PM&R最新文献

{"title":"Pain, disability, and quality of life in participants after concurrent onabotulinumtoxinA treatment of upper and lower limb spasticity: Observational results from the ASPIRE study.","authors":"Ganesh Bavikatte, Gerard E Francisco, Wolfgang H Jost, Alessio Baricich, Esther Duarte, Simon F T Tang, Marc Schwartz, Mariana Nelson, Tiziana Musacchio, Alberto Esquenazi","doi":"10.1002/pmrj.13195","DOIUrl":"10.1002/pmrj.13195","url":null,"abstract":"<p><strong>Introduction: </strong>Upper and lower limb spasticity is commonly associated with central nervous system disorders including stroke, traumatic brain injury, multiple sclerosis, cerebral palsy, and spinal cord injury, but little is known about the concurrent treatment of upper and lower limb spasticity with botulinum toxins.</p><p><strong>Objective: </strong>To evaluate onabotulinumtoxinA (onabotA) utilization and to determine if concurrent onabotA treatment of the upper and lower limbs has supported improvements in participants with spasticity.</p><p><strong>Design: </strong>Sub-analysis of a 2-year, international, prospective, observational registry (ASPIRE, NCT01930786).</p><p><strong>Setting: </strong>International clinic sites (54).</p><p><strong>Participants: </strong>Adult spasticity participants across etiologies, who received ≥1 concurrent onabotA treatment of the upper and lower limbs during the study.</p><p><strong>Intervention: </strong>Participants were treated with onabotA at the clinician's discretion.</p><p><strong>Outcomes: </strong>Baseline characteristics and outcomes of disability (Disability Assessment Scale [DAS]), pain (Numeric Pain Rating Scale [NPRS]), participant satisfaction, physician satisfaction, and quality of life (QoL; Spasticity Impact Assessment [SIA]) were evaluated. Adverse events were monitored throughout the study.</p><p><strong>Results: </strong>Of 744 participants enrolled, 730 received ≥1 dose of onabotA; 275 participants received treatment with onabotA in both upper and lower limbs during ≥1 session; 39.3% of participants were naïve to onabotA for spasticity. The mean (SD) total dose per treatment session ranged from 421.2 (195.3) to 499.6 (188.6) U. The most common baseline upper limb presentation was clenched fist (n = 194, 70.5%); lower limb was equinovarus foot (n = 219, 66.9%). High physician and participant satisfaction and improvements in pain, disability and QoL were reported after most treatments. Nine participants (3.3%) reported nine treatment-related adverse events; two participants (0.7%) reported three serious treatment-related severe adverse events. No new safety signals were identified.</p><p><strong>Conclusion: </strong>More than a third of enrolled participants received at least one concurrent onabotA treatment of the upper and lower limbs, with reduced pain, disability, and improved QoL after treatment, consistent with the established safety profile of onabotA for the treatment of spasticity.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":"1175-1189"},"PeriodicalIF":2.2,"publicationDate":"2024-11-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141176229","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":"Reply to: Anomalous education: You can't bypass electrodiagnostic training in PM&R residency.","authors":"David W Pruitt, Joseph E Burris, Greg M Worsowicz, Carolyn L Kinney","doi":"10.1002/pmrj.13280","DOIUrl":"https://doi.org/10.1002/pmrj.13280","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-26","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506489","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":"Dynamic ultrasonography for snapping meniscus in a young elite badminton player.","authors":"Batuhan Erhan Aktaş, Yiğitcan Karanfil, Levent Özçakar","doi":"10.1002/pmrj.13285","DOIUrl":"https://doi.org/10.1002/pmrj.13285","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506487","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":"Variability in youth coach concussion education requirements across states.","authors":"Sepehr Asgari, Peter Knowles, Amy K Bugwadia, Christine M Baugh, Lewis E Kazis, Gerald A Grant, Ross D Zafonte, Robert C Cantu, Roy D Pea, Piya Sorcar, Daniel H Daneshvar","doi":"10.1002/pmrj.13274","DOIUrl":"https://doi.org/10.1002/pmrj.13274","url":null,"abstract":"<p><strong>Background: </strong>Youth sports coaches play a critical role in proper concussion recognition and management, reinforcing the need for coach concussion education. As of 2021, most states have statutory and policy measures mandating concussion education for coaches. In practice, these mandates have been enacted through state legislatures and their respective youth sport governing bodies. Prior studies have found significant variations in the contents of state-level concussion risk reduction policies and have raised questions about their specificity.</p><p><strong>Objective: </strong>To expand on previous analyses to provide an overview of youth sports coach concussion education, highlighting variations in state policies and discrepancies between state mandates and youth sport governing bodies.