Physical Medicine Specialists Research Articles

Physician Workforce in Lithuania: Changes during Thirty Years of Independence.

Healthcare human resource planning is one of the biggest challenges facing the healthcare systems in many countries. Inadequate decisions in human resource planning can lead to an insufficient number of healthcare professionals then healthcare inequalities. One of the components of resource planning in the healthcare system is long-term data monitoring and the identification of potential trends. Since 1990, the number of physicians in Lithuania has decreased by 15.3% (-2266), but the decrease in the population has led to a 13.61% increase in the number of physicians per 10,000 inhabitants (5.32). During the analyzed period, the largest decrease in the number of physicians workforce by specialty was the number of medical physicians (-73.08%), epidemiology and hygiene (-69.30%), children's diseases (-49.08%), the most increased number was of family/general practitioners (GPs), geneticists, physical medicine, and rehabilitation specialists. Since 1992, the number of visits to physicians in Lithuania, which has been decreasing for a long time, began increasing, and in 2022 (9.3 visits) it has almost reached the number of visits (9.5) per capita as in 1991. The aim of this research was to collect long-term data from various databases, summarize them, and identify possible trends and the reasons for data changes. The study analyzed data from the Lithuanian healthcare system from the Declaration of Independence of Lithuania to the last 30 years. The data includes or affects the indicators of the healthcare system, changes in population and doctors, the number of visits to doctors, the number of medical students and residents, and data determining inequalities in the healthcare system. Long-term data analysis is useful for developing a model of healthcare human resource planning and for planning healthcare resources.

Limb spasticity and telemedicine consultation for reconstructive surgery: patient perspectives of surgical assessment.

Spasticity is characterized by increased muscle tone and stretch reflexes, often caused by an upper motor neuron (UMN) syndrome. Many patients live with their dysfunction of their upper or lower limbs for many years and are managed by a multidisciplinary team including physical medicine and rehabilitation specialists, neurologists, and/or physical therapists in an attempt to decrease their spasticity and enhance their quality of life. Reconstructive surgery is a treatment option for many patients living with spasticity. The goal of surgery is to permanently decrease their spastic tone and improve their quality of life. Spastic hemiplegia or hemiparesis is an area of orthopedic surgery that is uniquely suited to telemedicine evaluation. Telemedicine visits can lower the threshold for patients to obtain consultation, receive second opinions, and determine whether traveling for an in-person assessment might be worthwhile, particular to larger medical centers. The objective of our study was to characterize patient perceptions of telemedicine consultation for spasticity surgery and to determine its effectiveness for indicating reconstructive procedures. An electronic survey consisting of 16 questions was distributed to all patients after the virtual consultation from April 2020 to September 2022 as part of a neuro-orthopedic evaluation. Domains of inquiry included patient demographic and diagnosis information, satisfaction with provider assessment, ease of use, appointment preference, and whether surgery was eventually performed. Identifying information was voluntarily provided by patients and allowed for survey data to be linked to the medical record. Patients were included in the study if they were diagnosed with upper and/or lower extremity spasticity, were evaluated by telemedicine visit, and were over the age of 18. They were excluded from the study if they were evaluated for any condition aside from spasticity or returned an incomplete survey. Patients who completed the survey were prospectively followed through December 2022 to determine whether a subsequent in-person visit was pursued and/or reconstructive surgery was performed. A total of 19 of 36 patients completed surveys, for a response rate of 52.7 %. Nearly all (94.7 %, n=18) patients felt that the provider expressed maximal concern for patient questions/worries, included them in decisions regarding care, and appropriately discussed treatment strategies. Similarly, the majority (89.5 %, n=17) were maximally satisfied with explanations about their condition and would recommend the care provider to others. Most patients (84.2 %, n=16) also felt that the ease of communication via the virtual platform was very good. All patients were eventually indicated for and subsequently underwent reconstructive surgery for spasticity. Spasticity patients were overwhelmingly satisfied with their initial virtual consultation as an alternative to face-to-face visits. Telemedicine provides a clinical opportunity for seeking information about spasticity surgery and offers a cost-effective and convenient option for patients who find travel to specialty centers prohibitive.

