Evidence-based position paper on Physical and Rehabilitation Medicine (PRM) professional practice on telerehabilitation. The European PRM position (UEMS PRM Section).

INTRODUCTION: The evidence on the utility and effectiveness of rehabilitation interventions delivered via telerehabilitation is growing rapidly. Telerehabilitation is expected to have a key role in rehabilitation in the future. AIM: The aim of this evidence-based position paper (EBPP) is to improve PRM physicians' professional practice in telerehabilitation to be delivered to improve functioning and to reduce activity limitations and/or participation restrictions in individuals with a variety of disabling health conditions. METHODS: To produce recommendations for PRM physicians on telerehabilitation, a systematic review of the literature and a consensus procedure by means of a Delphi process have been performed involving the delegates of all European countries represented in the UEMS PRM Section. RESULTS: The systematic literature review is reported together with the 32 recommendations resulting from the Delphi procedure. CONCLUSIONS: It is recommended that PRM physicians deliver rehabilitation services remotely, via digital means or using communication technologies to eligible individuals, whenever required and feasible in a variety of health conditions in favor of the patient and his/her family, based on evidence of effectiveness and in compliance with relevant regulations. This EBPP represents the official position of the European Union through the UEMS PRM Section and designates the professional role of PRM physicians in telerehabilitation.

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.

Role of Rehabilitation in Spine Tumors.

ABSTRACT: Primary and metastatic spine tumors can lead to devastating complications, but timely and careful management of these patients can improve outcomes. A multidisciplinary and structured approach is the most effective way to evaluate patients with spine disease and mitigate the risk of complications. The neurologic, oncologic, mechanical and systemic disease framework gives comprehensive guidance to providers regarding appropriate management. Physiatrists play a critical role in these patients' initial evaluation and continued management throughout cancer treatment. Patients with spinal cord involvement have extensive needs, requiring an individualized management approach. Even though patients with nontraumatic spinal cord injury benefit from rehabilitation efforts and have improved outcomes, they are not routinely admitted to inpatient rehabilitation units or referred to outpatient cancer rehabilitation. Ongoing efforts are needed to promote rehabilitation medicine involvement in improving functional outcomes and quality of life for patients with spine involvement.

Proposing a Cancer Rehabilitation Medicine Curriculum for Physical Medicine and Rehabilitation Trainees.

ABSTRACT: With the rapid growth and rising interest in the subspecialty of cancer rehabilitation medicine, establishing a structured training and educational curriculum in cancer rehabilitation medicine has become more crucial than ever. For those who are responsible for the educational experiences of students, residents, fellows, or other healthcare professionals, this article provides a systematic approach for establishing a curriculum template relevant for cancer rehabilitation medicine training. This included the assessment of general and targeted needs for learners and educators, rotation goals and objectives, educational strategies, implementation, and evaluation and feedback.

Changes in Gender and Racial/Ethnic Diversity in US Residency Program Applications From 2018 to 2022.

Background Residency application patterns by gender and race/ethnicity offer important insights about diversity in residency recruitment. It is unknown how the COVID-19 pandemic and virtual interviewing affected these patterns. Objective We hypothesized that the introduction of virtual interviews caused an increase in applications submitted per applicant and that there may be differences by gender and race/ethnicity. Methods We extracted publicly reported Electronic Residency Application Service application data from 2018 to 2022 for 14 residency specialties with 1000 or more applicants in 2022 by self-reported gender and underrepresented in medicine (UIM) status. We compared patterns before and after virtual interviews were introduced in 2021. Results Among 401 480 residency applicants, the average number of applications submitted per applicant increased for all specialties between 2018 and 2022 across gender and race/ethnicity. Across all years, women applied to more programs than men in 5 specialties (dermatology, neurology, obstetrics/gynecology, pediatrics, and surgery), whereas men applied to more programs than women in 3 (anesthesia, family medicine, and physical medicine and rehabilitation). Across all years, non-UIM applicants applied to more programs than UIM applicants in all 14 specialties. There were no clear changes in application patterns by gender and race/ethnicity during in-person versus virtual interview years. Conclusions The average number of applications submitted per applicant increased over time across gender and race/ethnicity. In some specialties, women applied to more programs than men, and in others vice-versa, whereas non-UIM applicants applied to more programs than UIM applicants in all specialties. Virtual interviews did not change these patterns.

Multidisciplinary Team Working in Rehabilitation Medicine: Advantages and challenges.

Healthcare is delivered in a very complicated environment where numerous variables affect the patient related outcomes. A multidisciplinary team that places a high priority on patient satisfaction and healthcare quality can help to simplify and manage the environment of complex healthcare delivery. The foundation of rehabilitation treatments is a multidisciplinary team approach to provide interventions and care for the patients. Regardless of the population studied, multidisciplinary rehabilitation has been shown to be more effective than therapy delivered by individual therapists in a number of different populations. Due to the patient's complex impairments, a team-based approach is necessary for assessments and facilitates coordinated care planning in the rehabilitation settings. The aim of this paper is to offer a narrative review of the advantages and challenges of multidisciplinary team working. The key components of teamwork in rehabilitation are the individualization of patient care and effective team communication.

