Physical and Rehabilitation Medicine: say relational or functional, not holistic.

Modern medicine tends to privilege disciplines promising "objective" laws governing body parts (from molecules to organs). Studies on a person's illness and disability are (apparently) confined to "subjectivity." The Specialty of Physical and Rehabilitation Medicine is often regarded as a humanitarian approach, belonging at best to the family of "soft," "qualitative," or "quasi-experimental" sciences. This specialty often claims specificity by labelling itself as "functional" and "holistic." However, it is shown here that the former term is acceptable, yet redundant, and the second misleading. When human behaviors and perceptions are at stake, "function" indicates a person's relationship with the outer world (already tackled by the definitional term "physical" from the Greek "physis"). The word "holistic" emphasizes mind-body unity and person-environment interdependence but, in current usage, overshadows the complementary need for an analytic, experimental approach to any function. Medicine aims at fighting disease and disability in single persons. This endeavor requires knowing body parts and mechanisms and understanding how interventions on "parts" affect the "whole." This understanding rests on the experimental method. For instance, returning to a given societal role (participation) may require restoration of walking (activity), which may require reinforcement of weakened muscular groups (impairment). Working only on holistic bio-psycho-social "wholes" may miss the therapeutic mission of medicine.

Physiatry for Treating Hip, Knee, and Back Pain.

Physical Medicine and Rehabilitation (PM&R) is a rapidly expanding field. Physicians who practice PM&R are known as physiatrists and provide care primarily for patients who have disabilities or physical impairments affecting the musculoskeletal system, brain, and spinal cord. Physiatrists may work in an inpatient or outpatient setting, with outpatient physiatrists being an invaluable resource in treating patients experiencing pain. It is worthwhile to refer patients experiencing hip, knee, or back pain to a PM&R specialist because of their skill in making specific and accurate diagnoses, as well as providing a wide range of modalities to treat pain and augment function such as management of pain medications, osteopathic manipulative therapy, trigger point injections, intra-articular steroid injections, orthobiologic therapy, and interventional spinal procedures. Emphasis is on the use of the least invasive modality before employing more invasive treatments. The need for physiatrists to help individuals maximize function and enhance quality of life is increasing with the aging population, expanding workforce of older adults, and a growing population of people with a disability, especially since the COVID-19 pandemic.

(How) ChatGPT-Artificial Intelligence Thinks It Can Help/Harm Physiatry.

ABSTRACT: ChatGPT is a chatbot that is based on the generative pretrained transformer architecture as an artificial inteligence-based large language model. Its widespread use in healthcare practice, research, and education seems to be (increasingly) inevitable. Also considering the relevant limitations regarding privacy, ethics, bias, legal, and validity, in this article, its use as a supplement (for sure not as a substitute for physicians) is discussed in light of the recent literature. Particularly, the "opinion" of ChatGPT about how it can help/harm physiatry is exemplified.

Integrated Care Models for Long Coronavirus Disease.

Professional or governmental agencies and organizations have developed guidelines to define the problem and evaluate and manage patients with Post-Acute Sequelae of SARS CoV-2 (PASC). Multidisciplinary models largely exist in academic centers and larger cities; however, most care for PASC patients is provided by the primary care providers. The American Academy of Physical Medicine and Rehabilitation has been in the forefront in releasing consensus statements as a part of the long COVID collaborative.

Knowledge, attitudes, and beliefs of oncology trainees on function and cancer rehabilitation medicine.