Designing and Manufacturing an Affordable and Easy to Use Visual Bio Feedback Device to Fix Forward Head Posture: A Pilot Study Involving Female Students

Forward Head Posture (FHP) is when the head leans forward due to factors such as heavy backpacks or poor computer ergonomics. FHP can lead to neck strain and discomfort as well as potential long-term issues such as arthritis. Treatment options include specialized exercises, orthopedic devices, manual therapy, physical exercises, and visual feedback techniques, along with guidance from specialists in physical medicine and rehabilitation. In this study, a visual feedback-based approach was used to address FHP in female students. The study spanned ten days and included a visual feedback group and a control group. The results showed significant improvements in maximum head angle deviation in the visual feedback group compared to the control group; however, there was no significant change in the DFA number, indicating stability in policy control by the central nervous system. The study demonstrated that visual feedback sessions led to immediate benefits, with participants progressively acquiring skills involving the maintenance of proper head positioning. The test results indicated that the neck angle decreased to less than 15 degrees, indicating a return to a normal state. The versatility of the developed affordable and easy-to-use device and the potential for using smartphone motion sensors for similar visual feedback systems are discussed in this paper as well. The study suggests the promising potential of visual feedback in healthcare, including remote monitoring and smartphone-based solutions.

Physical Medicine and Rehabilitation residency in Peru: number of vacancies and analysis of study plans

Introduction. In Peru there is a shortage of physiatrists, and the standards for the training of specialists in Physical Medicine and Rehabilitation (PM&R) have not been updated since 2002. There are no studies that have focused on this problem. Objectives. To describe the number of PM&R positions and analyze the PM&R residency programs’ curriculums. Methods. Descriptive observational study. We reviewed the number of PM&R positions offered in the 2017-2022 period. Likewise, we collected the variables of interest from the curriculums that offer this residency program, including the approach of 30 basic competencies recommended by the International Society of PM&R (ISPRM). Results. During the 2017-2022 period, 11 universities offered 283 PM&R positions, of which 89.4% corresponded to the city of Lima. The number of positions showed a downward trend from 2018 to 2021. 7/11 curriculums addressed at least 75% of the basic competencies recommended by the ISPRM, and none of them addressed 100% of these competencies. In addition, we found heterogeneity between universities respect to the theoretical courses taught, the number of academic credits and the external rotations allowed. Conclusions. In Peru, the number of PM&R positions decreased during the COVID-19 pandemic, despite its crucial role in caring for the affected population and the shortage of physiatrists. No curriculum includes all the basic competencies recommended by ISPRM, highlighting the need to update and restructure them.

Pain Management Strategies for Botulinum Toxin Type A Injections in Children: A Comprehensive National Survey and Procedural Protocol.

Botulinum toxin type Ainjections are a first-line treatment forspasticity in children. Our purpose is to delineate the national landscape concerning pain management for botulinum toxin type A injections in pediatric patients and to formulate a protocol grounded in current scientific evidence. We conducted a nationwide survey targeting physical medicine and rehabilitation specialists performing botulinum toxin type A injections for focal spasticity in children in Portugal. We conducted a literature review to compare the survey results with clinical guidelines, good practice manuals, and protocols published in the literature. Finally, we developed a procedural protocol for pain management in botulinum toxin procedures. The survey was completed by 17 out of 18 identified specialists. All but one use some form of periprocedural analgesia. Five do not use any type of sedation. The majority do not assess pain during the procedures. From the reviewed articles, we obtained 23 articles, 19 of which provided data for detailed analysis. A prevailing concern centers around pain management during botulinum toxin procedures in children. Nevertheless, a distinct absence of uniformity persists in appraising and managing procedure-related pain. This notion is further underscored by the marked heterogeneity and paucity of published literature within this realm. The systematic implementation of a procedural protocol thus becomes highly crucial.

Clinician perspectives on postamputation pain assessment and rehabilitation interventions.