</p><p><strong>Methods: </strong>This report utilized qualitative content analysis to characterize and compare U.S. state and governing body concussion education requirements for youth sport coaches. State concussion statutes were identified via the National Conference of State Legislatures and Open States databases, and governing body handbooks/bylaws were obtained via their websites. Two researchers independently coded the policies, and discrepancies were resolved through consensus meetings with additional youth traumatic brain injury experts.</p><p><strong>Results: </strong>We found significant variability in educational requirements and their implementation. A majority (68%; n = 34) of states require the completion of concussion education training for coaches. Notably, many states designate responsibility for enforcement and implementation of provisions to another party but just four state statutes delineate explicit consequences for noncompliance. Additionally, only 12 state statutes extend mandates to noninterscholastic sports, limiting their reach. In most cases, independent sanctioning authorities implement more stringent policies than the minimum acceptable standard established by state law.</p><p><strong>Conclusion: </strong>Our findings provide a coded data set of youth coach concussion laws and independent sanctioning authority guidelines that can be used in future research efforts. Further research investigating a relationship between the strength of coach concussion education policies and relevant youth and adolescent concussion-related metrics is required.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506490","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":"Anomalous education: You can't bypass electrodiagnostic training in PM&R residency.","authors":"Ileana M Howard, Faye Chiou Tan, Robert W Irwin, Ruple S Laughlin, Anthony Chiodo, Peter A Grant, Shirlyn Adkins, Monika Krzesniak-Swinarska, Gautam Malhotra, Colin K Franz, Dianna Quan","doi":"10.1002/pmrj.13281","DOIUrl":"https://doi.org/10.1002/pmrj.13281","url":null,"abstract":"","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506485","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":"Low-value interventions to deimplement: A secondary analysis of a systematic review of low back pain clinical practice guidelines.","authors":"Daniel Tai, Eunyeop Kim, Prateek Grover, Alejandro Rodriguez, Timothy J Olivier, Thiru M Annaswamy","doi":"10.1002/pmrj.13270","DOIUrl":"https://doi.org/10.1002/pmrj.13270","url":null,"abstract":"<p><strong>Objective: </strong>To perform a secondary review of low back pain (LBP) clinical practice guidelines (CPG) identified in a recently conducted systematic review and to synthesize and summarize low-value recommendations as practices that may be candidates for deimplementation.</p><p><strong>Literature survey: </strong>LBP (subacute or chronic) CPGs in English (symptom based, created by a governmental or professional society, published between January 1990 and May 2020) were previously identified using MEDLINE, EMBASE, CINAHL, Ortho Guidelines, CPG Infobase, Emergency Care Research Institute, Guidelines International Network, National Institute of Health and Care Excellence, and Scottish Intercollegiate Guideline Network.</p><p><strong>Methodology: </strong>Twenty-one CPGs were reviewed from a systematic review (previously published). Full-text review of all 21 CPGs was conducted, and three recommendation categories indicative of low value (recommend strongly against, recommend weakly against, inconclusive/insufficient evidence) were identified using the Grading of Recommendations Assessment, Development, and Evaluation (GRADE) language and approach.</p><p><strong>Synthesis: </strong>One hundred thirty-five low-value recommendations were identified and classified under eight intervention categories: orthotics/support, traction, physical modalities, pharmacological interventions, injections, surgery, bed rest, and miscellaneous. Traction, transcutaneous electrical nerve stimulation (TENS), therapeutic ultrasound (TUS), and selective serotonin reuptake inhibitors (SSRI) had the most CPGs recommend strongly against their usage. Opioids were recommended strongly against by four CPGs. No significant difference (p > .05) was found between CPG quality and a specific deimplementation recommendation or between CPG quality and the number of strongly against, weakly against, and inconclusive/insufficient evidence recommendations.</p><p><strong>Conclusions: </strong>Clinicians managing patients with chronic LBP should consider deimplementing these low-value interventions (traction, TENS, TUS, and SSRI).