BACKGROUND: Improved function is associated with reduced morbidity and mortality in patients with cancer. Cancer rehabilitation medicine (CRM) is a subspecialty of physical medicine and rehabilitation (PM&R) that focuses on improving function in patients with cancer. One of the barriers to patients accessing CRM services is the lack of referrals from oncology providers. Understanding the knowledge, attitudes and beliefs of oncology trainees regarding the importance of function and the role of CRM is essential to reducing educational gaps and improving patients' access to essential rehabilitation services. OBJECTIVE: To determine oncology trainees' knowledge, attitude and beliefs about the importance of function and the role of CRM in the care of patients with cancer. SETTING: The study was conducted at a comprehensive cancer center in the United States. INTERVENTION: Descriptive survey study was administered to postgraduate oncology trainees who spent at least 1 day a week providing patient care. MAIN OUTCOME: Participants' report of their knowledge, attitudes, and beliefs on the importance of function and CRM in the care of patients with cancer. RESULTS: The survey was sent to 197 oncology trainees with a response rate of 67% (n = 132) and 126 were ultimately included. All participants believed that function is important in the care of patients with cancer. The majority believed that better function improves treatment tolerance (94%) and survival (84%). Most reported that having CRM physicians (80%) and an inpatient rehabilitation unit (88%) in the oncological setting is important; however, most participants reported that they refer fewer than 25% of their patients to CRM services. Participants with prior exposure to PM&R were significantly more likely to consult PM&R compared to those without exposure (p = .005). Most oncology trainees (81%) believed that education in CRM should be part of their oncology training. CONCLUSION: This study demonstrates that oncology trainees believe that function is important. They also believe that access to CRM would improve treatment tolerance and survival, but most report that they rarely refer patients to CRM services. Most trainees desire increased exposure to CRM during oncology training.

[Diagnosis and treatment of osteoporosis in patients with chronic kidney disease : Joint guidelines of the Austrian Society for Bone and Mineral Research (ÖGKM), the Austrian Society of Physical and Rehabilitation Medicine (ÖGPMR) and the Austrian Society of Nephrology (ÖGN)]. / Diagnose und Therapie der Osteoporose bei Patienten mit chronischer Niereninsuffizienz : Gemeinsame Leitlinie der Österreichischen Gesellschaft für Knochen- und Mineralstoffwechsel (ÖGKM), der Österreichischen Gesellschaft für Physikalische Medizin und Rehabilitation (ÖGPMR) und der Österreichischen Gesellschaft für Nephrologie (ÖGN).

DEFINITION AND EPIDEMIOLOGY: Chronic kidney disease (CKD): abnormalities of kidney structure or function, present for over 3 months. Staging of CKD is based on GFR and albuminuria (not graded). Osteoporosis: compromised bone strength (low bone mass, disturbance of microarchitecture) predisposing to fracture. By definition, osteoporosis is diagnosed if the bone mineral density T­score is ≤ -2.5. Furthermore, osteoporosis is diagnosed if a low-trauma (inadequate trauma) fracture occurs, irrespective of the measured T­score (not graded). The prevalence of osteoporosis, osteoporotic fractures and CKD is increasing worldwide (not graded). PATHOPHYSIOLOGY, DIAGNOSIS AND TREATMENT OF CHRONIC KIDNEY DISEASE-MINERAL AND BONE DISORDER (CKD-MBD): Definition of CKD-MBD: a systemic disorder of mineral and bone metabolism due to CKD manifested by either one or a combination of the following: abnormalities of calcium, phosphorus, PTH, or vitamin D metabolism; renal osteodystrophy; vascular calcification (not graded). Increased, normal or decreased bone turnover can be found in renal osteodystrophy (not graded). Depending on CKD stage, routine monitoring of calcium, phosphorus, alkaline phosphatase, PTH and 25-OH-vitamin D is recommended (2C). Recommendations for treatment of CKD-MBD: Avoid hypercalcemia (1C). In cases of hyperphosphatemia, lower phosphorus towards normal range (2C). Keep PTH within or slightly above normal range (2D). Vitamin D deficiency should be avoided and treated when diagnosed (1C). DIAGNOSIS AND RISK STRATIFICATION OF OSTEOPOROSIS IN CKD: Densitometry (using dual X­ray absorptiometry, DXA): low T­score correlates with increased fracture risk across all stages of CKD (not graded). A decrease of the T­score by 1 unit approximately doubles the risk for osteoporotic fracture (not graded). A T-score ≥ -2.5 does not exclude osteoporosis (not graded). Bone mineral density of the lumbar spine measured by DXA can be increased and therefore should not be used for the diagnosis or monitoring of osteoporosis in the presence of aortic calcification, osteophytes or vertebral fracture (not graded). FRAX can be used to aid fracture risk estimation in all stages of CKD (1C). Bone turnover markers can be measured in individual cases to monitor treatment (2D). Bone biopsy may be considered in individual cases, especially in patients with CKD G5 (eGFR < 15 ml/min/1.73 m2) or CKD 5D (dialysis). SPECIFIC TREATMENT OF OSTEOPOROSIS IN PATIENTS WITH CKD: Hypocalcemia should be treated and serum calcium normalized before initiating osteoporosis therapy (1C). CKD G1-G2 (eGFR ≥ 60 ml/min/1.73 m2): treat osteoporosis as recommended for the general population (1A). CKD G3-G5D (eGFR < 60 ml/min/1.73 m2 to dialysis): treat CKD-MBD first before initiating osteoporosis treatment (2C). CKD G3 (eGFR 30-59 ml/min/1.73 m2) with PTH within normal limits and osteoporotic fracture and/or high fracture risk according to FRAX: treat osteoporosis as recommended for the general population (2B). CKD G4-5 (eGFR < 30 ml/min/1.73 m2) with osteoporotic fracture (secondary prevention): Individualized treatment of osteoporosis is recommended (2C). CKD G4-5 (eGFR < 30 ml/min/1.73 m2) and high fracture risk (e.g. FRAX score > 20% for a major osteoporotic fracture or > 5% for hip fracture) but without prevalent osteoporotic fracture (primary prevention): treatment of osteoporosis may be considered and initiated individually (2D). CKD G4-5D (eGFR < 30 ml/min/1.73 m2 to dialysis): Calcium should be measured 1-2 weeks after initiation of antiresorptive therapy (1C). PHYSICAL MEDICINE AND REHABILITATION: Resistance training prioritizing major muscle groups thrice weekly (1B). Aerobic exercise training for 40 min four times per week (1B). Coordination and balance exercises thrice weekly (1B). Flexibility exercise 3-7 times per week (1B).

