Impact of postsurgical rehabilitation on outcomes for degenerative cervical myelopathy.

OBJECTIVE: Despite widespread use, there is limited evidence to support postsurgical rehabilitation to enhance neurological recovery after surgery for degenerative cervical myelopathy (DCM). Outcomes research for DCM seldom accounts for the effect of postsurgical rehabilitation. The aim of this study was to quantify the impact of postsurgical rehabilitation on outcomes after surgery for DCM. METHODS: This was a retrospective analysis of prospectively collected data from a single center. The study enrolled 66 patients who underwent spinal surgery for DCM. In addition to patient demographic, imaging, and surgical data, chart review was performed to document the timing, type, duration, and outcomes of postsurgical rehabilitation therapy. Outcomes were collected prospectively, including the modified Japanese Orthopaedic Association (mJOA) score, Neck Disability Index (NDI) score, and SF-36 physical component summary (PCS) score. Linear regression models were created to determine the independent effects of type and timing of postsurgical occupational therapy (OT) and physical therapy (PT) on outcomes. RESULTS: A total of 66 patients were included in the analysis. Multivariate regression analysis showed that postsurgical OT was associated with significantly greater improvement in 12-month SF-36 PCS scores (p = 0.009) and mJOA scores (p = 0.019). In the subset of patients who received therapy, delayed therapy (> 42 days after surgery) compared to early therapy (< 42 days after surgery) was associated with less improvement in SF-36 PCS scores (p = 0.03). CONCLUSIONS: Postsurgical outpatient rehabilitation was independently associated with improved postsurgical outcomes within the 1st year after surgery for DCM, and early therapy (< 42 days) was associated with superior outcomes compared to delayed therapy. This is one of the first studies to use a prospective database to demonstrate an independent effect for postsurgical rehabilitation on outcomes after surgery for DCM.

Burnout and Wellness Strategies Used by Academic Physiatry Programs: An Analysis and Perspective From the AAP Chairs Council.

ABSTRACT: Physiatrists are at elevated risk of burnout, a work-related exhaustion syndrome resulting from chronic stress associated with emotionally draining work demands. The high reported rate of burnout in physical medicine and rehabilitation led the Association of Academic Physiatrists Chair Council to convene a workgroup to address burnout among academic physical medicine and rehabilitation physicians. The council recognizes that leaders of departments are accountable for all organizational stakeholders, including faculty, trainees, and staff. Department leaders are expected to understand and effectively manage the drivers of burnout among stakeholders. The workgroup identified several opportunities, including identifying and disseminating effective burnout mitigation across US academic medical center physical medicine and rehabilitation programs. As a result, in 2019, a work group conducted a survey of US academic physical medicine and rehabilitation program leaders to ascertain the use of strategies for reducing physician burnout. With the aim of identifying, educating, and advancing the development of effective interventions to address burnout among academic physical medicine and rehabilitation departments, the Association of Academic Physiatrists Chair Council advocates for increased education and utilization of effective strategies aimed at promoting physician well-being across organizational levels (national, organizational, work unit, and individual).

Pain Medicine Milestones 2.0: a step into the future.

OBJECTIVE: To describe the process of revising the Pain Medicine Milestones 1.0 and implementing changes into the Pain Medicine Milestones 2.0 along with implications for pain medicine trainees. BACKGROUND: Competency-based medical education has been implemented in graduate medical education, including pain medicine. Milestones 1.0, introduced by the Accreditation Council for Graduate Medical Education (ACGME), has been used to assess learners in six competencies and respective sub-competencies. Recognizing areas for improvement in Milestones 1.0, the ACGME initiated the process of Milestones 2.0 and a working group was created to execute this task for pain medicine. The working group discussed revisions; consensus was sought when changes were introduced. Final milestones were agreed upon and made available for public comment prior to publication. RESULTS: Redundant sub-competencies were either merged or eliminated, reducing the number of sub-competencies. A maximum of three rows representing skill, knowledge, behavior and attitude were included for each sub-competency. Harmonized Milestones, aligning with other specialties in a predetermined ACGME framework, were adopted and modified to meet the needs of pain medicine. A supplemental guide was developed to assist educators in implementation of Milestones 2.0 and assessment of trainees. CONCLUSIONS: The intent of the Milestones 2.0 was to create an improved tool that is comprehensive, easier to utilize, and of increased value for pain medicine training programs. It is expected that implementation of Milestones 2.0 will streamline pain medicine trainee assessments by educators and prepare trainees for the future practice of pain medicine while serving to be the foundation of an iterative process to match the evolution of the specialty.

Upright Magnetic Resonance Imaging Study of Cervical Flexor/Extensor Musculature and Cervical Lordosis in Females After Helmet Wear.

