PM&R最新文献

{"title":"Regulatory complaint patterns in physical medicine and rehabilitation: A population-based cohort study.","authors":"Nigel Ashworth, Nicole Kain, Homeira Hamayeli-Mehrabani, Kushagr Kumar, Nancy Hernandez-Ceron, Iryna Hurava","doi":"10.1002/pmrj.70228","DOIUrl":"https://doi.org/10.1002/pmrj.70228","url":null,"abstract":"<p><strong>Background: </strong>Regulatory complaints provide insight into physician performance and professionalism. Although complaint patterns have been described for the collective physician workforce, little is known about complaint risk among physical medicine and rehabilitation (PM&R) specialists (physiatrists).</p><p><strong>Objective: </strong>To examine the rate, type, and predictors of complaints among Alberta physiatrists and to compare complaint patterns across specialties.</p><p><strong>Design: </strong>Population-based cohort study using linked administrative data on physician demographics, practice characteristics, prescribing, and complaints.</p><p><strong>Setting: </strong>Province of Alberta, Canada; data from a provincial medical regulatory authority.</p><p><strong>Participants: </strong>All 11,315 physicians licensed in the province in 2025, including 114 physiatrists.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Main outcome measures: </strong>Presence of any nondismissed complaint (NDC), NDC rate per registration year, and distribution of complaint types.</p><p><strong>Results: </strong>Physiatrists had lower complaint rates than other physicians (10% vs. 21%). The mean NDC rate per registration year was 0.009 for physiatrists, less than half the rate observed among other physicians (0.021). Complaint rates were highest among surgical specialties and family medicine. The nature of complaints against physiatrists differed substantially from other specialties: practice management (48%) and medical reporting (19%) accounted for most complaints, whereas quality-of-care concerns predominated in other specialties. Increasing years since registration (odds ratio [OR] = 2.48, 95% confidence interval [CI] = 1.33-5.28) and international medical training (OR = 4.87, 95% CI = 1.15-20.99) were associated with higher odds of NDCs, although estimates were limited by small sample size.</p><p><strong>Conclusions: </strong>Although complaint rates were lower among physiatrists in this cohort, their complaints demonstrated a distinct pattern characterized by communication, documentation, and medicolegal interactions rather than clinical error. These findings highlight specialty-specific differences in regulatory complaints and suggest areas for targeted professional development in rehabilitation practice.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149137998","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":"Methodological quality of systematic reviews on treatments in stroke rehabilitation: A cross-sectional study.","authors":"Yin Ting Chan, Sheung Yuen Siu, Chung Hei Mak, Fai Fai Ho, Betty Huan Wang, Claire Chenwen Zhong, Daisy Dexing Zhang, Vincent Chi Ho Chung","doi":"10.1002/pmrj.70202","DOIUrl":"https://doi.org/10.1002/pmrj.70202","url":null,"abstract":"<p><strong>Objective: </strong>Although high-quality systematic reviews (SRs) could provide reliable evidence on the effectiveness of stroke rehabilitation treatments, methodological flaws may weaken their trustworthiness. This study aimed to evaluate the methodological quality of an up-to-date sample of SRs on stroke rehabilitation treatments.</p><p><strong>Literature survey: </strong>A comprehensive search was conducted in four electronic databases (MEDLINE, EMBASE, PsycINFO, and Cochrane Database of Systematic Reviews) for SRs published between January 2021 and September 2023. Eligible SRs focused on randomized controlled trials and included at least one meta-analysis assessing the effectiveness of stroke rehabilitation treatments.</p><p><strong>Methodology: </strong>After systematic screening, bibliographical data were extracted from included SRs using a predesigned form. The methodological quality was assessed using the 16-item A MeaSurement Tool to Assess systematic Reviews 2 (AMSTAR 2) instrument. Associations between characteristics and methodological quality were examined using Kruskal-Wallis rank test, Spearman's rank correlation coefficient, and multivariable logistic regression models. Meta-analysis was not performed.