Rehabilitación propioceptiva del síndrome de hombro doloroso / Proprioceptive rehabilitation of painful shoulder syndrome / Reabilitação proprioceptiva da síndrome do ombro doloroso

El hombro es una de las regiones anatómicas de mayor movilidad en la vida cotidiana, siendo una de las causas de consulta más frecuentes en el área de fisioterapia para su rehabilitación, pues la primera línea de acción es el tratamiento conservador del hombro; por ello, es de suma importancia conocer y evaluar el complejo articular del hombro, así como también de la región cervicotorácica, con los resultados de la valoración establecer una estrategia de tratamiento que pueden ir desde la terapia manual, el masaje terapéutico, cambios de temperatura hasta el empleo de otros agentes físicos. Paciente femenino de 42 años, con ocupación de asistente odontológica; no reporta discapacidad previa. Como antecedente médico se presenta accidente de tránsito en motocicleta sin producir fractura de hueso ni luxación, ocurrido ocho años antes de la consulta en fisiatría, la paciente tiene afectado el desarrollo de las actividades de la vida cotidiana. Recibió serie de tratamientos durante 10 sesiones, en las cuales se aplican agentes físicos, dado que anteriormente recibió tratamiento farmacológico sin resultados favorables. Se aplica protocolo de rehabilitación fundamentado en las técnicas de propiocepción y al finalizar la terapia la paciente reporta dolor leve, y mejora en la realización de actividades de la vida diaria.

The shoulder is one of the anatomical regions of greater mobility in daily life, being one of the most frequent causes of consultation in the area of physiotherapy for rehabilitation, since the first line of action is the conservative treatment of the shoulder; therefore, it is of utmost importance to know and evaluate the articular complex of the shoulder, as well as the cervicothoracic region, with the results of the assessment to establish a treatment strategy that can range from manual therapy, therapeutic massage, temperature changes to the use of other physical agents. Female patient, 42 years old, with occupation as a dental assistant; she reports no previous disability. As medical history, she had a traffic accident on a motorcycle without bone fracture or dislocation, which occurred eight years before the physiatry consultation, the patient has affected the development of activities of daily living. She received a series of treatments during 10 sessions, in which physical agents are applied, since she had previously received pharmacological treatment without favorable results. Rehabilitation protocol based on proprioception techniques is applied and at the end of therapy the patient reports mild pain and improvement in the performance of activities of daily living.

