will report better baseline physical and mental health than patients presenting to a spine surgeon.</p><p><strong>Design: </strong>Retrospective study comparing physical and mental health (Patient-Reported Outcomes Measurement Information System [PROMIS]-10) in patients with LBP who are triaged for initial evaluations with physiatrists or spine surgeons.</p><p><strong>Setting: </strong>Tertiary orthopedic hospital.</p><p><strong>Patients: </strong>Adult patients presenting with chief concerns of nonemergent/nonurgent LBP to physiatry or spine surgery from April 1, 2019 to July 1, 2021.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Main outcome measures: </strong>Initial-visit PROMIS-10 mental and physical health scores.</p><p><strong>Results: </strong>A total of 2646 new patients presented to physiatrists (n = 1911 [72.2%]) and spine surgeons (n = 735 [27.8%]). Patients evaluated by physiatrists had higher mental health (physiatry 50.1 ± 8.5, spine surgery 46.7 ± 9.0; p < .001) and physical health scores (physiatry 43.7 ± 7.5, spine surgery 39.8 ± 7.2; p < .001) than those presenting to spine surgeons. Furthermore, patients evaluated by physiatrists were more likely to have mental and physical health scores >55 and less likely to have scores <45 (p ≤ .001). Patients with LBP + lower extremity (LE) pain had significantly lower mental and physical health scores than those with LBP alone (mental health 48.5 ± 8.6 [LBP + LE-pain], 49.9 ± 8.9 [LBP-alone]; physical health 41.5 ± 7.3 [LBP + LE-pain], 44.0 ± 7.7 [LBP-alone]; p < .001).</p><p><strong>Conclusions: </strong>Patients directed to spine surgeons via triage had worse PROMIS-10 mental and physical health, suggesting this subgroup of patients may especially need additional resources to address these issues in the course of their care. Physiatrists provided nearly two-thirds of nonurgent LBP evaluations in this tertiary orthopedic center, serving an important role in the initial evaluation and treatment of nonurgent LBP. The impact on patient outcomes, patient satisfaction, and associated health care costs requires further investigation.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-07","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008974","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":"A goal-directed rehabilitation protocol for people with transfemoral amputation receiving osseointegration prostheses.","authors":"Kristin Reeves, Shuyang Han, Matthew Cao, David B Doherty, Lauren Haney, Felix K Mintah, Vinay P Vanodia","doi":"10.1002/pmrj.13385","DOIUrl":"https://doi.org/10.1002/pmrj.13385","url":null,"abstract":"<p><strong>Background: </strong>Osseointegration (OI) has become an increasingly popular option for people with amputations around the world. However, limited information is available regarding the rehabilitation protocols before and after OI surgery, particularly for the civilian population who face several constraints.</p><p><strong>Objective: </strong>To evaluate the effectiveness of a civilian-focused, goal-directed rehabilitation protocol for patients with transfemoral amputation receiving a screw-type OI prosthesis to optimize functional outcomes.</p><p><strong>Design: </strong>A retrospective cohort study of patients with transfemoral amputation who received OI surgery.</p><p><strong>Setting: </strong>A national rehabilitation innovation center.</p><p><strong>Patients: </strong>Ten patients treated by the same orthopedic surgeon using the Osseoanchored Prostheses for the Rehabilitation of Amputees (OPRA) system were included in this study.</p><p><strong>Methods: </strong>Prehabilitation and rehabilitation protocols for the civilian population were developed, which outlined week-by-week, progressive rehabilitation goals before and longitudinally after the OI surgery. After Stage 2 of the surgery, patient outcome was evaluated using outcome measures at 6 months and 1 year.</p><p><strong>Results: </strong>On average, the number of rehabilitation sessions received by the patients was 15.9 ± 4.5 at 6 months, which increased to 26.7 ± 10.2 at 1 year. There were significant improvements in the Amputee Mobility Predictor (37.9 ± 5.0 vs. 38.9 ± 4.8, p = .003), 6-Minute Walk Test (225.3 ± 118.5 vs. 264.0 ±143.3 m, p = .02), and 10 M fast walk (11.9 ± 3.5 vs. 9.3 ± 2.4 seconds, p = .03). The 10-M self-paced walk test reduced from 19.5 ± 9.9 seconds at 6 months to 12.1 ± 4.7 seconds at 1 year, although the difference was insignificant (p = .20). At the conclusion of the study, all patients were walking post OI surgery.</p><p><strong>Conclusions: </strong>Given the constraints faced by civilians with transfemoral amputation, we proposed a rehabilitation protocol for the population who received OI prostheses. Critical clinical milestones were presented to guide rehabilitation progression. Initial results showed improvements in certain outcome measures between 6 months and 12 months following Stage 2 surgery. However, long-term randomized control studies are needed to further validate its efficacy.