The purpose of this study was to explore self-reported Veterans Affairs (VA) amputation clinician perspectives and clinical practices regarding the measurement and treatment for amputation-related pain. Cross-sectional survey with 73 VA rehabilitation clinicians within the VA Health Care System. The most frequent clinical backgrounds of respondents included physical therapists (36%), prosthetists (32%), and physical medicine and rehabilitation specialist (21%). Forty-one clinicians (56%) reported using pain outcome measures with a preference for average pain intensity numeric rating scale (generic) (97%), average phantom limb pain intensity numeric rating scale (80%), or Patient-Reported Outcomes Measurement Information System pain interference (12%) measures. Clinicians' most frequently recommended interventions were compression garments, desensitization, and physical therapy. Clinicians identified mindset, cognition, and motivation as factors that facilitate a patient's response to treatments. Conversely, clinicians identified poor adherence, lack of belief in interventions, and preference for traditional pain interventions (e.g., medications) as common barriers to improvement. We asked about the frequently used treatment of graded motor imagery. Although graded motor imagery was originally developed with 3 phases (limb laterality, explicit motor imagery, mirror therapy), clinicians reported primarily using explicit motor imagery and mirror therapy. Most clinicians who use standardized pain measures prefer intensity ratings. Clinicians select pain interventions based on the patient's presentation. This work contributes to the understanding of factors influencing clinicians' treatment selection for nondrug interventions. Future work that includes qualitative components could further discern implementation barriers to amputation pain rehabilitation interventions for greater consistency in practice.

Recommendations of the Moroccan Society of Rheumatology (SMR) for Diagnostic Management of Spondyloarthritis (SpA) and Psoriatic Arthritis (PsA).

In 2017, the Moroccan Society of Rheumatology (SMR) issued guidelines for the treatment of severe ankylosing spondylitis. The emergence of new therapeutic classes, the update of international guidelines for axial SpA and psoriatic arthritis, and the diagnostic and therapeutic challenges encountered by rheumatologists has led to the development of recent SMR guidelines for the management of SpA patients. A group-work included rheumatologists, specialists in physical medicine and rehabilitation, and epidemiologists from various sectors was tasked with writing these recommendations based on a literature review, then adapting them to the national context. Thus, 33 recommendations were selected and organized into two sections: diagnostic and therapeutic. The diagnostic section included three general principles and fourteen recommendations. The first, second, and third recommendations concerned the definition and diagnostic criteria for psoriatic arthritis and psoriatic arthritis. In the management of SpA, Recommendation 4 prioritized the importance of opportunity windows. The recommendation5 concerned the diagnostic and prognostic significance of HLAB27. The sixth and seventh recommendations related to imaging of the sacroiliac joints and the spine. The eighth recommendation focuses on the diagnosis and evaluation of perivascular thrombosis activity. The ninth and tenth recommendations concerned the evaluation of SpA activity and psoriatic arthritis. The eleventh and twelfth recommendations concern the evaluation of function and structural progression. The recommendation number thirteen concerned the diagnosis and treatment of coxitis. Recommendation 14 focuses on the most common co-morbidities and extra-rhinitological manifestations observed in SpA.

Recommendations of the Moroccan Society of Rheumatology (SMR) for the Therapeutic Management of Spondyloarthritis (SpA) including Psoriatic Arthritis (PsA).

The advent of new therapeutic classes and the updating of international recommendations have justified the development of recent recommendations by the Moroccan Society of Rheumatology. Methods Guidelines were drafted by a core steering committee after performing a literature search. A multidisciplinary task force, including three fellows, eleven rheumatologists, a specialist in physical medicine and rehabilitation, an epidemiologist from hospital-university, hospital and liberal sectors and one patient assessed the Best Practice Guidelines using 2 rounds of anonymous online voting by modified Delphi process. Thus, 19 recommendations were developed. Recommendation 1 concerns the therapeutic principles, recommendation 2 insists on the information and education of the patient, recommendation 3 concerns the general measures to be adopted, namely physical activity, smoking cessation and psychological support, recommendation 4 concerns Non-Steroidal Anti-Inflammatory Drugs which constitute the first-line treatment, recommendations 5 to 7 concern the use of analgesics, of general and local corticosteroid therapy and conventional synthetic disease-modifying antirheumatic drugs, recommendations 8 to 13 deal with the use of biologic agents, including new classes and their indications in radiographic and nonradiographic axial and peripheral spondyloarthritis, follow-up and management in case of failure or remission, recommendation 14 deals with the indication for Janus kinase inhibitors drugs, recommendation 15 deals with physical treatment and recommendation 16 deals with the indication of surgery. Recommendations 17 to 19 deal with special situations, namely fibromyalgia, vaccination and pregnancy. A well-defined therapeutic strategy with first- and second-line treatments has been established.