O ombro é uma das regiões anatômicas de maior mobilidade na vida diária, sendo uma das causas mais freqüentes de consulta na área de fisioterapia para reabilitação, pois a primeira linha de ação é o tratamento conservador do ombro; portanto, é extremamente importante conhecer e avaliar o complexo articular do ombro, bem como a região cervicotorácica, com os resultados da avaliação para estabelecer uma estratégia de tratamento que pode variar desde a terapia manual, massagem terapêutica, mudanças de temperatura até o uso de outros agentes físicos. Paciente do sexo feminino, 42 anos de idade, trabalhando como assistente odontológica; nenhuma deficiência anterior foi relatada. O histórico médico inclui um acidente de trânsito em uma motocicleta sem fratura ou deslocamento ósseo, que ocorreu oito anos antes da consulta ao fisiatra; as atividades de vida diária do paciente são afetadas. Ela recebeu uma série de tratamentos durante 10 sessões, nas quais foram aplicados agentes físicos, já que ela havia recebido anteriormente tratamento farmacológico sem resultados favoráveis. Um protocolo de reabilitação baseado em técnicas de propriocepção foi aplicado e ao final da terapia o paciente relatou dor leve e melhora no desempenho das atividades da vida diária.

Incorporating Holistic Review in Recruitment in a Physical Medicine and Rehabilitation Residency Program.

ABSTRACT: Traditional residency recruitment practices are vulnerable to unconscious biases, inequity, lack of diversity, and have limited ability to predict future clinical competency. Holistic review and evidence-based strategies, such as structured interviews and situational judgment tests, can mitigate these limitations. A physical medicine and rehabilitation residency program restructured its residency recruitment process using holistic review principles and evidence-based strategies during the 2020-2021 academic year. A subcommittee developed a weighted screening rubric based on Association of American Medical Colleges core competencies and semistructured interview questions targeting specific domains. Formal implicit bias training was provided. Screening scores determined interview invitations. Applicants participated in three different domain-focused semistructured interviews. Screening and interview scores were combined to form the program rank list. A postinterview anonymous questionnaire was sent to interviewees to obtain feedback. Four hundred eighty-nine applicants were screened (82 interview invitations, 80 interviewed, 8 matched). The respondents to the postinterview questionnaire found that interviews evaluated them objectively (90%) and improved their impression of the program (90%). The program's match was consistent with previous matches. Interviewed applicants represented a racially diverse group. Most questionnaire respondents had a positive impression of the interview process. This article demonstrates incorporating holistic review into residency recruitment and provides specific resources to aid other institutions pursuing similar goals.

[Pain reduction through physical medicine : Update on the evidence]. / Schmerzreduktion durch physikalische Medizin : Update zur Evidenz.

Epidemiological data from the core documentation of the regional cooperative rheumatism centers in Germany confirm that the symptom of pain is an immense problem in both active inflammatory rheumatic diseases and when in remission. By definition pain is an unpleasant sensory and emotional experience. In the context of inflammatory rheumatic diseases, nociceptive pain is triggered by inflammatory mediators or structurally mechanical distress via activation of the nociceptors. In addition, inflammation is also locally enhanced by the release of proinflammatory substances, such as substance P or calcitonin gene-related peptide (CGRP) from activated nociceptors. The phenomena of inflammation and pain are linked in a self-reinforcing mechanism, which explains why pain can be effectively controlled by inhibiting inflammation and, conversely, why inhibiting pain also has positive effects on the inflammatory response. This review focuses on publications on multimodal rheumatological complex treatment and thermotherapy, which, under evidence-based study criteria, showed a reduction in pain and a partial influencing of molecular markers with a subsequent influence on the development of pain and the inflammatory process. The results are presented in the context of current physiological knowledge on the development of pain.

Translating 2019 ACSM Cancer Exercise Recommendations for a Physiatric Practice: Derived Recommendations from an International Expert Panel.