</p><p><strong>Synthesis: </strong>A total of 140 SRs were appraised. Only two (1.4%) SRs were rated as having high overall methodological quality. The remaining SRs were rated as moderate (n = 2, 1.4%), low (n = 6, 4.3%), or critically low quality (n = 130, 92.9%). Cochrane SRs, SRs led by a corresponding author from the United States or Europe, SRs supported by European funding or those without funding support, SRs reporting intervention harms, and SRs published in journals with higher journal impact factors had a higher overall methodological quality than their counterparts. Only 4.3% of SRs conducted a comprehensive literature search, 12.9% provided a list of excluded studies with justifications, 7.1% explained study design selection for inclusion, 10.7% described the included primary studies in adequate detail, and 7.9% reported funding sources of primary studies.</p><p><strong>Conclusions: </strong>The methodological quality of SRs on stroke rehabilitation treatment is unsatisfactory. Findings of this study can shed light on potential areas of methodological improvements for future review authors.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114145","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":"Dextrose prolotherapy for chronic symptomatic rotator cuff tendinopathy and subacromial bursitis: A systematic review and meta-analysis.","authors":"Nicholas Zerzan, David Ewart, Catherine Sowerby, Steffi Yang, Caleb Kalinowski, Kristen Ullman, Adrienne Landsteiner, Wei Duan-Porter, Timothy J Wilt","doi":"10.1002/pmrj.70219","DOIUrl":"https://doi.org/10.1002/pmrj.70219","url":null,"abstract":"&lt;p&gt;&lt;strong&gt;Objective: &lt;/strong&gt;Dextrose prolotherapy is used for musculoskeletal injuries, but evidence of its effectiveness is limited. We assess the evidence base on effects of dextrose prolotherapy for chronic symptomatic rotator cuff disorders and/or bursitis.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Literature survey: &lt;/strong&gt;Ovid/Medline, Ovid/Embase, and Scopus from inception to March 2026. Content experts provided additional citations.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Methodology: &lt;/strong&gt;We included randomized controlled trials (RCTs) or observational studies evaluating dextrose prolotherapy for shoulder pain. Outcomes of interest included pain-related functioning, physical performance, pain severity, quality of life, adverse events, costs, and treatment burden. Study risk of bias (RoB) used Cochrane RoB-2 or RoB In Non-Randomized Studies of Interventions (ROBINS-I). Certainty of evidence (COE) used Grading of Recommendations Assessment, Development, and Evaluation. Meta-analyses were conducted if more than three studies evaluated similar interventions, comparators, and outcomes.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Synthesis: &lt;/strong&gt;We identified 14 studies (10 high RoB), including 13 RCTs and 1 observational study. These included participants with mixed rotator cuff tendinopathy and/or subacromial bursitis (k = 9) or only supraspinatus tendinopathy (k = 5). Studies enrolled individuals with pain/dysfunction &gt;3 months. Dextrose concentrations varied (12.5%-25%); eight studies used a single injection. Studies were short- to medium-term (k = 10 &lt; 6 months) and mostly small (n = 12-129). Comparators included normal saline (k = 5), corticosteroid injections (k = 4), physical therapy (PT) (k = 4), platelet-rich plasma (PRP) (k = 2) and atelocollagen (k = 1). For mixed bursitis and rotator cuff tendinopathy, the evidence is very uncertain regarding the effect of dextrose prolotherapy compared with normal saline on short- and medium-term pain-related functioning (standardized mean difference [SMD]&lt;sub&gt;medium-term&lt;/sub&gt;: -0.3 [-1.0; 0.4] (k = 3; n = 149); very low COE) and may have little to no benefit at long-term follow-up (low COE). Compared with corticosteroid injections, the evidence is very uncertain regarding the effect of dextrose prolotherapy on short- and medium-term pain-related functioning (SMD&lt;sub&gt;medium-term&lt;/sub&gt;: 0.6 [-2.2; 3.4] (k = 3; n = 147); moderate COE) and little to no difference in long-term pain-related functioning (low COE). Evidence comparing dextrose prolotherapy with PT or autologous blood products, as well as for other efficacy outcomes and adverse events, was sparse (mostly very low COE). Each study evaluating prolotherapy for supraspinatus tendinopathy used a different comparator (saline, corticosteroid, PT, PRP, or atelocollagen), limiting synthesis of their findings. Cost, health-related quality of life, and treatment burden were not reported.&lt;/p&gt;&lt;p&gt;&lt;strong&gt;Conclusions: &lt;/strong&gt;For chronic symptomatic mixed rotator cuff tendinopathy and/or subacromial bursitis, dextrose pr","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114212","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 exercise-induced hypoalgesia on pressure pain threshold in patients with chronic musculoskeletal pain: A systematic review and meta-analysis.","authors":"Joaquín Salazar-Méndez, Fabiola Benavides-Méndez, Rodrigo Núñez-Cortés, Felipe Araya-Quintanilla, Nelson Viscay-Sanhueza, Sergio Sazo-Rodríguez, Felipe Díaz-Ramírez, Javier Meza-Carvajal, Síbila Floriano Landim, Jorge Fuentes","doi":"10.1002/pmrj.70120","DOIUrl":"10.1002/pmrj.70120","url":null,"abstract":"<p><strong>Objective: </strong>To determine the effects of exercise programs on exercise-induced hypoalgesia in people with chronic musculoskeletal pain.