COMPARATIVE ANALYSIS OF THE INCIDENCE OF SPINAL DISTORTIONS IN ADOLESCENTS FOR THE PERIOD 2009-2021

Purpose: The study objective is to monitor changes in the incidence of spinal distortions in adolescents in the school years 2008/2009 and 2019/2020 in schools within the territory of the town of Kazanlak. The report presents an overview of the manner and organization of preventive screenings of adolescents and options for subsequent treatment. Materials and methods: The study was carried out by specialists in physical and rehabilitation medicine (PRM) in the school physicians’ offices with the consent of the directors, class teachers, parents and the regional education inspectorate. The preventive screenings were carried out completely free of charge for the pupils, and the treatment of newly discovered spinal distortions was carried out in outpatient conditions and was taken over by the National Health Insurance Fund. Results: The study outcomes showed no change in the incidence of spinal distortions of pupils in classes 1 to 4. However, among children from classes 5 to 10, there is a significant increase in the incidence rate over a period of 10 years. Conclusions: The introduction of modern technologies in pupils’ daily lives and their increasingly active lifestyles over the last 10 years has led to an increase in spinal diseases. PRM specialists are the physicians responsible for restoring preventive screenings for spinal distortions in schools. Our study with subsequent treatment and prevention of these conditions shows a successful approach to dealing with the increased number of scoliosis cases in the town of Kazanlak. Our team believes that this approach can be effectively implemented in each region by the PRM specialists and would have a strong social, economic and health effect in the long term for the population of the Republic of Bulgaria.

Physician attitudes toward sports medicine coverage of mixed martial arts.

The popularity of modern Mixed Martial Arts (MMA) has been increasing since 2000s. It has drawn the attention of the media due to higher injury rates compared to other sports, and it is possible that this may have led to a generally negative image of MMA among viewers, including but not limited to, physicians. Therefore, our study aimed to understand the attitudes of physicians toward MMA and being asked to cover MMA events. A cross-sectional study with an online survey was answered by 410 physicians from four physician organizations throughout the USA. Demographic data, sports event-related, sports coverage experience, athleticism, and familiarity with MMA answers were analyzed. Wilcoxon, Fisher Exact, and χ2 tests were used to compare the data. The main outcomes was the association between characteristics of physicians and attitude toward MMA coverage. Physician characteristics influenced positive attitudes toward MMA coverage. Those who regularly followed MMA felt more strongly that combat sport events required physician coverage, mainly for boxing (92.4% vs. 73.4%; P<0.001), kickboxing (89.9% vs. 54.7%; P<0.001), and taekwondo (50.6% vs. 38.4%; P=0.046). Doctors who considered themselves athletic or who had covered MMA events in the past were more likely to think that all sporting events should be covered by physicians (97.4% vs. 65.9%; P<0.01; 98.4% vs. 72.8%, P<0.001, respectively). Family medicine (72/139 [51.8%]) and physical medicine and rehabilitation (7/11 [63.6%]) were the specialties more inclined to agree with physician coverage for these events. Physicians familiar with MMA, either as a previous ringside physician or as a spectator, are more inclined to believe these events should have physician coverage as are those more experienced with sports medicine, such as family medicine and physical medicine and rehabilitation specialists. Therefore, specialized sports medicine training should be provided to allow for appropriate MMA physician coverage. With additional training, MMA event organizers should feel comfortable asking physicians in any specialty to provide sports medicine coverage to improve care for MMA athletes.

Transitioning care for adolescents with spina bifida in the US: challenges for management.

Open spina bifida (OSB) is a common neural tube defect. Medical and surgical care involves addressing the baseline orthopedic, urologic, and neurological dysfunction as well as the changes or declines that may occur as the patient ages. Given the complexity of this disease, coordinated, multidisciplinary care involving specialists in neurosurgery, orthopedics, urology, rehabilitation and physical medicine, pediatrics, and psychology is necessary to establish and optimize baseline function. Traditionally in the US, pediatric multispecialty spina bifida clinics have provided the patient with a coordinated medical support system. Unfortunately, this coordinated, medical home has been difficult to establish during the transition from pediatric to adult care. Medical professionals must have a strong understanding of OSB to properly manage the disease and detect and prevent associated complications. In this manuscript, we (1) describe the changing needs and challenges of people living with OSB over a lifespan, (2) delineate current practices in the transition of care for people with OSB from childhood to adulthood, and (3) provide recommendations for best practices in navigating the transition process for clinicians who provide care for those afflicted with this most complex congenital abnormality of the nervous system compatible with long term survival.

