[Beliefs and perceptions of the diagnosis and treatment of fibromyalgia in a group of rehabilitation and physical medicine specialists in Colombia]. / Conceptos y percepciones acerca del diagnóstico y tratamiento de la fibromialgia en un grupo de médicos especialistas en medicina física y rehabilitación en Colombia.

INTRODUCTION: Fibromyalgia is a chronic disease characterised by the presence of musculoskeletal pain, usually associated with other symptoms, including depression, fatigue, and sleep disorders. There is no objective information on the beliefs and perceptions of the diagnosis and treatment of fibromyalgia among rehabilitation and physical medicine specialists. The aim of this study was to describe these beliefs and perceptions among a group of physical medicine and rehabilitation specialists in Colombia. METHODS: We performed a cross-sectional study. A focus group was held with the participation of 2 rheumatologists, one physical medicine and rehabilitation specialist and an expert in qualitative research. The group designed a survey to assess the beliefs and perceptions of physical medicine and rehabilitation specialists of the diagnosis and treatment of fibromyalgia. The self-administered, anonymous questionnaire was completed during meetings of the Colombian Association of Physical Medicine and Rehabilitation. RESULTS: The questionnaire was completed by 99 physical medicine and rehabilitation specialists. Of these, 17.1% (n=17) believed there was insufficient evidence to consider fibromyalgia a disease, 86.8% (n=86) used the ACR 1990 criteria to diagnose patients with fibromyalgia, and 33.3% (n=33) used the criteria of the 2010 classification. The most commonly used drugs for the management of fibromyalgia were antidepressants, prescribed by 84.8% of the surveyed physicians, followed by analgesics (75.7%) and anticonvulsants (66.6%). Concerning multidisciplinary management, 50.6% referred these patients to a rheumatologist and 40.7% to a psychiatrist. In all, 77.2% of rehabilitation specialists believed that patients with fibromyalgia should be managed by their specialty. CONCLUSION: This study provides information on perceptions of the diagnosis and treatment of fibromyalgia among a group of Colombian rehabilitation specialists and found frequent use of the ACR 1990 classification. Among these physicians, the use of drugs, especially antidepressants and analgesics, was high. Most believed that patients with fibromyalgia should be treated by rehabilitation specialists.

"Look, Your Muscles Are Firing!": A Qualitative Study of Clinician Perspectives on the Use of Surface Electromyography in Neurorehabilitation.

OBJECTIVE: To examine the perceived value, benefits, drawbacks, and ideas for technology development and implementation of surface electromyography recordings in neurologic rehabilitation practice from clinical stakeholder perspectives. DESIGN: A qualitative, phenomenological study was conducted. In-depth, semistructured interviews and focus groups were completed. Sessions included questions about clinician perspectives and demonstrations of surface electromyography systems to garner perceptions of specific system features. SETTING: The study was conducted at hospital systems in a large metropolitan area. PARTICIPANTS: Adult and pediatric physical therapists, occupational therapists, and physiatrists from inpatient, outpatient, and research settings (N=22) took part in the study. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Interviews and focus groups were audio-recorded, transcribed verbatim, then coded for analysis into themes. RESULTS: Four major themes emerged: (1) low-tech clinical practice and future directions for rehabilitation; (2) barriers to surface electromyography uptake and potential solutions; (3) benefits of surface electromyography for targeted populations; and (4) essential features of surface electromyography systems. CONCLUSIONS: Surface electromyography systems were not routinely utilized for assessment or intervention following neurologic injury. Despite recognition of potential clinical benefits of surface electromyography use, clinicians identified limited time and resources as key barriers to implementation. Perspectives on design and surface electromyography system features indicated the need for streamlined, intuitive, and clinically effective applications. Further research is needed to determine feasibility and clinical relevance of surface electromyography in rehabilitation intervention.

Interventional Pain Procedures in Physical Medicine and Rehabilitation Residencies.

Exposure to interventional pain procedures is now a required component of training in physical medicine and rehabilitation residencies as mandated by the Accreditation Council for Graduate Medical Education. Data regarding resident exposure and competency in these procedures remain limited. Objectives were to determine the volume and type of exposure physical medicine and rehabilitation residents have to interventional pain procedures and to obtain faculty-perceived opinions regarding competency of incoming fellows as it pertains to interventional pain management. Online surveys were sent to program directors of physical medicine and rehabilitation residencies and fellowship directors of interventional spine, sports medicine, and pain medicine fellowships. Surveys inquired about educational methods, the volume of procedures in which residents actively participate, and faculty-perceived competency of trainees performing procedures. Thirty-nine residency programs and 27 fellowships responded to the surveys. Of the 39 residencies that responded, there was great variation in the exposure residents receive. Most programs reported that residents have moderate exposure to common procedures such as ultrasound-guided knee injections and lumbar epidural injections. In addition, while most residency program directors report graduates to be "fairly prepared" (33%) to "well prepared" (20.5%) with regard to spine procedures, most fellowship directors (63%) describe incoming fellows to be at the "beginner" level.

Cooperation between general practitioners, occupational health physicians, and rehabilitation physicians in Germany: what are problems and barriers to cooperation? A qualitative study.

PURPOSE: General practitioners (GPs), occupational health physicians (OPs), and rehabilitation physicians (RPs) fulfill different functions in the rehabilitation process, which need to be interlinked effectively to achieve a successful medical and occupational rehabilitation. In Germany, this cooperation at the interfaces is often suboptimal. The aim of this study was to identify and discuss perceived barriers to cooperation between GPs, OPs, and RPs. METHODS: We used a qualitative study design with eight focus group discussions (FGD) with GPs, OPs, RPs, and rehabilitants. Two FGDs per expert group with 4-10 participants were conducted. The transcripts were analyzed using qualitative content analysis. RESULTS: A number of obstacles to cooperation were reported by the participants, including (1) organizational (e.g., missing contact details, low reachability, schedule restrictions), (2) interpersonal (e.g., rehabilitants level of trust in OPs, low perceived need to cooperate with OPs, low motivation to cooperate), and (3) structural barriers (e.g., data privacy regulations, regulations concerning rehabilitation reports). CONCLUSION: The present data agree with study results from other countries, which addressed interfaces in the rehabilitation process. While some barriers could be overcome by the participants themselves, a multi-level stakeholder approach might be necessary. Future quantitative research is required to assess the relative weight of the findings.

Breaking bad news to patients with spinal cord injury in Turkey - physiatrists' perspective.

OBJECTIVE: To explore Turkish physiatrists' experiences and opinions about breaking bad news (BBN) to patients with spinal cord injury (SCI). DESIGN: A cross sectional study. SETTING: Turkey. PARTICIPANTS: Sixty-nine physiatrists completed a questionnaire about experiences and opinions regarding BBN and self-assessment of communication skills (CS). RESULTS: Eleven percent of specialists and 53% of residents were trained on basic CS. All participants believed that physiatrists should play a role in BBN and the majority reported that they delivered the bad news in their clinic. Sixty-seven percent believed that the primary responsibility belongs to physiatrists. Sixty-eight percent reported that the most appropriate time for BBN is during rehabilitation. Self-assessments of CS were considered satisfactory in most steps of SPIKES protocol. Twenty percent told absolute truth to patients while 80% stated that they did so sometimes or partially. Only 41% confirmed that they do not use unrealistic statements to comfort patients. Fewer than 60% stated that they performed the most appropriate and excellent behaviors for items in "empathy" section. CONCLUSION: Physiatrists had different opinions about the style of BBN. Self-assessments of CS were optimistic, however physiatrists were not fully satisfied with their empathy skills.