Coronavirus disease 2019 (COVID-19) has been declared a global public health emergency. The demand for services has altered the organization of medical services resulting in significant changes that have altered dramatically the education of residents in various medical specialties including physical and rehabilitation medicine. In this rapid communication, we summarize the impact of COVID-19 on residency training programs in five European countries. Open interviews were conducted with Country Ambassadors of the International Society of Physical and Rehabilitation Medicine World Youth Forum. The most common changes were closing of rehabilitation units and outpatient clinics, redeployment of residents to acute care services, and the increase use of technology for patient care and educational purposes.

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Objective: The objective of this study is to investigate the association between body mass index (BMI) and the functional progress among patients with a recent hip replacement. Data suggest that a number of medical societies and organizations are restricting patient access to joint replacement surgeries based on the patient's BMI. This restriction seems to be related to the increased risk of complications, primarily wound infections, at the time of surgery. Few studies have been conducted on the relationship between BMI and outcomes during rehabilitation after hip replacement surgery. Design: Retrospective cohort study. Setting: All patients admitted to a rehabilitation hospital, with a recent diagnosis of hip replacement and available hospital admission height and weight data during the years 2014-2017. Main Outcome Measure: Functional independence measure (FIM) gain per day of patients by BMI category. Results: The chart review identified 479 patients had undergone hip replacement surgery. Over half of the patients were overweight or obese. FIM efficiency (FIM change/day) was the highest in the obese class II category (3.65), followed by obese class III (3.60). The differences in FIM efficiency between the normal and obese I groups reached statistical significance in favor of obese I (P = 0.024). Conclusion: This study did not demonstrate that obesity significantly impairs functional outcomes during the rehabilitation process after hip replacement surgery.

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Background: In 2012, the Centers for Medicare and Medicaid Services began to reduce payments to qualifying hospitals for 30-day readmission rates that were higher than predicted for specific diagnoses. The process was broadened to include skilled nursing facilities in 2018. It is reasonable to expect future expansion will include acute inpatient rehabilitation facilities. A pre-intervention quality improvement project from 2017 identified that patients admitted to an acute inpatient rehabilitation facility (IRF) for the primary diagnosis of debility were readmitted within 30 days of discharge at a rate of 38%, which was nearly three times higher than the next most readmitted diagnosis. A literature review identified rapid primary care provider (PCP) outpatient follow up as a worthy intervention to reduce readmissions. Objectives: Over a six-month intervention period, we attempted to achieve a reduction in 30-day readmission rates in the debility population of an IRF by scheduling PCP follow-ups within seven business days after discharge. Results: Of those that received the intervention, 7% were readmitted (P=0.018). Of those who did not receive the intervention, 56% were readmitted. Conclusion: The adoption of PCP follow-up within seven business days of discharge may lower the 30-day readmission rate for patients admitted to IRF with a primary diagnosis of debility.

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Background and Objective: Given the known association between inflammatory conditions and stroke, this study was designed to assess whether the diagnosis of human immunodeficiency virus (HIV) – which is associated with chronic inflammation – would affect the functional trajectory of patients hospitalized for the treatment of stroke. Methods: This is a retrospective study comparing the functional outcomes of 688,066 stroke patients with a diagnosis of HIV to those without a diagnosis of HIV from 2002 to 2017. Results: HIV+ patients were found to have a much lower age at admission, with a difference of over 10 years when compared to HIV− patients. HIV+ patients were also less likely to discharge to home when compared to HIV− patients (P < 0.0001). Gains in functional independence measure (FIM) scores per day were found to be greater among those who were HIV− compared to those who were HIV+ (P = 0.086). Factors associated with a lower FIM efficiency included older age at admission, male gender, and having a hemorrhagic stroke (P < 0.0001). Conclusion: This study found that, among those hospitalized for the treatment of a stroke, the functional gain per day was inferior among those with HIV than among those without HIV at admission.

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Introduction: One-third of children with cerebral palsy (CP) do not yet walk at the age of 5. Orthopedic deformity is one of the pathologies that may compromise the efficiency of gait in those patients. The aim of our study was to describe the clinical characteristics of orthopedic deformities for CP patients and to describe device prescription to manage the deformities. Methods: A retrospective chart review was conducted at the Equipment Teaching Hospital of Madagascar, after ethic committee approval, during a period of 1 year, from the beginning of January 2017 to the end of December 2017. Patients diagnosed with CP, during the period of the study, regardless of age and gender, were included in the study. Incomplete patients' records have been excluded from the study. The different types of orthopedic deformities were analyzed. Results: New cases of CP were in the order of 5.61% (n = 100) in 1783 new patients seen in consultation during 2017. Ninety-five patients were kept out. Eighty-nine percent of patients reported to the hospital after 12 months of age. Orthopedic deformity was detected in 48 patients, including 27.36% with deformity of the foot, 5.26% of the knee, 4.21% of the hip, and 16.84% of the spine. More than 73% of the patients had spasticity. In 45.26% of the cases, patients with CP had a complete functional restriction with a Gross Motor Function Classification System V (GMFCS), and only 27 patients had GMFCS I or II. In 82.1% of the cases, patients with CP needed devices to reduce their deficit or maintain functional gain. Conclusion: CP is a public health problem. Orthopedic deformities are often discovered late, affecting the gait quality for these patients. Orthopedic deformities prevention is crucial, and multidisciplinary care should be done early.

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Neuropathic pain after spinal cord injury is common and debilitating. Several nonpharmacological neuromodulation techniques have been tried with controversial outcomes. A novel intervention called breathing-controlled electrical stimulation (BreEStim) is developed based on discoveries about the systemic effects of voluntary breathing and the physiological interactions with body systems. Recent laboratory research studies are reviewed. The results demonstrated that BreEStim produced effective analgesic effects with the restoration of autonomic dysfunction via central neuromodulatory mechanisms. A case of long-term application of BreEStim highlights its clinical therapeutic potential.

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Pain syndromes affecting women have a significant global impact. There is increasing evidence that chronic pain affects a higher proportion of women than men around the world; unfortunately, women are less likely to receive treatment. Moreover, women generally experience more recurrent pain, more severe pain and longer-lasting pain than men. Pain conditions are more prevalent in women such as fibromyalgia, chronic pelvic pain and lumbopelvic pain during pregnancy and postpartum. Gender differences in pain sensitivity, pharmacological therapy, and nonpharmacological pain interventions have also been reported. It is becoming evident that gender differences in pain and its relief arise from an interaction of genetic, anatomical, physiological, neuronal, hormonal, psychological and social factors that modulate pain differently.

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