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-05","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144016800","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":"Factors influencing active participation in cardiac rehabilitation among patients with cardiovascular disease: A nationwide cohort study.","authors":"Chul Kim, Jung Hwa Hong, Jang Woo Lee","doi":"10.1002/pmrj.13392","DOIUrl":"https://doi.org/10.1002/pmrj.13392","url":null,"abstract":"<p><strong>Background: </strong>Cardiac rehabilitation (CR) is a well-established program for improving exercise capacity, quality of life, and long-term outcomes in patients with cardiovascular disease (CVD). Despite its proven benefits, CR participation rates remain low in many countries. Identifying the barriers to CR participation is crucial for developing effective strategies to enhance patient engagement in these programs.</p><p><strong>Objective: </strong>To analyze the barriers to CR participation among patients with CVD. To analyze the barriers to cardiac rehabilitation (CR) participation among patients with cardiovascular disease (CVD).</p><p><strong>Design: </strong>A nationwide cohort study using data from the Korean National Health Insurance Database.</p><p><strong>Setting: </strong>South Korea.</p><p><strong>Patients: </strong>In 2019, patients who received coronary revascularization at hospitals operating CR program.</p><p><strong>Interventions: </strong>Comparison of the demographic, socioeconomic, and medical status between patients who actively participated in CR and those who did not.</p><p><strong>Main outcome measures: </strong>The analysis considered potential influencing factors such as gender, age, residence area, income level, disability status, medical comorbidities, accompanying disease, cigarette smoking, alcohol consumption, physical activity levels, and obesity.</p><p><strong>Results: </strong>The CR participation rate was low among women, older adults, rural residents, and low-income families. In addition, the participation rate was low when there was a disability or medical comorbidity, such as hypertension, diabetes, and musculoskeletal disorders. CR participation rate was also low in patients who experienced CVD recurrence within 10 years.</p><p><strong>Conclusion: </strong>CR participation is affected by medical comorbidities, in addition to gender, age, income level, and residence. In particular, participation rate is lower in patients with a high risk of CVD recurrence due to medical comorbidities.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144035497","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":"Developing an intensive aerobic exercise program after stroke: A pilot study.","authors":"Brian Schibler, Michael Spinner, Imama A Naqvi, Joel Stein, Scott Barbuto","doi":"10.1002/pmrj.13374","DOIUrl":"https://doi.org/10.1002/pmrj.13374","url":null,"abstract":"<p><strong>Background: </strong>Stroke is a major cause of disability. Exercise is associated with reduced stroke recurrence and improved function. Most interventions have focused on supervised training in clinical settings rather than unsupervised home exercise.</p><p><strong>Objective: </strong>To determine the feasibility of conducting a randomized trial comparing unsupervised, high-intensity home aerobic training to a waitlist control group in survivors of stroke.</p><p><strong>Design: </strong>Assessor blinded randomized controlled pilot study.</p><p><strong>Setting: </strong>Assessments in medical center, home training.</p><p><strong>Participants: </strong>Twenty-three participants who sustained a mild-moderate stroke (National Institutes of Health Stroke Scale score <15) at least 3 months prior were randomized to home aerobic training or waitlist control.</p><p><strong>Intervention: </strong>Aerobic training consisted of 8 weeks of stationary bicycle training, five times per week for 30 minutes with heart rate-guided intensity. Control group maintained their normal activities.</p><p><strong>Outcome measures: </strong>Adherence and retention were the primary focus of this evaluation. Secondary outcomes (aerobic capacity VO₂max, gait, balance, and functional tests) were included for initial efficacy.</p><p><strong>Results: </strong>Of the 23 participants, only 15 were retained in the study. Dropouts were predominantly in the waitlist control group (3/13 in aerobic group, 5/10 in control group). No serious adverse events occurred. Self-efficacy and adherence to training duration and frequency was high, but only 50% achieved exercise intensity goals. Training benefits were modest with a VO₂max increase of 1.7 mL/kg/min in the intervention group. The only statistical improvement in outcomes was with box and block testing, likely due to baseline intergroup differences.</p><p><strong>Conclusions: </strong>Before conducting a larger trial, challenges with home aerobic training in the stroke population must be addressed. Despite high exercise self-efficacy, there was high attrition, particularly in the waitlist control group. Future study design should implement an active control. Benefits were limited, likely due to low training intensity, and efforts should be made to improve quality of unsupervised training, such as providing motivational coaching and wearable exercise trackers.