</p><p><strong>Literature survey: </strong>This systematic review and meta-analysis included a search of MEDLINE, Web of Science, CINAHL, SCOPUS, and EMBASE databases from inception until May 18, 2025. Randomized controlled trials that examined aerobic or anaerobic exercise interventions in patients with chronic musculoskeletal pain and that assessed pressure pain thresholds were considered.</p><p><strong>Methodology: </strong>The Hartung-Knapp-Sidik-Jonkman random-effects method or Mantel-Haenszel fixed-effects method, depending on the heterogeneity, was applied to estimate the effects of exercise-induced hypoalgesia. The risk of bias was assessed with the risk of bias 2 tool and the certainty of the evidence was evaluated with Grading of Recommendations Assessment, Development, and Evaluation.</p><p><strong>Synthesis: </strong>Nineteen articles were included. The meta-analysis found a small statistically significant difference in favor of other physical therapy treatments compared with isolated exercise for pressure pain thresholds in both individuals with chronic neck-shoulder pain and those with chronic low back pain pain, with low and very low certainty of the evidence, respectively. For the overall risk of bias, 2 studies had a low risk, 6 had some concerns, and 11 had a high risk.</p><p><strong>Conclusions: </strong>Isolated exercise in people with chronic neck and shoulder pain and those with chronic low back pain is not superior to other therapeutic modalities for improving pressure pain thresholds. Other physical therapy modalities generate higher pressure pain thresholds than isolated exercise with small effect size. These findings should be interpreted with caution due to the limited certainty of the evidence.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1225-1239"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147594112","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":"Upper extremity injuries in high school soccer goalkeepers.","authors":"Christian Nicolosi, Jeffrey Kepple, Mani Singh, Jeri E Forster, Christin Miller, Ashley Pietra, Adele Meron","doi":"10.1002/pmrj.70227","DOIUrl":"https://doi.org/10.1002/pmrj.70227","url":null,"abstract":"<p><strong>Background: </strong>Soccer participation continues to grow globally and in the United States, accompanied by an inherent risk of injury. Although most soccer injuries involve the lower extremities, goalkeepers experience disproportionately higher rates of upper extremity (UE) injuries due to position-specific demands. Although this pattern is well described at collegiate and professional levels, data among high school athletes remain limited.</p><p><strong>Objective: </strong>To compare prevalence, characteristics, and outcomes of UE injuries between high school soccer goalkeepers and field players, as well as assess gender-based differences among goalkeeper injuries.</p><p><strong>Methods: </strong>Data were obtained from the National High School Reporting Information Online surveillance system from 2008 to 2018. UE injuries were defined as injuries to the shoulder, upper arm, or elbow resulting in ≥1 day of time loss. Injuries distal to the elbow were excluded. Injury prevalence, event setting, anatomical site, mechanism, recovery time, and return-to-play status were compared between injuries to goalkeepers and injuries to field players, and between injuries to male and female goalkeepers. Chi-square testing was used with statistical significance set at α = .05.</p><p><strong>Results: </strong>Among 10,355 total soccer injuries, 266 involved the UE. Goalkeepers sustained a higher proportion of UE injuries than field players (8.0% vs. 1.9%, p <.001), representing a 4.1-fold increased burden of injury. No significant gender-based differences in UE injury prevalence were observed among goalkeeper injuries. Most goalkeeper UE injuries occurred during competition (58%) and involved the shoulder/upper arm (84%), with trauma accounting for 94% of cases. Often this was due to diving or falling on an outstretched arm. Goalkeepers more frequently required >22 days for recovery yet were more likely to return to sport than field players (93.6% vs. 79.9%, p = .006).</p><p><strong>Conclusions: </strong>Among high school soccer players, UE injuries occur more frequently in goalkeepers than in field players, mirroring trends in collegiate and professional levels. These findings highlight the need for goalkeeper-specific UE injury prevention strategies, particularly at the high school level.