Association between Nutritional Status, Lifestyle Habits, and Disease Activity in Dalmatian Patients with Rheumatoid Arthritis.

The aim of this study was to evaluate body composition, handgrip strength, quality of life, disease duration and activity and lifestyle habits in patients with rheumatoid arthritis (RA) and to evaluate possible associations between all of the abovementioned factors. Seventy-five stable RA patients were included. Data on sociodemographic data, disease activity, quality of life, nutritional risk, body mass composition, anthropometric parameters, and clinical and laboratory parameters were collected for each study participant. The results showed that the mean score of the disease activity score (DAS28) was 5.4, the mean score of the health assessment questionnaire-disability index (HAQ-DI) was 1.19, and the mean disease duration in our population was 13.9 years. Our studied population had a long disease duration and high disease activity. Positive predictors of muscle mass in RA patients were daily caloric intake, fat-free mass, bone mass, basal metabolic rate, total body water, weight, body mass index (BMI), height, and muscle strength. There were no significant negative predictors. Positive predictors of muscle strength in RA patients were daily caloric intake, basal metabolic rate, predicted muscle mass, fat-free mass, bone mass, weight, total body water, metabolic age, hemoglobin, BMI, and number of exercises per week. In contrast, negative predictors of muscle strength were number of comorbidities, number of swollen joints, DAS, number of tender joints, erythrocyte sedimentation rate (ESR), and duration of RA. An association was also found between bone mineral density and both muscle mass and muscle strength. A structured nutritional approach in terms of multidisciplinary collaboration between rheumatologist, dietitian and physical medicine specialist is needed in the Dalmatian RA population.

M.U.P.S (Medically Unexplained Physical Symptoms): Is the Accurate Diagnosis Necessary for the Rehab-Team?

Background: Physiatrists often treat patients with medically unexplained symptoms (MUPS), which suggest various psychiatric, psychosomatic or physical diagnoses. Some patients are finally diagnosed with somatoform, dissociative or factitious disorders, while some experience psychological factors affecting physical conditions. It happens that patients are admitted to rehabilitative medical facilities without a clear diagnosis. Apparently, there are overlapping symptoms between chronic fatigue syndrome, PTSD (post-traumatic stress disorder), "Gulf War syndrome", fibromyalgia, CRPS, and others.Aims: To assess recognition of medically unexplained physical symptoms (MUPS) by physicians, mostly specialists in physical and rehabilitative medicine are engaged.Methods: All information was collected from scientific database site, and derived from the authors' nearly 50 years of clinical experience.Results: Cognitive-affective disturbance, chronic muscle and joint pain, panic disorder, chronic fatigue syndrome, malingering, and others can be described in the medical literature as unexplained physical symptoms.Conclusions: Treatment should comprise a multidisciplinary-integrative approach, by practitioners from medicine, psychology, allied health professionals and social work. MUPS is not a "non-disease" entity, but rather, an unexplained clinical phenomenon. Patients are entitled to benefit from the rehabilitative medicine model of treatment even if their clinical diagnosis is not accurate or clear.

The effect of the COVID-19 pandemic on pediatric physiatric health care in Croatia among children with neurological risk: A retrospective study.

Since the start of COVID pandemic, the Croatian government issued many recommendations and guidelines, imposed reorganization of health care system, and ordered two lock-downs to mitigate the spread of the disease. All of this may have had an unwanted effect on the standard of health care for non-COVID-19 patients, including children with neurological risk factors. To highlight the possibility that measures taken to mitigate the COVID-19 pandemic may lead to a substantial delay of examination by physical medicine specialists and timely rehabilitation programs for children with neurological risks. A retrospective medical history-based study between 2020 and 2021. The study was performed in Department of Physical and Rehabilitation Medicine at the University Hospital Centre of Split, Croatia. Children with neurological risk examined by pediatric physical rehabilitation specialists in the Department of Physical and Rehabilitation Medicine between January 2017 and December 2021. Case records of patients were reviewed, dividing them into groups according to severity of neurological risk and their age at the time of first examination. We also noted in what months of the year those examinations were performed. The outcome was change in the number of the first examinations and the age of the patients when the examination was first performed. During the pandemic year 2020, the total number of first examinations was lower by 244 (38%; 95% confidence interval [CI]: 34%-42%), and the number of first examinations of children with neurological risks was lower by 216 (36%; 95% CI: 33%-40%).On the contrary, in 2021, there was an increase in the total number of first examinations by 114 (18%; 95% CI: 15%-21%) and first examinations of children with neurological risks compared to the pre-pandemic years by 97 (16%; 95% CI: 13%-20%). Furthermore, the division of patients according to age at the time of first examination significantly differed in the pre-pandemic and pandemic 2021 periods (λ =11.8; p=.018). The greatest contributing factor to this difference was the group of patients older than 12 months. The study suggests that the chaotic initial stages of the COVID-19 pandemic during 2020 caused delay in examinations by physical medicine specialists for children with neurological risks that could potentially affect neurodevelopmental outcomes.