</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506488","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":"Autonomic rehabilitation: Vagal and sympathetic impacts of modified occipitomastoid suture V-spread.","authors":"Austin Miller, Daniel Gustin, Jonathan Wilson, Jeffery Johns, James Burch, Thomas Fotopoulos, Rahul Garg, Audrey Vasauskas","doi":"10.1002/pmrj.13268","DOIUrl":"https://doi.org/10.1002/pmrj.13268","url":null,"abstract":"<p><strong>Background: </strong>Autonomic rehabilitation using osteopathic manipulative treatment (OMT) to stimulate the vagus nerve may be a good adjunct therapy by physiatrists who treat dysautonomia. Heart rate variability (HRV) may provide quantitative evidence for the benefits of OMT on autonomic nervous system function. Elevated HRV indicates optimal health and reduced mortality risk, whereas low HRV is associated with stress, pain, and chronic disease pathology.</p><p><strong>Objective: </strong>To analyze the impact of modified occipitomastoid suture v-spread OMT technique on vagal tone by measuring HRV.</p><p><strong>Design: </strong>Within-participant design with 5-minute HRV measurement pre- and post-OMT treatment.</p><p><strong>Setting: </strong>Clinical examination suites.</p><p><strong>Participants: </strong>Thirty healthy osteopathic medical students.</p><p><strong>Interventions: </strong>A modified occipitomastoid suture v-spread treating somatic dysfunction by osteopathic physicians trained in osteopathic neuromusculoskeletal medicine.</p><p><strong>Main outcome measures: </strong>HRV variables related to vagal tone including root mean square of successive differences (RMSSD), percentage of successive normal sinus RR intervals >50 ms (pNN50), high frequency (HF), Parasympathetic Nervous System Index (PNSI), and Sympathetic Nervous System Index (SNSI). Repeated measures t-test analyzed the difference in mean HRV values after OMT.</p><p><strong>Results: </strong>There were statistically significant increases in each of the HRV measures after OMT. Participants had a mean (95% confidence interval) RMSSD of 50.5 ms (38.3-62.8) at baseline and 55.0 ms (41.2-68.7, p = .013) post-OMT. pNN50 was 24.5% (17.6-31.3, n = 30) at baseline and 28.2% (20.8-35.6, p = .003) post-OMT. HF was 1549.6 ms² (389.8-2709.4) at baseline and 1901.8 ms² (618.2-3185.4, p = .103) post-OMT. PNSI was -0.1 (-0.5 to 0.2) at baseline and 0.1 (-0.3 to 1.5, p < .01) post-OMT, and SNSI was 0.2 (-0.1 to 0.6) at baseline and 0.05 (-0.3 to 0.4, p < .01) post-OMT. Normalization, due to high baseline variance, results include RMSSD 1.1 ms (1.0 to 1.1, p = .012), pNN50 1.3 (1.1 to 1.4, p = .011), and HF 1.2 ms² (1.1 to 1.4, p = .018).</p><p><strong>Conclusions: </strong>Modified occipitomastoid suture v-spread may provide clinical benefit through increased vagal tone and decreased sympathetic activity.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-23","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142506486","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 visualization of Botulinum toxin injection: Identifying clinical correlates to optimize outcomes in spasticity management.","authors":"Kristen A Harris, Stacey Jou, Lora Kasselman, Steven V Escaldi","doi":"10.1002/pmrj.13269","DOIUrl":"10.1002/pmrj.13269","url":null,"abstract":"<p><strong>Background: </strong>Botulinum toxin injections are well established and commonly used for spasticity management. Clinicians strive to optimize outcomes from toxin injections. One potential complication is toxin spread beyond the intended muscle, which can lead to unwanted weakness. The utilization of ultrasound allows direct visualization of target muscles and identification of toxin leakage from the target muscle. Ultrasound evaluation of clinical factors that correlate to toxin leakage have not been studied.</p><p><strong>Objective: </strong>To identify cases of botulinum toxin injectate leak beyond the targeted muscle during ultrasound-guided spasticity injections and associate cases of leak with predictive clinical factors, which include muscle size, fibroadipose changes, and number of previous injections.</p><p><strong>Design: </strong>This was a prospective observational study.</p><p><strong>Setting: </strong>An outpatient clinic in an academic medical center.</p><p><strong>Patients: </strong>Patients who demonstrated wrist flexor spasticity warranting intervention were invited to participate.</p><p><strong>Interventions: </strong>Patients received standard-of-care spasticity management with injection of onabotulinumtoxinA into the flexor carpi radialis muscle based upon clinical presentation and prescribing guidelines. Ultrasound video was recorded, and a blinded review was conducted by the study team.</p><p><strong>Main outcome measures: </strong>The primary outcome measure was visualized leak of injectate on recorded ultrasound video. Documented leak was then associated with clinical factors including diameter of the flexor carpi radialis, volume of injectate used, history of prior injections, and fibrotic change of the muscle.