Sport participation among children with complicated mild traumatic brain injury.

BACKGROUND: Complicated mild traumatic brain injury (C-mTBI) represents mTBI with positive trauma-related radiographic findings, such as hematoma. It is estimated that 7.5% of all pediatric mTBIs meet these criteria. There is a paucity of research on return to sports in children with C-mTBI. OBJECTIVE: To examine children with C-mTBI, mTBI with skull fracture (mTBI-SF) only and mTBI in relation to sport participation and factors associated with repeated injury. DESIGN: Cross-sectional survey. SETTING: Level I pediatric trauma center. PARTICIPANTS: Parents of children who were 5-18 years of age at the time of injury who sustained C-mTBI or mTBI from 2010 to 2013. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Sports participation characteristics before and after injury in children with C-mTBI and mTBI as a function of degree and length of recovery. Repeat mTBI after the index injury was also examined. RESULTS: Of 247 children who participated in sports preinjury (27.5% with C-mTBI and 9.7% with mTBI-SF), 95.1% returned to sports. There was no significant difference by mTBI type regarding participation in any sports (p = .811) nor with high-risk sports (p = .128). C-mTBI but not mTBI-SF (versus mTBI) was associated with lower odds of sustaining a repeat mTBI (odds ratio = 0.30, p = .045). Waiting longer (>3 months compared to <1 month) to return to contact sports was associated with lower odds of sustaining a repeat mTBI (odds ratio = 0.23, p < .05). CONCLUSIONS: Children with C-mTBI and mTBI-SF resume similar sports as children with mTBI. Those with C-mTBI and those who take longer to return to play may have lower risk of repeat mTBIs. Prospective research is needed to inform the development of evidence-based guidelines for children with C-mTBI and mTBI-SF.

The Women Physiatrists Facebook Group: Evaluating the Value of a Private Online Community.

ABSTRACT: This study evaluated Women Physiatry Facebook group members' perceptions of the value of an online community. The authors hypothesized that members would find the group protective against burnout, and early career participants would be more likely to use the group for education and networking. This was a cross-sectional survey study of women physicians in the field of physical medicine and rehabilitation primarily in the United States. The survey consisted of 51 questions covering demographic information, work/life satisfaction, and physician burnout.There were 310 respondents. Those at an earlier career stage accessed the Women Physiatrists Facebook page significantly more often (P = 0.038). Most respondents were neutral regarding the group reducing burnout. Across all career stages, the group was most often used as an educational tool to review patient cases (82.2%). Mid- to late-career members were more likely to use the group to learn about maintenance of certification or continuing medical education requirements (P = 0.019) and searching for a physiatrist in another part of the county (P = 0.016). This study suggests that closed Facebook groups can be useful educational tools across career stages.

How Physician Compensation and Education Debt Affects Financial Stress and Burnout: A Survey Study of Women in Physical Medicine and Rehabilitation.

OBJECTIVE: To investigate the contribution of financial stress to physician burnout and satisfaction among women physiatrists. Relationships among education debt and compensation with demographic, sociologic, and workplace factors were also assessed. DESIGN: This was a cross-sectional survey study of women physicians in the field of physical medicine and rehabilitation (PM&R) in the United States. The survey consisted of 51 questions covering demographic information (current and maximum education debt, race/ethnicity, years out of training, practice type and setting, hours worked, family structure, and domestic duties), work/life satisfaction, and burnout. The association between current/maximum debt and demographic characteristics, work/life satisfaction, and physician burnout were examined. RESULTS: Of the 245 U.S. women attending physiatrists who met inclusion criteria, 222 (90.6%) reported ever having education debt (median category $101 000-150 000) and 162 (66.1%) reported current debt (median category ≤ $50 000). Of these participants, 218 (90.5%) agreed that they would have fewer burnout symptoms if they were able to do more work that is core to their professional mission and 226 (92.2%) agreed that feeling undervalued at work is linked to physiatrists' burnout symptoms. Greater debt was seen in those who identified as Black/African American, were fewer years out of training, practiced general physiatry, and had both inpatient and outpatient responsibilities. Greater current debt had a significant relationship with measurements of work/life dissatisfaction. Burnout was associated with higher debt, lower compensation, more hours worked per week, and fewer hours of exercise performed per week. CONCLUSIONS: This study examined women physiatrists' perceptions of financial stress and found that greater education debt was associated with personal life dissatisfaction, career regret, and burnout. Further research is needed to address related causes and solutions.

Spasticity Outpatient Evaluation via Telemedicine: A Practical Framework.

The COVID-19 global pandemic has resulted in significant changes to delivery of care in the field of physiatry. Most prominently, in-person visits have fast tracked to virtual visits. As we are forced to quickly adopt this new technology for our doctor-patient interactions, many questions remain with regard to structuring telemedicine visits for optimal outcomes. Little has been written on virtual evaluations of patients with spasticity. The intent of this article was to provide a framework for conducting a virtual spasticity assessment via telemedicine. We will provide tips on how to conduct a person-centered virtual examination assessment and how to document goals related to the virtual assessment.