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"149114121","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":"Core stability in women with and without chronic pelvic pain.","authors":"Hannah V Chatwin, Abhilasha Kumar, Michael Wesolowski, Laura Glaser, Colleen M Fitzgerald, Stacey Bennis","doi":"10.1002/pmrj.70103","DOIUrl":"10.1002/pmrj.70103","url":null,"abstract":"<p><strong>Background: </strong>Physical activity (PA) and core stability levels are unknown for women with musculoskeletal chronic pelvic pain (CPP) compared to healthy women. At this time, there is no validated treatment method aimed specifically at CPP.</p><p><strong>Objective: </strong>To elucidate the PA habits and core stability of women with and without CPP. We hypothesized that aerobic and resistance PA (aPA, rPA) and core stability would differ significantly.</p><p><strong>Design: </strong>Prospective, cross-sectional study. Wilcoxon rank sum tests, simple and multiple linear regressions, and Pearson chi-square test were used for analysis.</p><p><strong>Setting: </strong>Primary and specialty care outpatient physical medicine and rehabilitation, female pelvic medicine and reconstructive surgery, and gynecology clinics associated with a large tertiary center.</p><p><strong>Patients: </strong>We recruited 91 women aged 18-70 years with and without CPP (defined by American College of Obstetricians and Gynecologists).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measures: </strong>Physical activity, core stability scores.</p><p><strong>Results: </strong>Women with CPP demonstrated lower overall core stability (p = .04). Having CPP predicted a 2-point decrease in overall core score (p < .01). Women with CPP demonstrated significantly worse scores for the supine bridge (p < .01) and prone bridge (p = .03). There were no significant differences in aPA or rPA between women with and without CPP. Pelvic floor muscle strength did not have a significant effect on core scores in women with CPP before or after adjusting for age, parity, and body mass index.</p><p><strong>Conclusions: </strong>This study reports a novel finding that women with CPP had significantly reduced core scores (suggestive of weaker core stability) but similar levels of physical activity (aPA and rPA) compared to women without CPP. Future directions will include larger, multicenter, randomized controlled trials to investigate the association between pelvic floor muscles and core stability as well as therapeutic interventions to include specific exercises targeted at improving overall core stability in women with CPP.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1184-1193"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686104/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147444825","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}

{"title":"Botulinum toxin use in patients with neurological disorders: A U.S.-based claims database analysis.","authors":"David M Simpson, Jonathan Bouchard, Simon Page, Seth Goldfarb, Atul T Patel","doi":"10.1002/pmrj.70105","DOIUrl":"10.1002/pmrj.70105","url":null,"abstract":"<p><strong>Background and objective: </strong>Real-world evidence describing long-term persistency with botulinum toxin (BoNT) therapy is limited. We assessed treatment patterns and persistency with BoNT in clinical practice over 2 years.</p><p><strong>Design: </strong>Retrospective, longitudinal, claims database analysis.</p><p><strong>Setting: </strong>Medical claims data from the Merative MarketScan database in the United States.</p><p><strong>Participants and intervention: </strong>Patients with an index medical claim for any BoNT therapy between October 1, 2016 and October 31, 2019, and at least 2 follow-up years.</p><p><strong>Main outcomes measures: </strong>Number of treatments, time between treatments, and persistency (based on a 120-day look-forward from treatment date) were evaluated over the 2-year follow-up period. Using the 120-day look-forward from treatment date, 31.1% of all patients (n = 19,711) received only one BoNT injection cycle in the 2-year follow-up, indicating a notable drop in the proportion of patients who persisted with BoNT treatment. This prompted further analysis of cohorts by indication: patients with adult spasticity (n = 1912), pediatric spasticity (n = 638), stroke (n = 611), cervical dystonia (n = 688), migraine (n = 7778), or bladder dysfunction (n = 1791) diagnoses. [Correction added on 02 April 2026, after first online publication: In the previous sentence, \"decrease\" has been changed to \"drop\" in this version.] RESULTS: A large proportion of patients treated with BoNT stopped after 1-2 cycles. Across cohorts, the mean (SD) number of treatments administered was 2.1-4.7 (1.0-3.0). The time between treatments (80th percentile reported) ranged from 105 days to 319 days depending on the cohort.