Search

Copyright of PM & R: Journal of Injury, Function & Rehabilitation is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: Differences in patient–physician interactions based on physician gender have been demonstrated. However, the association between patients' self‐perceived health and their decision to see a female versus male physician is still unclear. Objective: To determine if self‐reported physical or behavioral health is different in musculoskeletal patients who present to female vs male physicians. We hypothesized that patients who present to female physicians report worse physical and behavioral health. Design Cross‐sectional study. Setting: Tertiary academic medical center. Patients Consecutive 21 980 adult patients who presented to a musculoskeletal medicine specialist for initial evaluation of a musculoskeletal condition between April 1, 2016 and November 1, 2017. Main Outcome Measures: Physical Function, Pain Interference, Anxiety, and Depression Computer Adaptive Test domains of the Patient‐Reported Outcomes Measurement Information System (PROMIS). The primary study outcome was the mean difference (MD) in PROMIS scores by physician gender. Results: Patients who presented to female physicians self‐reported slightly worse health in all domains: Physical Function (female physicians 40.2, male physicians 42.4, MD ‐2.1; 95% confidence interval [CI] ‐2.5 to −1.8), Pain Interference (female physicians 61.6, male physicians 60.4, MD 1.3 [1.0‐1.5]), Anxiety (female physicians 52.5, male physicians 51.4, MD 1.1 [0.8‐1.5]), and Depression (female physicians 47.5, male physicians 46.2, MD 1.3 [0.9‐1.6]) (all P <.001). Patients who presented to female physicians were also slightly younger (51.9 vs 52.4 years, P =.034) and more likely to be female (63% vs 56%, P <.001). Conclusions: Patients who presented to female physicians self‐reported slightly worse physical and behavioral health compared to those patients who presented to male physicians. Further investigation into this finding may provide insight into drivers of patients' preferences, which may enable physicians of both genders to optimize patient care. [ABSTRACT FROM AUTHOR]

Intraarticular knee injuries and subsequent posttraumatic arthritis (PTOA) are common in athletes. Unfortunately, PTOA may significantly affect performance and overall function, but this condition remains difficult to characterize. In this review, we provide an overview of imaging modalities used to evaluate PTOA among athletes and physically active individuals following knee injury, with the goal to discuss the strengths and limitations of their application in this population. A literature search was performed to identify clinical studies focusing of knee injuries in athletes and athletic persons, specifically using imaging for diagnosis or monitoring disease progression. A total of 81 articles were identified, and 23 were included for review. Studies on plain radiographs (n = 8) and magnetic resonance imaging (MRI) assessed arthritic burden (n = 13), with MRI able to depict the earliest cartilage changes. Few studies (n = 2) leveraged ultrasound. Challenges persist, particularly regarding standardization and reliability across different radiographic grading systems. Additionally, further research is needed to establish the clinical significance of techniques to assess cartilage composition on MRI, including ultrashort echo-time enhanced T2*, T1rho and T2 imaging. Addressing these challenges through standardized protocols and intensified research efforts will enhance the diagnostic utility of imaging modalities in musculoskeletal medicine and enable high-quality prospective studies., (© 2024 The Author(s). PM&R published by Wiley Periodicals LLC on behalf of American Academy of Physical Medicine and Rehabilitation.)

Background: Epidural steroid injections are common procedures in physical medicine and rehabilitation practice. However, their environmental impact has not been characterized., Objective: The primary aim is to estimate and compare the carbon footprint of two standard injection kits used to perform epidural steroid injections at a single academic institution. Secondary objectives were (1) to create a step-by-step guide for estimating the carbon footprint of materials and (2) to survey physicians on practice patterns and identify areas for improvement., Design: Pilot study., Setting: Academic medical center., Participants: N/A., Interventions: N/A., Outcome Measures: Carbon emissions measured in CO 2 equivalents (CO 2 eq)., Methods: Using guidance from the Greenhouse Gas Protocol, the carbon footprint of the two kits was estimated by taking the sum of carbon emissions resulting from the production of the kit materials and the carbon emissions resulting from the waste disposal of the kit materials., Results: The carbon footprint of the transforaminal epidural steroid injection (TFESI) kit was estimated at 1.328 kg CO 2 eq. The carbon footprint of the interlaminar epidural steroid injection (ILESI) kit was estimated at 2.534 kg CO 2 eq. For both kits, the carbon emissions resulting from the production of the kits were greater than the emissions resulting from disposal. The survey of interventionalists performing TFESI revealed all respondents required materials in addition to those provided in the standard epidural kit. Despite this, kit materials were typically wasted in 62% of respondents., Conclusion: Creating a methodology for quantifying carbon emissions is the first step to reducing carbon emissions. Once emissions are measured, the health care industry can determine the most effective strategies for reducing its impact. Our analysis has shown that it is feasible to perform emissions calculations and delineates a clear method with publicly available resources. Solutions to reduce epidural injection carbon footprint waste may include improved kit customization., (© 2023 American Academy of Physical Medicine and Rehabilitation.)