</p><p><strong>Outcomes: </strong>The study included 54 patients, 77.8% of whom had an underlying diagnosis of cerebrovascular accident. Injectate leak was observed in 18.5% of injections and could not be confirmed in 9.3% of injections. Multivariable analysis demonstrated increased odds of leak with higher Modified Heckmatt Scale score. No statistically significant increase in leak was noted with higher volume of injectate or smaller muscle diameter.</p><p><strong>Conclusion: </strong>Extramuscular leak of botulinum toxin injection may be associated with fibroadipose muscle change.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-22","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142472934","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":"Incidence of lymphedema among adults with cerebral palsy.","authors":"Christine R Gettys, Sean Smith, Kimberly K Rauch, Daniel G Whitney","doi":"10.1002/pmrj.13277","DOIUrl":"https://doi.org/10.1002/pmrj.13277","url":null,"abstract":"<p><strong>Background: </strong>Lymphedema is a chronic and progressive condition but is understudied among adults with cerebral palsy (CP).</p><p><strong>Objective: </strong>To compare the 2-year incidence of lymphedema between adults with versus without CP before and after accounting for multimorbidity, cancer diagnosis/treatment, and lymph node/channel surgery.</p><p><strong>Design: </strong>Retrospective cohort study.</p><p><strong>Setting: </strong>Nationwide commercial claims data from January 1, 2011 to December 31, 2017.</p><p><strong>Participants: </strong>Adults ≥18 years old with and without CP with at least 12 months of continuous health plan enrollment, defined as the baseline period, were included for analysis. The 12-month baseline period was used to establish information on preexisting lymphedema (for exclusion), presence of cancer, including radiation treatment and lymph node surgery, and the Whitney Comorbidity Index (WCI).</p><p><strong>Interventions: </strong>Not applicable.</p><p><strong>Main outcome measure: </strong>The 2-year incidence rate (IR) and IR ratio (IRR) of lymphedema were evaluated. Cox regression estimated the hazard ratio (HR) of 2-year lymphedema after adjusting for age, gender, WCI, cancer diagnosis/treatment, and lymph node/channel surgery.</p><p><strong>Results: </strong>The 2-year IR of lymphedema was 5.73 (95% confidence interval [CI] = 4.59-6.88) for adults with CP (n = 9922) and 1.81 (95% CI = 1.79-1.83) for adults without CP (n = 12,932,288); the IRR was 3.17 (95% CI = 2.59-3.87) and the adjusted HR was 2.43 (95% CI = 1.98-2.98). There was evidence of effect modification by gender, age, and WCI score. All HRs were elevated, but men with versus without CP had higher HRs than women with versus without CP; HRs for adults with versus without CP were higher for younger participants and those with lower WCI scores.</p><p><strong>Conclusions: </strong>Adults with CP had a higher 2-year rate of lymphedema compared with those without CP. Men with CP had a disproportionately higher rate than women with CP when compared with their gender-based reference cohorts without CP.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392669","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":"Postprocedure protocols after intraarticular orthobiologic injections-A scoping review.","authors":"Ryan C Kruse, Kristina D Rossmiller, Timothy R Fleagle","doi":"10.1002/pmrj.13271","DOIUrl":"https://doi.org/10.1002/pmrj.13271","url":null,"abstract":"<p><p>Osteoarthritis is a chronic degenerative disease affecting 500 million people throughout the world. Although orthobiologics have been proposed as a symptom and disease modifying treatment for osteoarthritis, there is significant heterogeneity in the results of the orthobiologic procedures in the literature. One possible explanation for the heterogeneity is the inconsistent reporting and description of the postorthobiologic protocols. The goal of this scoping review was to identify the current literature on the use of orthobiologics for osteoarthritis and critically evaluate the postorthobiologic protocol within these studies. A total of 200 identified studies met inclusion criteria. In 37.5% of studies, there was no mention of a postorthobiologic protocol. Of the 125 studies that did mention a postorthobiologic protocol, only 38.4% included a rehabilitation protocol, 21.6% included postprocedure weightbearing restrictions, and only 2 (1.6%) mentioned the use of durable medical equipment. Nonsteroidal anti-inflammatory drug restriction was described in 91.2% of study protocols, whereas corticosteroids and immunosuppressants were restricted in 84.8% and 19.2% of protocols, respectively. The results of this scoping review demonstrate the inconsistent reporting of postorthobiologic procedure protocols in the literature, with significant heterogeneity in those that are described. These findings highlight the need for future research and improved reporting of postorthobiologic protocols.</p>","PeriodicalId":20354,"journal":{"name":"PM&R","volume":" ","pages":""},"PeriodicalIF":2.2,"publicationDate":"2024-10-09","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"142392670","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}