</p><p><strong>Conclusions: </strong>Increased understanding of BoNT treatment persistency in clinical practice is essential to help to optimize patient care. This study opens the discussion and field for future studies about why many patients discontinue BoNT therapy after only one or two treatment cycles. Further research will help to determine the underlying reasons for cessation of treatment.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1164-1175"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686105/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147435133","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}

{"title":"Ultrasound evaluation of joint and bursal fluid changes after a 5-km run in healthy adults.","authors":"Jakub Jačisko, Andrew Busch, Natálie Procházková, Levent Özçakar","doi":"10.1002/pmrj.70190","DOIUrl":"10.1002/pmrj.70190","url":null,"abstract":"<p><strong>Background: </strong>Musculoskeletal ultrasound is widely used to assess joint and bursal effusions, yet the impact of moderate-distance running on fluid accumulation in asymptomatic individuals remains unclear. Previous studies have shown mixed results depending on exercise type and timing, highlighting a gap in understanding transient physiological responses to common physical activity such as running.</p><p><strong>Objective: </strong>To determine whether a 5-km run induces detectable changes in fluid presence within selected joints and bursae in healthy adults, as assessed with musculoskeletal ultrasound.</p><p><strong>Design: </strong>Prospective observational trial.</p><p><strong>Setting: </strong>Institutional setting at a university hospital.</p><p><strong>Participants: </strong>Thirty healthy adults (17 female, 13 male; ages 20-47 years) without musculoskeletal symptoms or recent injuries were recruited. All participants completed the study.</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure(s): </strong>Binary (yes/no) presence of fluid in the tendon sheath of the long head of the biceps brachii, deep infrapatellar bursa, retrocalcaneal bursa, and talocrural joint were assessed bilaterally with ultrasound at baseline, immediately post run, and 24 hours post run.</p><p><strong>Results: </strong>Significant increases in fluid were observed 24 hours post-run in the retrocalcaneal bursa (left: p < .001, g = 0.46; right: p < .001, g = 0.40) and talocrural joint (left: p = .001, g = 0.36; right: p = .002, g = 0.33). Long head of the biceps brachii showed transient changes (left: p = .002 next day). No significant changes were found in the deep infrapatellar bursa (all p > .05).</p><p><strong>Conclusions: </strong>A short 5-km run can produce delayed increases in fluid at the ankle region, with the largest changes observed at 24 hours. Clinicians should account for recent physical activity when performing and interpreting ultrasound findings, as exercise may increase the prevalence of detectable fluid at certain sites. However, as the final assessment was performed at 24 hours, the full time course of these changes remains to be determined.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1211-1216"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"148593188","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":"Improvements in interoceptive sensibility, pain and functional clinical outcome measures after participation in an interdisciplinary pain management program.","authors":"Stephanie Voss, Shannon La Penna, Alison Yum, Neha P Gothe, Christine M Gagnon","doi":"10.1002/pmrj.70110","DOIUrl":"10.1002/pmrj.70110","url":null,"abstract":"<p><strong>Background: </strong>Altered interoception, the sense of signals from inside the body, is linked to chronic pain. No studies to date have examined whether interoceptive sensibility, one's self-reported beliefs about the body and tendencies to be internally focused, changes following participation in an interdisciplinary pain management program (IPMP).</p><p><strong>Objective: </strong>The primary aim was to determine whether interoceptive sensibility changes following IPMP participation. The second aim was to explore whether change in interoceptive sensibility could explain improvement in functional outcomes.</p><p><strong>Methods: </strong>An observational cohort study was conducted at an outpatient pain management center housed within an urban academic rehabilitation center. A heterogeneous sample of  53 (mean age = 50.3, 81.1% female) patients with high-impact chronic pain completed study measures in addition to receiving interdisciplinary care with physical therapy, occupational therapy, and psychology. Measures included the Multidimensional Assessment of Interoceptive Awareness (MAIA-2), Patient-Reported Outcomes Measurement Information System Pain Intensity and Interference short forms, Canadian Occupational Performance Measure (COPM), and the Patient Specific Functional Scale. Paired t-tests examined change in outcomes from program start to program completion. Hierarchical linear regressions tested the unique contribution of change in interoceptive sensibility on functional outcomes.