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144027753","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":"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.13386","DOIUrl":"https://doi.org/10.1002/pmrj.13386","url":null,"abstract":"<p><strong>Background: </strong>There have been significant advances in machine learning and artificial intelligence technology over the past few years, leading to the release of large language models (LLMs) such as ChatGPT. There are many potential applications for LLMs in health care, but it is critical to first determine how accurate LLMs are before putting them into practice. No studies have evaluated the accuracy and precision of LLMs in responding to questions related to the field of physical medicine and rehabilitation (PM&R).</p><p><strong>Objective: </strong>To determine the accuracy and precision of two OpenAI LLMs (GPT-3.5, released in November 2022, and GPT-4o, released in May 2024) in answering questions related to PM&R knowledge.</p><p><strong>Design: </strong>Cross-sectional study. Both LLMs were tested on the same 744 PM&R knowledge questions that covered all aspects of the field (general rehabilitation, stroke, traumatic brain injury, spinal cord injury, musculoskeletal medicine, pain medicine, electrodiagnostic medicine, pediatric rehabilitation, prosthetics and orthotics, rheumatology, and pharmacology). Each LLM was tested three times on the same question set to assess for precision.</p><p><strong>Setting: </strong>N/A.</p><p><strong>Patients: </strong>N/A.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Main outcome measure: </strong>Percentage of correctly answered questions.</p><p><strong>Results: </strong>For three runs of the 744-question set, GPT-3.5 answered 56.3%, 56.5%, and 56.9% of the questions correctly. For three runs of the same question set, GPT-4o answered 83.6%, 84%, and 84.1% of the questions correctly. GPT-4o outperformed GPT-3.5 in all subcategories of PM&R questions.</p><p><strong>Conclusions: </strong>LLM technology is rapidly advancing, with the more recent GPT-4o model performing much better on PM&R knowledge questions compared to GPT-3.5. There is potential for LLMs in augmenting clinical practice, medical training, and patient education. However, the technology has limitations and physicians should remain cautious in using it in practice at this time.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2025-05-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144008745","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":"Multicomponent telerehabilitation program for veterans with multimorbidity: A randomized controlled feasibility study.","authors":"Michelle R Rauzi, Lauren M Abbate, Laura Churchill, Alexander J Garbin, Jeri E Forster, Cory L Christiansen, Jennifer E Stevens-Lapsley","doi":"10.1002/pmrj.13299","DOIUrl":"10.1002/pmrj.13299","url":null,"abstract":"<p><strong>Background: </strong>Older veterans with multimorbidity experience physical and social vulnerabilities that complicate receipt of and adherence to physical rehabilitation services. Thus, traditional physical rehabilitation programs are insufficient to address this population's heterogenous clinical presentation.</p><p><strong>Objective: </strong>To evaluate the feasibility and acceptability of a MultiComponent TeleRehabilitation (MCTR) program for older veterans with multimorbidity.</p><p><strong>Design: </strong>Randomized controlled cross-over feasibility study.</p><p><strong>Setting: </strong>Telehealth from Veterans Affairs Medical Center to participants' homes.</p><p><strong>Participants: </strong>Fifty U.S. military veterans, age ≥60 years (mean ± SD; 69.2 ± 6.7) with ≥3 comorbidities (6.0 ± 1.9), and impaired physical function were randomized and allocated equally to two groups.</p><p><strong>Intervention: </strong>The MCTR program consisted of high-intensity rehabilitation, coaching, social support, and technologies. Physical therapists delivered 12 individual and 20 group telerehabilitation sessions/participant. Participants in the education group started the MCTR program after 12 weeks.</p><p><strong>Main outcome measures: </strong>The primary outcome was combined adherence (>75% of participants attending ≥80% sessions). Acceptability was measured by the Acceptability of Intervention Measure. Secondary outcomes included safety, participant surveys, and physical function. Patient-level outcomes were collected at baseline, 12 (primary time point), and 24 weeks.</p><p><strong>Results: </strong>Of 50 participants, 39 adhered to total session attendance (0.78 [95% confidence interval: 0.64-0.88], p = .76), 45 adhered to individual sessions (0.90 [95% confidence interval: 0.78-0.97], p = .01), and 48 rated the program as acceptable (0.96 [95% confidence interval: 0.85-0.99], p < .001). Thirty-five participants reported 78 safety events, and 12 (15%) had some degree of relatedness to the protocol. Most patient-level outcomes were similar between groups at 12-weeks.</p><p><strong>Conclusions: </strong>The MCTR program was feasible based on high adherence to individual sessions and high acceptability. Adherence results were consistent with previous exercise studies in older adults. Most in-session safety events were related to underlying medical conditions and consistent with in-person physical rehabilitation safety events. These results can inform use of telerehabilitation for similar populations.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"548-562"},"PeriodicalIF":2.2,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12065667/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142953847","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}