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2022| April-June | Volume 5 | Issue 2
June 13, 2022
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A critical review of interventional treatments for myofascial pelvic pain
Aaron Lin, Hadeer Abbas, Maryam Sultan, Tony Tzeng
April-June 2022, 5(2):41-45
Chronic pelvic pain affects between 6% and 25% of women. It is a complex condition that has multifactorial etiologies, including but not limited to conditions arising from the gynecologic, urologic, gastrointestinal, musculoskeletal, neurologic, and psychologic systems. In this literature review, we examine and summarize evidence for interventional treatments compared to conservative treatments for women with musculoskeletal or myofascial pelvic pain. Searches were performed in PubMed and Embase databases. Studies were included if they were randomized controlled trials with a treatment arm of physical therapy, dry needling, trigger point injection (TPI), or injection with botulinum toxin. A total of 106 studies were returned with our search terms, and six articles were included in this review. These studies suggest that pelvic floor physical therapy, dry needling of abdominal wall trigger points, and TPI to abdominal wall and pelvic floor trigger points have some evidence as being effective for treatment of pelvic pain. The evidence for treatment with botulinum toxin was not as robust and also had higher rates of adverse events when compared to other interventions. Most of these studies are limited by small sample sizes and varied baseline demographics, which makes generalization of these findings to different patient populations difficult. In general, treatments for myofascial pelvic pain are low-risk and are effective in reducing myofascial pelvic pain.
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In-person versus virtual musculoskeletal ultrasound education during the coronavirus disease 2019 pandemic: A single-center study
Ya-Ting Chen, Raymond Chou, Minna J Kohler, Christine Eng, Joanne Borg-Stein
April-June 2022, 5(2):61-68
Musculoskeletal ultrasound (MSKUS) curricula in physical medicine and rehabilitation (PM and R) residency programs have traditionally relied on in-person teaching workshops. However, the social distancing requirements during the coronavirus disease 2019 pandemic has led to a growing interest in remote ultrasound education.
The aim of the study is to assess residents' MSKUS skill confidence after in-person vs. virtual MSKUS teaching workshops in a PM and R residency program.
Twenty-one PM and R residents at a single academic center were assigned to either an in-person MSKUS demonstration by a sports medicine faculty member (
= 10) or a real-time virtual demonstration (
= 11) for workshops of the knee and wrist and hand. Surveys using Likert scales were employed to assess the change in residents' confidence with performing MSKUS examinations and their satisfaction with the curriculum.
There was a significant increase in confidence scores from baseline to postworkshop for both the virtual and in-person groups. The linear mixed effect model showed that there were no significant differences between the virtual and in-person groups for their baseline, postworkshop, and changes in confidence scores. All participants were satisfied with the updated curriculum.
With the ongoing pandemic, incorporating virtual teaching platforms into existing MSKUS curricula is feasible and may provide similar improvements in residents' skill confidence as the in-person workshops. Successful implementation requires consideration of several factors, including ultrasound machine availability, participants' familiarity with technology, and the quality of the virtual streaming platform. A multi-institutional randomized controlled trial can further evaluate the effectiveness of remote MSKUS education for PM and R trainees.
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Melatonin administration for sleep disorders in traumatic brain injury: A review of the literature
Christina Barton, Christopher Falco
April-June 2022, 5(2):46-50
Melatonin is a neurohormone that acts at the suprachiasmatic nucleus to diminish the wake-promoting signal of the circadian clock and induce sleepiness. Exogenous melatonin is available as an over-the-counter supplement to induce sleepiness with 1.3% of adults reporting melatonin use in the past 30 days in 2012. Melatonin is also a frequently used treatment for sleep disturbances in the traumatic brain injury (TBI) population, however, evidence of melatonin efficacy for disordered sleep in this population is scarce. This article reviews the evidence regarding melatonin or melatonin receptor agonists used for sleep disorders in the TBI population. A literature search was performed using PubMed, Embase, Ovid MEDLINE, Cochrane Library, and Google Scholar. In total, four clinical randomized controlled trials were summarized and graded based on the American Academy of Neurology clinical practice guidelines. The evidence that exists suggests melatonin or melatonin receptor agonists improve some aspects of sleep in the TBI population. Additional high-quality studies investigating how melatonin affects the sleep and functional recovery of individuals with TBIs are needed.