[Rehabilitative technologies in patients after total endoprosthesis of lower limbs' major joints: scientometric analysis]. / Reabilitatsionnye tekhnologii u patsientov posle total'nogo endoprotezirovaniya krupnykh sustavov nizhnikh konechnostei: naukometricheskii analiz.

Dynamically developing sphere of physical and rehabilitative medicine raises an important issue on implementation of technologies with proven effectiveness to recover neuromuscular, skeletal and movement-related functions, activity and partipation of traumatological patients into rehabilitation practice. The aim of this review is the consistent information analysis and synthesis of evidence-based researches of current effective methods in the context of medical rehabilitation after endoprosthesis of lower limbs' major joints, as well as the provision of structured information that helps to influence on decision-making for doctors of physical and rehabilitative medicine and other professionals who take part in multidisciplinary interaction.

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.

EURO-MUSCULUS/USPRM Dynamic Ultrasound Protocols for Ankle/Foot.

ABSTRACT: In this dynamic scanning protocol, ultrasound examination of the ankle is described using various maneuvers to assess different conditions. Real-time patient examination and scanning videos are used for better simulation of daily clinical practice. The protocol is prepared by several/international experts in the field of musculoskeletal ultrasound and within the umbrella of European Musculoskeletal Ultrasound Study Group in Physical and Rehabilitation Medicine/Ultrasound Study Group of the International Society of Physical and Rehabilitation Medicine.

[Annual progress in pulmonary rehabilitation 2023].

Pulmonary rehabilitation is a key component of long-term management strategies for chronic respiratory diseases (CRD). This comprehensive intervention, carefully tailored to individual patients based on thorough assessments, has undergone significant expansion and refinement toward personalization and precision in recent years. This review consolidates findings from studies published between October 2022 and September 2023, covering advances in CRD rehabilitation, assessment criteria, mechanisms, and innovative equipments. The primary objective is to enhance the knowledge base of healthcare professionals and pave the way for future research efforts in this important area.

Diversity, Equity, and Inclusion Curriculum Embedded in a Physical Medicine and Rehabilitation Residency Program.

ABSTRACT: Diversity, equity, and inclusion initiatives are continuing to have increased importance in medical training, including rehabilitation medicine. Although resident-led curricula have been integrated into medical education in other training programs, to our knowledge, this the first report focusing on integrating these topics into resident education for a physical medicine and rehabilitation program. We created a didactic curriculum for our rehabilitation residents that included: quarterly lectures on diversity, equity, and inclusion topics followed by small group discussions. Each session also included an article that was included in the discussion. The sessions used both anonymous presurvey and postsurvey data to assess the efficacy of our initiative. Our initial data showed that our quarterly sessions created a safe and comfortable environment for discussing diversity, equity, and inclusion topics. In addition, our session specific data supported that increased awareness of diversity, equity, and inclusion disparities with rehabilitation and medicine was achieved. Our committee used the data and feedback to create further iterations of this initiative within our program, and we believe that this is a model that can be adopted by other physical medicine and rehabilitation residencies.

Physical Medicine Applications in Hand Burns: Treatment or Rehabilitation.

The aim of this study is to investigate the contribution of concurrent physical therapy to the preservation of hand function in patients with hand burns. This retrospective cohort study included the records of adult patients who presented with hand burns between July 1, 2020, and December 1, 2021. A total of 67 of 1578 burn patients who attended the clinic were included in this study. The patients' age, sex, total BSA with burns, causative agent, depth of burn on the hand, right or left hand, location of the burned area on the hand, treatment applied, healing time of the burn on the hand, limitation of movement, the joint restrictions, contractures, and compliance with physical therapy were assessed and recorded. Among the 67 patients included, 82.1% (n = 55) had no limitation in terms of their joint range of motion, whereas 17.9% (n = 12) had a limitation of movement in their finger joints. When the prevalence of movement limitation was examined by gender, such limitation was found to be more common in females (P = .041). Moreover, contractures were found to occur more frequently in patients with full-thickness burns (P = .032). It was also found that the limitation of movement was more severe in patients with skin grafts (P = .044). In addition, it was observed that the recovery time of the burn area was longer in those patients who had movement limitations (P = .004). In this study, we found that applying early physical therapy to patients after burn injuries facilitated the recovery of hand functions.

AI-ChatGPT/GPT-4: An Booster for the Development of Physical Medicine and Rehabilitation in the New Era!

Artificial intelligence (AI) has been driving the continuous development of the Physical Medicine and Rehabilitation (PM&R) fields. The latest release of ChatGPT/GPT-4 has shown us that AI can potentially transform the healthcare industry. In this study, we propose various ways in which ChatGPT/GPT-4 can display its talents in the field of PM&R in future. ChatGPT/GPT-4 is an essential tool for Physiatrists in the new era.