Physical Medicine Research Articles

Planetary Health in Rehabilitation: A Call to Arms… and legs, gait aids, and other equipment.

Sometimes out of necessity and sometimes out of convenience, medicine is wasteful. Resource stewardship is a critical and expanding field for reducing wasteful practices. Numerous international organizations are driving resource stewardship globally, including >20 countries worldwide participating in Choosing Wisely initiatives. However, opportunities for environmental stewardship have been long overlooked. Planetary health, climate action, and environmental stewardship in medicine consider opportunities which offer a co-benefit to the planet while improving or maintaining appropriate patient care across the healthcare continuum, including acute care, transitions in care, and post-acute care, as well as in primary, secondary, and tertiary care settings. As rehabilitation is necessary across all healthcare settings, developing a culture amongst rehabilitation care providers that is conscientious about planetary health is imperative for sustainability of rehabilitation medicine and the health of our planet. We devised a recommendation for Choosing Wisely Canada's planetary health focus: don't dispose of adaptive equipment, mobility devices, orthoses, and prostheses that could be reused or recycled. This brief report discusses 1) why rehabilitation providers should engage with planetary health and climate action; 2) the rationale for the Choosing Wisely Canada Physical Medicine & Rehabilitation planetary health recommendation, and 3) existing avenues and novel opportunities for rehabilitation care providers worldwide to reduce waste in rehabilitation.

Handgrip Strength and Cognitive Recovery in Older Stroke Survivors: A Prospective Study

Background and Objectives: Handgrip strength (HGS) is an important indicator of overall physical capability and is linked to various health outcomes in older adults. Despite extensive research on the relationship between HGS and cognitive decline, longitudinal studies on poststroke cognitive changes in relation to HGS are scarce. This study aimed to observe whether HGS at discharge from acute stroke rehabilitation affects cognitive function 6–12 months after stroke onset and to compare cognitive outcomes between patients with normal and low HGS at discharge. Materials and Methods: This prospective cohort study was conducted in the Department of Rehabilitation Medicine at a tertiary care hospital. In agreement with the Asian Working Group for Sarcopenia 2019 criteria, low muscle strength was defined as an HGS of less than 28 kg for men and less than 18 kg for women, and participants were categorized into normal and low HGS groups. Neuropsychological evaluations were conducted before discharge (approximately one month after stroke onset) and between 6 and 12 months after stroke onset. Results: The low HGS group was older and had lower Montreal Cognitive Assessment scores. However, after adjusting for covariates, the linear mixed model analysis showed no significant differences between the groups in global cognition or specific cognitive domains, except for psychomotor speed during the subacute phase. Notable improvements in language ability were observed in both groups over time, while significant improvements in executive function were observed exclusively in the low HGS group. Conclusions: This longitudinal study is the first to explore the relationship between HGS and changes in cognitive function in older adults with stroke, providing insights into physical strength and cognitive recovery during stroke rehabilitation.

The Effect of TENS and Ultrasound Diathermy on Osteoarthritis Patients in Physical Medicine and Rehabilitation Unit of Patut Patuh Patju Hospital, West Nusa Tenggara

Osteoarthritis is generally recognized as a common musculoskeletal condition in Indonesia, characterized by the degeneration of joint cartilage and narrowing of the joint space. The form of therapy that can be given to knee OA patients is a combination of TENS therapy and ultrasound diathermy (USD). WOMAC is an index used to measure osteoarthritis patiens based on pain, stiffness, and physical function. Patut Patuh Patju General Hospital is the only hospital in West Lombok district where physical medicine and medical rehabilitation have recently been introduced. This research aims to determine the effects of administering TENS and ultra sound diathermy on OA patients in the physical medicine and rehabilitation unit of Patut Patuh Patju Hospital, a newly established district hospital in NTB, which has been operational for the past year. This type of research uses a pre-experimental design with a one group pretest-posttest method. Sampling was taken using a purposive sampling technique with a total sample of 30. The research population was knee osteoartritis patients undergoing physiotherapy treatment at the Medical Rehabilitation Unit of Patut Patuh Patju General Hospital. Data was collected using the WOMAC questionnaire before and after 6 until 8 times therapy. The distribution of research data was analyzed using the Shapiro-Wilk test. If the data distribution is normal, it is analyzed using the paired t-test, whereas if it is not normal, it is analyzed using the Wilcoxon test. The combination of TENS therapy and ultra sound diathermy results in improvement of WOMAC scores in knee osteoarthritis patients with p-value = 0.000 (p < 0.05).