In 2018, the American College of Sports Medicine (ACSM) reconvened an international, multi-disciplinary group of professionals to review pertinent published literature on exercise for people with cancer. The 2018 roundtable resulted in the publication of three articles in 2019. The three articles serve as an important update to the original ACSM Roundtable on Cancer, which convened in 2010. Although the focus of the three 2019 articles is on exercise, which is only one part of comprehensive cancer rehabilitation, the evidence presented in the 2019 ACSM articles has direct implications for physiatrists and other rehabilitation professionals who care for people with cancer. As such, the narrative review presented here has two primary objectives. First, we summarize the evidence within the three ACSM articles and interpret it within a familiar rehabilitation framework, namely the Dietz model of Cancer Rehabilitation, in order to facilitate implementation broadly within rehabilitation practice. Second, via expert consensus, we have tabulated relevant exercise recommendations for specific cancer populations at different points in the cancer care continuum and translated them into text, tables, and figures for ease of reference. Notably, the authors of this article are members of the Cancer Rehabilitation Physician Consortium (CRPC), a group of physicians who subspecialize in cancer rehabilitation medicine (CRM).

Norma técnica para los servicios de habilitación y rehabilitación en salud / Technical standard for health habilitation and rehabilitation services

La presente norma técnica tiene por objeto establecer las disposiciones técnicas y administrativas para regular la promoción, prevención, diagnóstico y tratamiento en los servicios de habilitación y rehabilitación. Están sujetos al cumplimiento de la presente norma, el personal que proporciona dichos servicios en los establecimientos públicos y privados del Sistema Nacional Integrado de Salud (SNIS). El Ministerio de Salud a través de la Oficina de Habilitación y Rehabilitación, debe gestionar y dar seguimiento al cumplimiento de los procesos en materia de habilitación y rehabilitación, facilitando la inclusión, para la atención integral en salud de la persona en el curso de vida

The purpose of this technical standard is to establish the technical and administrative provisions to regulate the promotion, prevention, diagnosis and treatment in rehabilitation and rehabilitation services. The personnel who provide such services in public and private establishments of the National Integrated Health System (SNIS) are subject to compliance with this regulation. The Ministry of Health, through the Office of Rehabilitation and Rehabilitation, must manage and monitor compliance with the processes in terms of habilitation and rehabilitation, facilitating inclusion, for the comprehensive health care of the person in the course of life

Terapias físicas en pacientes con trastornos de la articulación temporomandibular / Physical therapies in patients with temporomandibular joint disorders

RESUMEN Introducción: Se denomina trastorno temporomandibular al conjunto de condiciones musculoesqueléticas que afectan la articulación temporomandibular, los músculos de la masticación y las estructuras anatómicas adyacentes. Objetivo: Evaluar la efectividad de las terapias físicas en pacientes con trastornos de la articulación temporomandibular. Métodos: Se efectuó una intervención terapéutica en la Clínica Estomatológica Provincial Docente Mártires del Moncada de Santiago de Cuba, desde junio de 2016 hasta febrero de 2020. La muestra quedó conformada por 264 pacientes distribuidos en 4 grupos con 66 integrantes cada uno, a quienes se les aplicaron diferentes terapias físicas, tales como ultrasonido, laserterapia, magnetoterapia y técnica de estimulación eléctrica transcutánea, respectivamente. Se analizaron las siguientes variables: edad, grado de trastorno de la articulación temporomandibular y efectividad terapéutica. Se empleó el porcentaje como medida de resumen y el estadígrafo de Ji al cuadrado con un nivel de significación de 0,05. Resultados: Predominó el sexo femenino en todas las terapias aplicadas con más de 75,0 % y el grupo etario de 40 - 49 años. Al finalizar el tratamiento se observó que en los grupos donde se empleó ultrasonido, láser y magneto, la respuesta fue efectiva en más de 90,0 % de los pacientes, con primacía del primero (96,6 %); sin embargo, en el grupo donde se utilizó la técnica de estimulación eléctrica transcutánea solo se logró en 89,4 % de los afectados. Conclusiones: La ultrasonoterapia fue más efectiva en pacientes con trastornos de la articulación temporomandibular.