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Implementation of rehabilitation innovations: A global priority for a healthier society
Bhasker Amatya, Fary Khan
April-June 2022, 5(2):51-60
With improved global survival rates, there is an increased demand for health-care needs for persons with noncommunicable diseases, chronic illnesses, and disaster survivors (including pandemics). Many countries struggle to meet the existing demand for health care, including rehabilitation services. Further, many persons with disability still experience socioeconomic inequity/disparities in accessing rehabilitation services. Despite increased demand for rehabilitation, many countries globally struggle to meet existing demand due to economic, social, and other barriers. The World Health Organization (WHO) initiative “Rehabilitation 2030: A Call for Action” promotes universal access to rehabilitation and prioritizes the scaling-up and strengthening of rehabilitation services and strong governance of global health partnerships and coordination between the authorities and public. The WHO launched a conceptual framework “WHO Rehabilitation in Health Systems: Guide for Action” for the development and implementation of an effective rehabilitation program within the health-care system. This pivotal resource provides detailed steps to lead governments through rehabilitation system strengthening practice specifically in low- and middle-income countries, organized in four key phases: (i) assessment of the situation; (ii) development of a rehabilitation strategic plan; (iii) establishment of the monitoring, evaluation, and review processes; and (iv) implementation of the strategic plan. The goal is to shift health trajectories onto the rehabilitation-inclusive system in a sustainable and equitable path. The article aims to provide an overview of key global initiatives in disability and rehabilitation, exclusively highlighting the WHO framework and other innovative care models for consideration.
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Postintensive care syndrome after severe COVID-19 respiratory illness and functional outcomes: Experience from the rehabilitation hospital in Qatar
Krishnaprasad Ittilavalappil Narayanankutty, Sami Ullah, Saquib Hanif, Mohamed Lamine Missaoui, Rafat Mohmamed Abdullah Saad
April-June 2022, 5(2):75-80
This study aimed to observe functional outcomes post coronavirus disease (COVID) rehabilitation in COVID-19 patients with postintensive care syndrome (PICS).
We present 13 cases of severe COVID-19 pneumonia who required prolonged intensive care unit (ICU) stay, and were later admitted to our rehabilitation institute with features of PICS and functional disability, during the months of July and August 2020. All these patients underwent a multidisciplinary rehabilitation program and are the first group of patients successfully discharged to the community.
Among 13 patients presented, 11 were male patients and 2 were female, in the age range 34–64 years. Ten out of 13 patients had at least one chronic illness such as diabetes mellitus, systemic hypertension, dyslipidemia, obstructive airway disease, and coronary artery disease, and seven among them had more than one illness. None of them had any known neuropsychiatric illnesses. All of them had severe pneumonia which required mechanical ventilation from 12 to 30 days and an average length of ICU stay of 36 days (Range 21–54 days). The most common impairments on rehabilitation admission were impaired exercise tolerance with poor scores in Modified Medical Research Council (mMRC) dyspnea scale and desaturation on 40-step walking test, as well as significant ICU acquired weakness with a Medical Research Council (MRC) sum score in the range of 30–46 out of 60. Eight out of 13 patients had critical illness myopathy and/or neuropathy diagnosed with neuro-electrodiagnostic testing. The average length of stay for the patients in rehabilitation was 36 days, with a range of 18–65 days.
Early multidisciplinary rehabilitation has got a potential benefit in the functional outcome of COVID-19 survivors. More studies are required in this area to further evaluate the benefits of different rehabilitation interventions, their intensity, duration, long-term benefits, and to create guidelines for addressing similar situations in the future.
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Quality improvement project of a closed catheter system to reduce catheter-associated urinary tract infections during acute inpatient rehabilitation using stepped-wedge design
Argyrios Stampas, Jason Hua, Heather Naumann, Claudia I Martinez, DeAnn Roberts, Claudia Pedroza
April-June 2022, 5(2):69-74
To investigate if an indwelling catheter with a one-way valve (BioFlo® [BF]) reduces the incidence of catheter-associated urinary tract infections (CAUTIs).
Prospective quality improvement project.
Stepped-wedge nursing unit enrollment in acute inpatient rehabilitation facility (IRF) was conducted over 9 months. All patients admitted to IRF that used an indwelling catheter at any time during admission were included, with all days and types of voiding methods collected when in the study period. Comparisons were between BF versus usual care (Foley catheter), with incidence of CAUTI as the primary outcome measure.
There were 227 patients: 21 using BF only, 146 using Foley only, and 60 using both. This resulted in 206 Foley users and 81 BF users. The BF group had a greater percentage of patients with CAUTI compared to the Foley group (30% vs. 17%,
= 0.021). Using generalized linear modeling and adjusting for confounders revealed an 89% increased risk of CAUTI in the BF group compared to the Foley group (odds ratio: 1.89,
= 0.033). Bayesian analysis determined that the probability of BF increasing the rate of CAUTI was 96% (95% credible interval: 0.95–2.7).
Maintaining a closed catheter system with BF does not reduce the rates of CAUTIs during acute inpatient rehabilitation.
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