Expert consensus on the application of big data on rehabilitation medicine (2024 edition)

With the development and progress of technology, the transformation of biomedical models, and the application of digital technology, the field of rehabilitation medicine has also generated massive and diversified big data. However, the current level of utilization of rehabilitation medicine is relatively low. Empowering the development of rehabilitation medicine through big data is crucial. In order to better promote the standardized development of rehabilitation big data in China, the Rehabilitation Big Data Working Committee of the Chinese Rehabilitation Medical Association organized an expert plan on the concept, significance, and necessity of rehabilitation big data; Rehabilitation big data source; Priority areas for rehabilitation big data application research; Basic research methods for rehabilitation big data; The standards and principles for establishing a rehabilitation database; Consensus has been developed on six aspects of clinical application scenarios for rehabilitation big data, providing reference for healthcare workers and researchers related to rehabilitation big data.

Testing and Evaluation of Health Care Applications of Large Language Models

Large language models (LLMs) can assist in various health care activities, but current evaluation approaches may not adequately identify the most useful application areas. To summarize existing evaluations of LLMs in health care in terms of 5 components: (1) evaluation data type, (2) health care task, (3) natural language processing (NLP) and natural language understanding (NLU) tasks, (4) dimension of evaluation, and (5) medical specialty. A systematic search of PubMed and Web of Science was performed for studies published between January 1, 2022, and February 19, 2024. Studies evaluating 1 or more LLMs in health care. Three independent reviewers categorized studies via keyword searches based on the data used, the health care tasks, the NLP and NLU tasks, the dimensions of evaluation, and the medical specialty. Of 519 studies reviewed, published between January 1, 2022, and February 19, 2024, only 5% used real patient care data for LLM evaluation. The most common health care tasks were assessing medical knowledge such as answering medical licensing examination questions (44.5%) and making diagnoses (19.5%). Administrative tasks such as assigning billing codes (0.2%) and writing prescriptions (0.2%) were less studied. For NLP and NLU tasks, most studies focused on question answering (84.2%), while tasks such as summarization (8.9%) and conversational dialogue (3.3%) were infrequent. Almost all studies (95.4%) used accuracy as the primary dimension of evaluation; fairness, bias, and toxicity (15.8%), deployment considerations (4.6%), and calibration and uncertainty (1.2%) were infrequently measured. Finally, in terms of medical specialty area, most studies were in generic health care applications (25.6%), internal medicine (16.4%), surgery (11.4%), and ophthalmology (6.9%), with nuclear medicine (0.6%), physical medicine (0.4%), and medical genetics (0.2%) being the least represented. Existing evaluations of LLMs mostly focus on accuracy of question answering for medical examinations, without consideration of real patient care data. Dimensions such as fairness, bias, and toxicity and deployment considerations received limited attention. Future evaluations should adopt standardized applications and metrics, use clinical data, and broaden focus to include a wider range of tasks and specialties.

Comparison between Effects of Intralesional Platelet Rich Plasma and Corticosteroid Injection on Pain and Functional Outcome in Patients with Lateral Epicondylitis of Elbow

Background: A debilitating and painful elbow problem is lateral epicondylitis. Objective: In this study, pain and functional outcomes were examined in relation to intralesional platelet-rich plasma (PRP) and corticosteroid injections patients with lateral epicondylitis. Methodology: This randomized experimental study was done in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU) from March 2017 to February 2018. Thirty patients with diagnosed lateral epicondylitis, aged between 21- 60 years and had been ill for more than a month were enrolled and randomly assigned into two groups. In Group A received two doses of intralesional PRP injection, and Group B received two doses of intralesional corticosteroid injection. Pain and functional outcomes were evaluated by using a visual analog scale (VAS) for pain and a patient-rated tennis elbow assessment (PRTEE) questionnaire, respectively. In the lateral epicondylar region, intralesional PRP or corticosteroids were administered during the first (week 1=W1) and fourth (week 7=W7) treatment visits. Results: The findings revealed a statistically significant decline in pain over time, as well as improvements of functional outcomes in both groups as evidenced by significantly lower VAS scores and lower PRTEE scores up to 11 weeks post-injection. There was no discernible difference in progress between the two groups up until W1 to W9 scores, however at the eleventh week, group A showed greater improvement than group B (p<00.5). Conclusions: Intralesional PRP injection is a promising therapy option for lateral epicondylitis, offering sustained pain relief and improved functional outcomes over time compared to corticosteroid injection. Journal of Monno Medical College June, 2024; 10 (1):30-35

The Use of Diagnostic Transcranial Magnetic Stimulation as a Predictor of the Functional Outcome in Ischemic Stroke