A Study on the Prescription of Herbal Medicines by Physicians for the Elderly in Tehran

Objectives: The use of herbal medicine is one of the most widely used methods of complementary medicine around the world. Studies have shown that the elderly use a variety of herbal medicines and believe that these products are harmless due to being natural. This study aims to evaluate the amount of herbal medicines prescribed by physicians for the elderly in Iran. Methods &amp; Materials: This is a secondary analysis study with a cross-sectional design. The study population consist of the paper prescriptions for all older adults in Tehran, Iran in 2020. Of these, 1591 paper prescriptions for older people aged &gt;60 years referred to pharmacies in Tehran were selected by a cluster random sampling method. The data were analyzed using descriptive statistics (Mean, No. [%]) and inferential statistics (Chi-square test, independent t-test) in SPSS software, version 24. Results: Out of 1591 prescriptions, 79(5%) contained herbal medicines. Laxatives, ginkgo, and ginseng were the most prescribed medicines. Chi-square test results showed the statistically significant relationship of the educational level of the elderly (P=0.018), having insurance (P=0.004) and polypharmacy (P=0.000) with the prescription of herbal medicines, but the gender and marital status of the elderly and the gender, age and work experience of the physicians had no significant relationship with the prescription of herbal medicines. The rate of herbal medicine prescription by general practitioners was 5.7% and by specialized physicians was 4.7%, but no significant relationship was found between them. Among the specialized physicians, infectious disease specialists prescribed the most herbal medicines (14%) followed by physical medicine specialists (12%) and orthopedics (9.2%). Chi-square test results showed a significant relationship between the expertise of physicians and prescription of herbal medicines (P=0.042). Conclusion: The rate of herbal medicine prescription in Tehran city is low, but due to the interest of the elderly in herbal medicines, producing various herbal medicines with suitable forms and dosages and increasing the knowledge of physicians about these medicines can help increase the prescription of herbal medicines.

Toxine Botulique de type A et médecine du sport: ­revue de littérature et applications pratiques

In sports medicine, Botulinum Toxin type A (BoNT-A) can sometimes be used as an alternative for some of the most common pathologies of the musculoskeletal system. The objective of this narrative review is to identify the main current indications for BoNT-A in common sports pathologies, the technical conditions for its use, the doses used, and the main beneficial or adverse effects expected, in order to allow a practical approach for the clinician. The injections are performed by a Physical and Rehabilitation Medicine or Sports Medicine specialist, and requires an operator trained in EMG and/or ultrasound muscle detection. The main indications are epicondylalgia, plantar fasciitis, chronic exertional compartment syndrome (CECS), the functional popliteal artery entrapment syndrome (FPAES) and patellofemoral syndrome. The main effect sought being muscle-relaxant, undesirable transient paresis may occur, requiring some precautions regarding the dose used and a search for the optimal period in the sports calendar in order to minimize this risk. Despite the multiplication of recent studies on the subject, the current level of evidence remains low and limits the use of BoNT-A to cases of failure or contraindication to first- or second-line treatments, and is performed without any guarantee of financial coverage.