</p><p><strong>Results: </strong>There was a significant increase in interoceptive sensibility and improvement on all pain and functional outcomes (p's < .001, absolute d's = 0.70-1.55). Six of the eight MAIA-2 subscales increased significantly (p's < .001, d's = 0.42-0.83), with the greatest increase in the Self-Regulation and Not Worrying subscales. An increase in overall interoceptive sensibility contributed an additional 6.3% (β = 0.267, p < .05) and 15.8% (β = 0.424, p ≤ .001) to the variance in improved COPM-Performance and COPM-Satisfaction scores after program completion, respectively.</p><p><strong>Discussion: </strong>This study provides emerging evidence that interoceptive sensibility improves following IPMP participation and is associated with improved functional engagement in high-impact chronic pain.</p><p><strong>Conclusion: </strong>IPMPs may be uniquely suited to improving interoceptive self-regulation, which could be an important treatment target in chronic pain. More research is needed to examine the role of interoceptive sensibility in different pain conditions as well as the impact of cultural, demographic, and psychosocial differences on interoceptive sensibility in chronic pain.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1122-1132"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686118/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147469077","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}

{"title":"Fear of falling is associated with physical functioning, activity performance, and participation in individuals with multiple sclerosis.","authors":"Libak Abou, Jeeyeon Kim, Chloe McCloskey, Cory Wernimont, Anna L Kratz","doi":"10.1002/pmrj.70131","DOIUrl":"10.1002/pmrj.70131","url":null,"abstract":"<p><strong>Background: </strong>Fear of falling (FoF) is a common concern in individuals with multiple sclerosis (MS). Understanding whether and how FoF affects activities and participation is crucial for developing effective rehabilitation programs in individuals with MS.</p><p><strong>Objective: </strong>To examine the relationship between measures of FoF (degree of FoF and avoidance behavior due to FoF) and measures of activities and participation in ambulatory individuals with MS. We also aim to investigate whether avoidance behavior due to FoF is relevant beyond the effect of degree of FoF.</p><p><strong>Design: </strong>Cross-sectional survey-based design.</p><p><strong>Setting: </strong>Community.</p><p><strong>Participants: </strong>A convenience sample of 531 community-dwelling ambulatory individuals with MS.</p><p><strong>Interventions: </strong>N/A.</p><p><strong>Main outcome measures: </strong>Activities measures included Patient-Reported Outcomes Measurement Information System (PROMIS) physical functioning and self-efficacy to manage activities of daily living (ADLs). Measures of participation included PROMIS ability to participate in social roles and activities (SRAs) and Community Participation Indicators-Control subscale.</p><p><strong>Results: </strong>After controlling for age, gender, duration of MS, disability level, history of previous falls, and MS subtype, hierarchical linear regression analyses indicated participants with moderate and high FoF showed lower physical functioning and ability to participate in SRAs (B = -4.75 to -10.81, p < .01) compared to those with low FoF. Participants with high FoF also had reduced self-efficacy in managing ADLs (B = -6.29, p < .01) and less control over community participation (B = 6.77, p < .05) compared to those with low FoF. Avoidance behavior due to FoF was associated with lower self-efficacy to manage ADLs (Β = -1.59, p < .01), ability to participate in SRAs (Β = -2.62, p < .01), and control over community participation (Β = 3.34, p < .01).</p><p><strong>Conclusions: </strong>FoF is a significant predictor of activities performance and participation in individuals with MS. Our findings highlight the importance of assessing avoidance behavior due to FoF to inform rehabilitation approaches aimed at improving the participation and community integration of individuals with MS.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1194-1203"},"PeriodicalIF":2.0,"publicationDate":"2026-10-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC13686106/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"147691843","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}