INTRODUCTION: Addition of head-supported mass imparts greater demand on the human neck to maintain functionality. The same head-supported mass induces greater demand on the female spine than the male spine because female necks are comparatively slender. Prevalence of neck pain is greater in military than civilian population because of the head-borne mass (among other factors). The goal of this study is to determine quantifiable parameters related to muscle geometry using female human volunteers and upright magnetic resonance imaging. MATERIALS AND METHODS: Young healthy subjects were consented. Demographics and head-neck anthropometry were recorded. For all the 7 subjects, the T1- and T2-weighted magnetic resonance imaging in the neutral sitting position was obtained immediately following donning and after 4 hours of continuous wear of standard issued military helmet, while seated in the same posture for 4 hours. Cross-sectional areas of sternocleidomastoid and multifidus muscles from C2-C7, overall and segmental Cobb angles (C2-T1), and centroid and radius of each muscle were calculated. Data were compared with determine differences with the continuous helmet wear. RESULTS: There were level specific changes in morphological parameters for each of the muscles. Significant difference (P < 0.05) in cross-sectional areas was noted at C2-3 level for sternocleidomastoid and at C3-4 and C5-6 levels for multifidus. For centroid angles, significant difference (P < 0.05) was observed at C2-3 and C5-6 levels for sternocleidomastoid and at C3-4 level for multifidus. There was no significant difference (P > 0.05) in muscle centroid radii between the pre- and posttest conditions. CONCLUSIONS: Alterations in muscle geometries were muscle specific and level specific: sternocleidomastoid was significant at the upper level, whereas multifidus was significant at the mid-lower cervical spine segments. The insignificant difference in the Cobb angles was attributed to length of time of continuous helmet wear attributed and sample size. Helmet wear can lead to morphometric alterations in cervical flexor/extensor musculature in females.

Navigator Role for Promoting Adaptive Sports and Recreation Participation in Individuals With Disabilities.

OBJECTIVE: The aims of the study were to gain a better understanding of the resources, barriers, and facilitators of participation in adaptive sport and recreational activities as a means of achieving physical activity recommendations in individuals with disability and to understand preferences for a patient navigator service to help mitigate the barriers. DESIGN: Clinical, academic, and community stakeholders applied a community-engaged research approach to develop online surveys and focus group questions for adults with a disability or parents of a child with a disability to meet study objectives. RESULTS: One hundred ninety-eight adults and 146 parents completed the online surveys. Sixteen adults and 18 parents took part in focus groups. Many participants lacked knowledge of available adaptive sport and recreational resources; other barriers were expense, limited number of trained volunteers, and need for instruction. Conversely, persons were facilitated by community, socialization, and words of encouragement/motivation. Participants strongly preferred a patient navigator to be a person active in adaptive sport and recreational or an informative resource-filled website. CONCLUSIONS: Our findings suggest that physical activity programs including adaptive sport and recreational should be designed to offer people with disabilities opportunities to build social networks and strengthen social support. A patient navigator service could help increase participation in adaptive sport and recreational and physical activity within a community context.

A Rare Case of Nontraumatic Thoracic Compression Fracture in a 28-Year-Old Man.

ABSTRACT: A 28-yr-old African American man with a history of synovitis, acne, pustulosis, hyperostosis, and osteitis syndrome, tobacco use, and sickle cell trait was referred to a physiatrist at a multidisciplinary spine center with a 1-yr history of nontraumatic thoracic back pain that had significantly worsened over the previous 4 wks. In the context of recurrent infections requiring hospital admissions and the patient's immunosuppressed status, magnetic resonance imaging of his thoracic spine was obtained, showing an acute or subacute anterior compression deformity of the T7 vertebral body. He was subsequently provided with a hyperextension brace, physical therapy referral, and a trial of intranasal calcitonin. The patient reported significant improvement in pain at his 3-mo follow-up appointment and continued to show pain and functional improvement in physical therapy sessions up to 6 mos later.

Promoting Physical Activity by Creating Awareness of Adaptive Sports and Recreation Opportunities: An Academic-Community Partnership Perspective.

OBJECTIVE: To i) initiate community-academic partnerships in the area of adaptive sports and recreation (ASR) and ii) develop an understanding of local ASR opportunities and how they are used by individuals with disabilities (ID). DESIGN: Clinicians at an academic medical center (AMC) identified a lack of knowledge regarding local ASR opportunities as a barrier to developing strategies to increase physical activity (PA) among ID. Partnerships with community organizations serving ID were formed to increase awareness of ASR opportunities. A community event was held to raise awareness of ASR opportunities among local ID and provided an opportunity for organizations to connect. A survey regarding ASR opportunity awareness and participation barriers was distributed to event attendees. RESULTS: Strategic partnerships with three community organizations were formed to plan the event. A 66% survey response rate (n = 197) was observed, with 40% (n = 78) identifying as an ID, 37% (n = 73) as a caregiver/family member of an ID (CF), and 23% (n = 46) as a community member without a disability (CM). The majority of participants were Caucasian, although this finding was not significant. A difference between perceived barriers among ID/CF and CM was observed, as well as differences in awareness of ASR opportunities among the groups. CONCLUSIONS: Preliminary data emphasize the need to engage ID regarding participation in ASR. Additionally, this study suggests a need to increase engagement among ID/CF of color. This information serves as a foundation for broader community based needs assessments.

Implementing a global integrative rehabilitation medicine rotation: a physical medicine and rehabilitation residency program's experience.

An innovative international rotation in integrative rehabilitation medicine was implemented as part of the physical medicine and rehabilitation residency program at the Medical College of Wisconsin. Rotation objectives were to introduce medical knowledge of integrative medicine treatments into physical medicine and rehabilitation practice and to initiate collaboration with international academic partners. Residents were approved based on their academic record, completion of prerequisites, and personal statement. During a 4-wk rotation located in Italy, residents developed an integrative treatment strategy for each patient using conventional medical care and other therapeutic options, including acupuncture, biofeedback, aquatic therapy, yoga, and others. Postrotation assessment included evaluations by Italian team and patients, residents' evidence-based presentations, and postrotation self-reflection. Participating residents reported high achievement in clinical performance, improved application of integrative medicine, broader appreciation of cultural diversity in patient care, and increased personal and professional development. This reciprocal program model serves as an example for other programs interested in implementing similar international rotations.