Cerebral palsy in Morocco: state of affairs and challenges

Cerebral palsy (CP) constitutes a major public health problem in Morocco; there is a lack of prevalence and incidence studies. Objectives. The aim of our work is to study and analyze the epidemiological profile of disability, list the challenges and pitfalls concerning the management of CP in Morocco and developing countries, and highlight practical recommendations for health policymakers in terms of CP in particular and disability in general. Material and methods. Authors performed a literature search using MEDLINE, EMBASE, SCIENCE DIRECT, and Google scholar, but also searched in international and local journals to identify articles that examined CP in Morocco. Combination of keywords, such as “Cerebral Palsy” “disability” and “nervous system”, and matching it with “Morocco”, or other developing countries. Outcomes. There are an unsatisfactory number of specialists in physical medicine, lack of good collaboration between specialists involved in CP management and physiotherapists. This situation is more pronounced in small cities and rural areas. However, in Morocco compared to other developing countries, as in Sub-Saharan Africa, the situation is much better. Conclusion. CP is becoming a priority of Moroccan ministry of health and ministry of social affairs and huge improvements are made, mainly in university hospitals, the use of new techniques and reducing the management gap of regional hospitals, and rural areas with the recent use of tele rehabilitation.

Evaluation of disease burden, patient journey, unmet diagnosis and treatment needs of patients with HIP and knee osteoarthritis in Turkey: A study through Delphi Methodology

ObjectiveTo get information-driven insights from expert physicians regarding multiple aspects of the patient journey in knee and hip OA and establish a consensus for future studies and decision tree models in Turkey. Design157 questions were asked in total during this three-round modified Delphi-method panel to 10 physical medicine and rehabilitation specialists (2 have rheumatology and 3 have algology subspeciality), one orthopaedic surgeon and one algology specialist from anaesthesia specialty background. A consensus was achieved when 80% of the panel members agreed with an item. Contradictions between different disciplines were accepted as a non-consensus factor. ResultsPanellists agreed that American College of Rheumatology classification criteria is mostly sufficient to provide an OA diagnosis in clinical practice, OA patients with ≥5 Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain or physical function score can be defined as moderate-to-severe OA if they have an additional ≥2 Kellgren-Lawrence (KL) score, a minimum improvement of 30% from baseline in WOMAC pain or function subscales or in PGA score can be accepted as moderate treatment response where ≥50% improvement from baseline in those scores as substantial response. Panellists stated that arthroplasty procedures need to be delayed as long as possible, but this delay should not jeopardize a beneficial and successful operation. ConclusionsThese findings show that there is a significant disease burden, unmet treatment needs for patients with moderate-to-severe OA in Turkey from experts’ perspective. Therefore, an updated systematic approach and decision tree models are needed to be implemented.

Debilitating hip degeneration in trichothiodystrophy: Association with ERCC2/XPD mutations, osteosclerosis, osteopenia, coxa valga, contractures, and osteonecrosis.

Trichothiodystrophy (TTD) is a rare, autosomal recessive, multisystem disorder of DNA repair and transcription with developmental delay and abnormalities in brain, eye, skin, nervous, and musculoskeletal systems. We followed a cohort of 37 patients with TTD at the National Institutes of Health (NIH) from 2001 to 2019 with a median age at last observation of 12 years (range 2-36). Some children with TTD developed rapidly debilitating hip degeneration (DHD): a distinctive pattern of hip pain, inability to walk, and avascular necrosis on imaging. Ten (27%) of the 37 patients had DHD at median age 8 years (range 5-12), followed by onset of imaging findings at median age 9 years (range 5-13). All 10 had mutations in the ERCC2/XPD gene. In 7 of the 10 affected patients, DHD rapidly became bilateral. DHD was associated with coxa valga, central osteosclerosis with peripheral osteopenia of the skeleton, and contractures/tightness of the lower limbs. Except for one patient, surgical interventions were generally not effective at preventing DHD. Four patients with DHD died at a median age of 11 years (range 9-15). TTD patients with ERCC2/XPD gene mutations have a high risk of musculoskeletal abnormalities and DHD leading to poor outcomes. Monitoring by history, physical examination, imaging, and by physical medicine and rehabilitation specialists may be warranted.

Respiratory Rehabilitation Management in Adult Neglected Spinal Muscular Atrophy Type II Patient: A Case Report

Introduction: Physical Medicine and Rehabilitation Specialists (Physiatrists) usually take care of patients with Spinal Muscular Atrophy Type II in an early childhood. The progression of respiratory dysfunction should be considered as the most disabling condition in patient with Spinal Muscular Atrophy Type II and need further respiratory rehabilitation approaches.This case describes an adult Spinal Muscular Atrophy Type II that is considered a late or neglected case as a lost case in the management of respiratory rehabilitation but his remain functional reserve must be optimized to reach a manageable respiratory outcome in daily living.