Developing an Inclusive Training Environment: Accommodations in Physical Medicine and Rehabilitation Residency Training for Residents With a Disability.

ABSTRACT: This study examines the challenges and accommodations for medical residents with disabilities within physical medicine and rehabilitation training programs. Medical residency presents unique stressors and responsibilities, with the potential for added complexities for residents with disabilities. Few data exist regarding the prevalence and experiences of people with disabilities as medical trainees and the limited studies available highlight an underrepresentation of individuals with disability in medical training and practice. Through cross-sectional surveys administered to physical medicine and rehabilitation residents, this research assesses disability prevalence, characterizations, barriers to training, and accommodations provided. Of 140 respondents, 9.3% identified as having disabilities, with varying prevalence among genders and disability types. Results revealed distinct challenges for residents with mobility and nonmobility disabilities, spanning learning environments, standardized testing, procedural skills, and accessibility. Self-provided accommodations exceeded program-provided ones, indicating room for improvement in program support. These findings underscore the need for proactive dialog between residents and leadership to address barriers, enhance accommodations, and create an inclusive training environment. The study's insights emphasize the importance of advocating for equal opportunities and cultivating supportive conditions to enable individuals with disabilities to thrive in medical residency programs, ultimately contributing to more diverse and inclusive medical communities.

A Comparison of Self-Reported Unmet Healthcare Needs among Adaptive and Able-Bodied Athletes.

BACKGROUND: Studies have revealed a higher incidence of injury and illness among elite adaptive athletes when compared to able-bodied athletes in competition. However, individuals with disabilities report poorer access to health care. OBJECTIVE: The purpose of this study is to identify differences in healthcare access, satisfaction, and unmet needs between recreational adaptive and able-bodied athletes in all sports and within a single sport (hockey). DESIGN: Cross-sectional, survey-based study. SETTING: Recreation sports programs in Boston, MA and Chicago, IL. PARTICIPANTS: Adult, recreational, competitive adaptive, and able-bodied athletes. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): The Short-Form Patient Satisfaction Questionnaire (PSQ-18) for healthcare access and satisfaction; percentage of athletes reporting unmet sports-related healthcare needs in the prior year. RESULTS: Sixty adaptive athletes (78% male, age 35.7 ± 12.4 years) and 65 able-bodied athletes (40% male, age 34.9 ± 11.9 years) participated. Mean access and satisfaction scores were not significantly different between groups in all sports (P = .53 and P = .19, respectively) or hockey (P = .28 and P = .55, respectively). Unmet needs were more commonly reported among adaptive athletes (18.3% all sports, 20.0% hockey) as compared to able-bodied athletes (9.2% all sports, 4.0% hockey). This reached statistical significance in the hockey group (P = .03), but not all sports (P = .12). CONCLUSIONS: No differences were seen between groups in healthcare access or satisfaction scores. Adaptive athletes of the same sport reported a higher rate of unmet sports-related healthcare needs but with few doctor's visits in the preceding year, suggesting discrepancies in expectations and healthcare-seeking behavior. LEVEL OF EVIDENCE: III.

Tibial Acceleration Measured from Wearable Sensors Is Associated with Loading Rates in Injured Runners.

BACKGROUND: The loadrate of the vertical ground reaction force at impact has been associated with a variety of running injuries. Peak tibial shocks occur during the early stance phase and has been shown to be correlated to the loadrates in healthy runners using a rearfoot strike pattern. As a result, tibial accelerometry has been used as a surrogate for loadrates. However, these correlations have not been assessed in injured runners nor in runners with differing footstrike patterns. OBJECTIVE: To examine the relationship between tibial acceleration and loadrates in injured runners who are habitual rearfoot (RFS), midfoot (MFS), and forefoot (FFS) strikers. Tibial acceleration was expected to be positively associated with loadrates across all footstrike patterns. DESIGN: Cross-sectional cohort. SETTING: Academic medical center with biomechanics laboratory. PARTICIPANTS: One hundred sixty-nine injured runners (age 38.7 ± 13.1 years, 127 RFS, 17 MFS, 25 FFS). METHODS: Each participant completed a biomechanical assessment for injury including evaluation on a force treadmill with a triaxial accelerometer fastened by a Velcro strap to the distal medial tibia. Peak vertical and resultant tibial acceleration (VTA, RTA) were measured from the accelerometer. Vertical average and instantaneous loadrates (VALR, VILR) and the resultant instantaneous loadrate (RILR) were determined from the force data. MAIN OUTCOME MEASUREMENTS: The relationship between tibial acceleration and loadrates measured using Pearson's correlation coefficient (r). RESULTS: Loadrates were each associated with VTA (r = 0.66-0.82, P < .001) and RTA (r = 0.41-0.68, P < .05) across all footstrike groups with the exception of association of VILR to RTA in the FFS group. The strength in correlations was lowest between RTA and loadrates for the FFS runners (r = 0.41-0.47, P < .05). CONCLUSION: Vertical tibial acceleration is the stronger surrogate for loadrates in injured runners across differing footstrike patterns.

Popliteal Artery Entrapment Syndrome-Return to Sport Considerations: A Case Report.

This is a case of a 19-year-old female collegiate field hockey player with left leg pain, numbness, and tingling. A comprehensive workup including dynamic ultrasound, magnetic resonance imaging (MRI), and magnetic resonance angiogram (MRA) revealed a type VI functional popliteal artery entrapment syndrome (PAES). There are many options for treatment of functional PAES including activity modification, botulinum toxin injection, and surgery. To the authors' knowledge there is no published return to sport recommendation for postsurgical functional PAES. This report highlights alternative treatment options and proposes a postsurgical return to play rehabilitation protocol in functional PAES. LEVEL OF EVIDENCE: V.

Measuring the Impact of Research Using Conventional and Alternative Metrics.

Bibliometrics use statistical methods to measure the scholarly impact of publications. Bibliometrics are categorized as conventional metrics or alternative metrics. Conventional metrics have often been considered the standard to measure the impact of publication-related scholarship. With the growing popularity of social media and ease of instantaneous distribution of information globally, alternative metrics have become an important complementary measure of scholarly activity. Bibliometrics may provide a standard performance measurement that may be used for tenure and/or promotion among academic institutions. The alternative metric industry has shown considerable growth with increasingly improved algorithms working towards standardization. Together, conventional metrics and alternative metrics may synergistically complement each other to provide an accelerated translation from research to clinical care that may lead to tremendous benefits in patients. All physicians and other healthcare professionals should receive training in bibliometrics and understand the potential impact of professional social media use.

Regenerative Sports Medicine: Past, Present, and Future (Adapted From the PASSOR Legacy Award Presentation; AAPMR; October 2016).

Regenerative medicine has shown dramatic expanse and evolution in the past decade. Within that milieu, physiatrists are taking an active role in research, clinical care delivery, and education. The purpose of this review is to provide a balance among evidence, theory, experience, clinical trends, and the foreseeable future. We focus on the literature that reports the research with the best methodology in each practice area, recognizing that the level of evidence varies substantially among different treatment modalities and conditions. The following elements are included: an overview of the evolution of currently available regenerative techniques, evidence base for each available modality (prolotherapy, platelet rich plasma, bone marrow aspirate concentrate and stem cells, adipose-derived stem cells, and amniotic tissue products), general principles in the application of these treatments, and discussion and a vision of what lies ahead. We expect that practitioners will use this review to facilitate clinical decision making and to provide a core knowledge base to assist when counseling patients. LEVEL OF EVIDENCE: IV.