ABSTRACT Introduction: A temporomandibular disorder is a group of musculoskeletal conditions that affect the temporomandibular joint, the mastication muscles and the adjacent anatomical structures. Objective: To evaluate the effectiveness of the physical therapies in patients with temporomandibular joint disorders. Methods: A therapeutic intervention was carried out in Mártires del Moncada Teaching Provincial Stomatological Clinic from Santiago de Cuba, from June, 2016 to February, 2020. The sample was formed by 264 patients distributed in 4 groups with 66 members each one, to whom different physical therapies were applied, such as ultrasound, laser therapy, magnetotherapy and technique of transcutaneous electric stimulation, respectively. The following variables were analyzed: age, grade of dysfunction of the temporomandibular joint and therapeutic effectiveness. The percentage as summary measure and the chi-squared test were used with a significance level of 0.05. Results: There was a prevalence of the female sex in all the therapies applied with more than 75.0 % and the 40 - 49 age group. When concluding the treatment it was observed that in the groups where ultrasound, laser and magneto was used, the response was effective in more than 90.0 % of the patients, with primacy of the first one (96.6 %); however, in the group where the technique of transcutaneous electric stimulation was used it was just achieved in 89.4 % of the affected patients. Conclusions: The ultrasonotherapy was more effective in patients with temporomandibular joint disorders.

Beyond a Hashtag: Strategies to Move Toward a More Inclusive Physiatry Workforce.

ABSTRACT: The field of physical medicine and rehabilitation should strive for a physician workforce that is ethnically/racially, sex, and ability diverse. Considering the recent realities of disparities in health outcomes related to COVID-19 and in racial injustice in the United States, we are called to be champions for antiracism and equity. The specialty of physical medicine and rehabilitation should be the leaders in fostering a culture of inclusion and pay special attention to the population of applicants who are underrepresented in medicine. The specialty needs tools to start addressing these disparities. This article aims to provide strategic and intentional evidence-based recommendations for programs to follow. Holistic review, implicit bias training, structured interviews, and targeted outreach for those underrepresented in medicine are some of the tools that will help students enter and become successful in our specialty. Furthermore, this article provides novel guidance and considerations for virtual interviews during the COVID-19 pandemic.

Utilidad del punto Yongquan en el tratamiento rehabilitador del adulto mayor / Usefulnees of the Yongquan Point in the Rehabilitative Treatment of the Older Adult

Los puntos acupunturales son zonas biológicamente activas que se encuentran en la superficie del cuerpo. Presentan baja resistencia al paso de la corriente eléctrica y permiten aplicar diversas terapias tradicionales en el tratamiento de las enfermedades.

Lifestyle Medicine.

Lifestyle medicine is a growing field of medicine that addresses key health behaviors, which are the root causes of most premature death, chronic disease, and health care costs. Coaching patients with evidence-based behavior change strategies can help them to make lasting habits in key areas, such as physical activity, healthy eating, improved sleep, cessation of tobacco, forming and maintaining relationships, and stress management. Similarities in philosophy between lifestyle medicine and physical medicine and rehabilitation make them complementary and synergistic in treating the whole patient in their social context.

EURO-MUSCULUS/USPRM Global Report on Musculoskeletal Ultrasound Publications.

The developments in technology have improved access to the use of musculoskeletal ultrasound (MSUS) in different clinical settings. Accordingly, MSUS has been applied to a wide range of musculoskeletal problems including inflammatory and degenerative diseases, sport injuries, and regional pain syndromes both for clinical practice and research. In this report, the authors aimed to globally examine the publications on MSUS among different specialties, countries, and topics. Sixteen reviewers under the umbrella of the European Musculoskeletal Ultrasonography Society Group and the Ultrasound Study Group of International Society of Physical and Rehabilitation Medicine have evaluated approximately 15,000 publications on MSUS. The authors believe that the results of this comparative analysis may provide a holistic snapshot with regard to the utility of MSUS, not only for clinicians/academicians but also for the industry. Accordingly, while aiming to further increase their awareness, this article would possibly guide future investments as well.