Evaluation of sleep health documentation and sleep-related intervention by physiatrists treating musculoskeletal disorders: A retrospective investigation.

BACKGROUND: Sleep health is linked to pain, function, and global health. Unfortunately, sleep health may not be consistently addressed as a part of musculoskeletal care. OBJECTIVE: To describe the frequency of sleep health documentation and intervention by musculoskeletal physiatrists. Additionally, patient-reported outcome measures were compared between patients with and without sleep impairment. We hypothesized that sleep health is documented and addressed in less than half of initial patient encounters and that patients with a sleep impairment have worse patient-reported outcomes scores compared to those without sleep impairment. DESIGN: Retrospective study. SETTING: Tertiary orthopedic hospital. INTERVENTIONS: None. MAIN OUTCOME MEASURES: Frequency of provider documentation of sleep health, frequency and characteristics of sleep health intervention provided, and Patient-Reported Outcome Measurement Information System (PROMIS)-10 mental health and physical health scores. RESULTS: Initial visits for a musculoskeletal condition of 39,452 patients from January 1, 2020 to October 1, 2022 were included. Documentation of sleep health was found in 33.0% (13,002/39,452) of patients. Of those with sleep health documentation, 59.2% (7697/13,002) were classified as having a sleep impairment. Only 19.0% of patients were provided with sleep-related education or other intervention. Patients with a sleep impairment had worse PROMIS-10 mental health and physical health scores (p < .001), as compared to those without a sleep impairment. CONCLUSIONS: Patients with sleep impairment had worse mental and physical health scores than those without sleep impairment, and only 19.0% received sleep health intervention. These data suggest that sleep impairment is common in patients presenting for evaluation of a musculoskeletal condition, and advanced provider education and tools to help patients improve their sleep health are needed.

The Impact of the Early COVID-19 Pandemic on Inpatient Clinical Experience for Physical Medicine and Rehabilitation Resident Physicians.

ABSTRACT: The objective of this retrospective, observational study was to quantitatively study the impact of the early COVID-19 pandemic on the inpatient clinical experience of Physical Medicine and Rehabilitation resident physicians in an inpatient rehabilitation facility setting. Inpatient clinical experience as evidenced by admissions, rehabilitation diagnosis, medical emergencies, acute care transfers, and resident work hours from January to June 2019 (prepandemic) were compared January to June 2020 (immediately before and during pandemic). There was a statistically significant decrease in the mean daily admissions in April 2020 and a significant increase in medically complex admissions in June 2020, reflective of medical patterns due to the pandemic. There was a decrease in mean work hours during the pandemic, but no statistically significant difference in admission rate of other rehabilitation diagnoses, medical emergencies, or transfers to acute care. This study demonstrates no substantial pandemic-related impact on inpatient clinical experience for physical medicine and rehabilitation residents in the studied program.

Ultrasound-guided glenohumeral joint injections for shoulder pain in ALS: A case series.

Introduction: Shoulder pain is a common secondary impairment for people living with ALS (PALS). Decreased range of motion (ROM) from weakness can lead to shoulder pathology, which can result in debilitating pain. Shoulder pain may limit PALS from participating in activities of daily living and may have a negative impact on their quality of life. This case series explores the efficacy of glenohumeral joint injections for the management of shoulder pain due to adhesive capsulitis in PALS. Methods: People living with ALS and shoulder pain were referred to sports medicine-certified physiatrists for diagnostic evaluation and management. They completed the Revised ALS Functional Rating Scale and a questionnaire asking about their pain levels and how it impacts sleep, function, and quality of life at baseline pre-injection, 1-week post-injection, 1 month post-injection, and 3 months post-injection. Results: We present five cases of PALS who were diagnosed with adhesive capsulitis and underwent glenohumeral joint injections. Though only one PALS reported complete symptom resolution, all had at least partial symptomatic improvement during the observation period. No complications were observed. Conclusions: People living with ALS require a comprehensive plan to manage shoulder pain. Glenohumeral joint injections are safe and effective for adhesive capsulitis in PALS, but alone may not completely resolve shoulder pain. Additional therapies to improve ROM and reduce pain should be considered.

Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS): A pediatric case report with six year follow-up.

BACKGROUND: Chronic lymphocytic inflammation with pontine perivascular enhancement responsive to steroids (CLIPPERS) is an inflammatory disorder involving brainstem, pons in particular, characterized by a predominant T-cell pathology and responsiveness to glucocorticosteroids. We describe a difficult 6 year course of this rare syndrome in a 10-year-old girl. CASE REPORT: Our patient presented with diplopia, spastic paraparesis, and unsteady gait. MRI showed characteristic punctate hyper-intensities with enhancement in the brain stem, cerebellar peduncles, and optic chiasm and diffuse nodular enhancement throughout the cervical and thoracic spinal cord. Brain biopsy revealed perivascular inflammatory lesions compatible with CLIPPERS. Pulse intravenous methylprednisolone followed by oral prednisolone resulted in significant clinical improvement. She had multiple clinical relapses associated with new brain and/or spinal cord lesions despite sequential maintenance methotrexate and rituximab with low dose steroids. Each relapse responded to pulse steroids. CONCLUSION: Her overall clinical course was progressive but responsive to pulse steroids. Long-term treatment remains challenging.