Background: Lifestyle factors are associated with musculoskeletal pain and metabolic chronic diseases. To date, intensive lifestyle medicine programs have predominantly targeted metabolic rather than musculoskeletal conditions., Objective: To assess the feasibility of an intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions., Design: Prospective observational feasibility study., Setting: Tertiary academic medical center., Patients: Adults diagnosed with musculoskeletal condition(s) and lifestyle-related chronic disease(s) who previously completed standard-of-care musculoskeletal treatments, enrolled from 2018 to 2020., Interventions: Patients enrolled in an intensive interprofessional lifestyle medicine program led by a physiatrist, with options to interface with an acupuncturist, dietician, massage therapist, psychologist, physical therapist, and smoking cessation specialist. The physiatrist engaged in shared decision making with patients to establish program goals related to function, overall health, and required lifestyle changes. Bimonthly interprofessional team conferences facilitated communication between treatment team and patients., Main Outcome Measures: Feasibility was measured by patient participation and goal attainment. Secondary outcomes included changes from program enrollment to discharge in patient anthropometric, metabolic lab, sleep apnea risk, and Patient-Reported Outcomes Measurement Information System (PROMIS) function, pain, and behavioral health measures., Results: Twenty-six patients enrolled in the program (18 [69%] female, mean age 59 [SD 14.5] years, baseline hemoglobin A1c 6.0% [0.8%], high-sensitivity C-reactive protein 7.7 [12.1] mg/dL, 25-hydroxy vitamin D 32.0 [14.2] ng/mL). Of 21 (81%) patients who completed the program, 13/21 (62%) met their goal. On average, program completers presented for 26.2 (10.6) total visits over 191 (88) days. By discharge, program completers achieved clinically meaningful improvement in PROMIS Anxiety (mean difference -3.5 points, 95% confidence interval [-6.5 to 0.5], p = .035), whereas noncompleters did not (p > .05)., Conclusions: An intensive interprofessional lifestyle medicine program for patients with musculoskeletal conditions is feasible. With training in lifestyle intervention, physiatrists are well suited to lead interprofessional teams aimed at assisting patients in making lifestyle changes to achieve personalized function- and health-related goals., (© 2021 American Academy of Physical Medicine and Rehabilitation.)

Abstract: The objective was to determine the effectiveness of fluoroscopically guided genicular nerve radiofrequency ablation for painful knee osteoarthritis. Primary outcome measure was improvement in pain after 6 mos. Secondary outcomes included the Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index. Two reviewers independently assessed publications before October 10, 2020. The Cochrane Risk of Bias Tool and Grades of Recommendation, Assessment, Development, and Evaluation system were used. One hundred ninety-nine publications were screened, and nine were included. Six-month success rates for 50% or greater pain relief after radiofrequency ablation ranged from 49% to 74%. When compared with intra-articular steroid injection, the probability of success was 4.5 times higher for radiofrequency ablation (relative risk = 4.58 [95% confidence interval = 2.61-8.04]). When radiofrequency ablation was compared with hyaluronic acid injection, the probability of treatment success was 1.8 times higher (relative risk = 1.88, 95% confidence interval = 1.38-2.57). The group mean Oxford Knee Score and Western Ontario and McMaster Universities Osteoarthritis Index scores improved in participants receiving genicular radiofrequency ablation compared with intra-articular steroid injection and hyaluronic acid injection. According to Grades of Recommendation, Assessment, Development, and Evaluation, there is moderate-quality evidence that fluoroscopically guided genicular radiofrequency ablation is effective for reducing pain associated with knee osteoarthritis at minimum of 6 mos. Further research is likely to have an important impact on the current understanding of the long-term effectiveness of this treatment., Competing Interests: Financial disclosure statements have been obtained, and no conflicts of interest have been reported by the authors or by any individuals in control of the content of this article., (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)

Background: Differences in patient-physician interactions based on physician gender have been demonstrated. However, the association between patients' self-perceived health and their decision to see a female versus male physician is still unclear., Objective: To determine if self-reported physical or behavioral health is different in musculoskeletal patients who present to female vs male physicians. We hypothesized that patients who present to female physicians report worse physical and behavioral health., Design: Cross-sectional study., Setting: Tertiary academic medical center., Patients: Consecutive 21 980 adult patients who presented to a musculoskeletal medicine specialist for initial evaluation of a musculoskeletal condition between April 1, 2016 and November 1, 2017., Main Outcome Measures: Physical Function, Pain Interference, Anxiety, and Depression Computer Adaptive Test domains of the Patient-Reported Outcomes Measurement Information System (PROMIS). The primary study outcome was the mean difference (MD) in PROMIS scores by physician gender., Results: Patients who presented to female physicians self-reported slightly worse health in all domains: Physical Function (female physicians 40.2, male physicians 42.4, MD -2.1; 95% confidence interval [CI] -2.5 to -1.8), Pain Interference (female physicians 61.6, male physicians 60.4, MD 1.3 [1.0-1.5]), Anxiety (female physicians 52.5, male physicians 51.4, MD 1.1 [0.8-1.5]), and Depression (female physicians 47.5, male physicians 46.2, MD 1.3 [0.9-1.6]) (all P < .001). Patients who presented to female physicians were also slightly younger (51.9 vs 52.4 years, P = .034) and more likely to be female (63% vs 56%, P < .001)., Conclusions: Patients who presented to female physicians self-reported slightly worse physical and behavioral health compared to those patients who presented to male physicians. Further investigation into this finding may provide insight into drivers of patients' preferences, which may enable physicians of both genders to optimize patient care., (© 2020 American Academy of Physical Medicine and Rehabilitation.)