ABSTRACT. Determination of rehabilitation potential (RP) is necessary for optimal rehabilitation strategy and the best rehabilitation measures. Navigational transcranial magnetic stimulation (nTMS) has been proposed as a method for PR determination in after-stroke patients.THE AIM. was to study the importance of navigational diagnostic transcranial magnetic stimulation as a neurofunctional predictor of motor function recovery after ischemic stroke.MATERIAL AND METHODS. The study included 28 after-stroke patients, 19 men and 9 women, the mean age was 60.07±5.67 years, who underwent a course of inpatient medical rehabilitation at the Moscow Research and Practice Center for Medical Rehabilitation, Restorative and Sports Medicine named after S.I. Spasokukotsky in 2022–2023. Clinical examination and assessment were conducted before and after the rehabilitation course using validated scales and questionnaires — the Medical Research Committee (MRCs) scale, the Box and Block Test (BBT), the modified Rankin scale (mRS); the rehabilitation routing scale (RRS). The patients were also examined using nTMS at the N.V. Sklifosovsky Research Institute for Emergency Medicine with the determination of motor evoked potential (MEP) parameters from the muscles of the upper and lower extremities.RESULTS. In patients with preserved MEP, there was a significant increase in the strength of the paretic limb on the MRCs scale from 4.00 (2.94–4.06) to 4.22 (3.83–4.89) points (p <0.001) for the upper limb and from 4.00 (3.67–4.00) to 4.44 (3.83–4.61) (p<0.001) for the lower limb. Improvements were revealed according to the mRS scale — the number of patients with an mRS score of 2 points in the group of patients with defined MEP increased by 26.1%, reached values of 1 point — 13.0% of patients, and the number of patients with an assessment of disability and self-care ability of 4 points decreased by 8.7%.CONCLUSION. Navigational transcranial magnetic stimulation is one of the methods for assessing the rehabilitation potential in patients with ischemic stroke. But TMS should not be used as the only method of evaluating rehabilitation potential. The assessment of RP should be comprehensive and based on the complex data obtained.

AI (as an Ally) for Musculoskeletal Ultrasound in PRM- Haute Couture After Renaissance.

This DeLisa lecture highlights the invaluable role of musculoskeletal ultrasound (i.e. the renaissance) in Physical and Rehabiltation Medicine. In particular, update as regards how artificial intelligence is also being incorporated in the prompt utility of ultrasound. The discussion does not only pertain to its use in daily clinical practice but also comprises exemplary cutting edge research.

Working towards consensus on the assessment of mood after severe acquired brain injury: Focus groups with UK-based professionals.

The assessment of mood after brain injury is more challenging when people have ongoing severe cognitive and receptive communication impairments. There is no gold standard on how these assessments should be undertaken. This study aimed to reach a consensus on this among specialists working with this population. Focus groups were completed using a structured nominal group technique. Groups were compared for overlapping themes and agreed processes. Five focus groups with a total of 14 participants who work with the population of interest were completed. Participants included 12 clinical psychologists, one psychiatrist and one consultant in rehabilitation medicine. Each of the five groups reached a consensus on a process for assessing mood in this population. Results overlapped and were combined into a proposed circular and iterative model of assessment that includes: (pre) information gathering, (peri) assessment processes, and (post) treatment; with formulation being seen as a vital part of the process. Standardised measures were not recommended for use with this population. Beyond the consensus processes, three implicit themes were identified: (1) depression is different after severe brain injury, (2) overlapping tasks and roles, and (3) looking at the bigger picture. A good level of consensus was achieved across the five groups on processes to follow when assessing mood when people have ongoing cognitive and receptive communication impairments after severe brain injury. We recommend that this formulation-based model be followed when assessing people in this clinical population.

Development of HEMA-Succinic Acid-PEG Bio-Based Monomers for High-Performance Hydrogels in Regenerative Medicine.

In recent years, hydrogels have found a special place in regenerative medicine for tissue repair, rehabilitation, and drug delivery. To be used in regenerative medicine, hydrogels must have desirable physical, chemical, and biological properties. In this study, a new biomonomer based on hydroxyethyl methacrylate-succinic acid-polyethylene glycol 200 (HEMA-Suc-PEG) was synthesized and characterized. Then, using the synthesized monomers and different ratios of polyethylene glycol diacrylate (PEGDA) as a crosslinker, biocompatible hydrogels were synthesized through thermal and UV curing methods. The mechanical, physical, chemical, and biological properties of the hydrogels and the behavior of endothelial cells, an essential component of the cardiovascular system, were evaluated. The results showed that the hydrogel synthesized with 0.2 g of PEGDA (UV curing) has desirable mechanical and physical properties. Biological tests showed that these hydrogels are not only nontoxic to cells but also enhance cell adhesion. Therefore, the hydrogel containing the synthesized monomer HEMA-Suc-PEG and 0.2 g of PEGDA has the potential to be used in the cardiovascular system.

Crafting the Future of Community-Based Medical Rehabilitation: Exploring Optimal Models for Non-Inpatient Rehabilitation Services through a Narrative Review.

Community-based medical rehabilitation encompasses diverse programs that cater to patients outside of inpatient settings, such as home rehabilitation, day rehabilitation centers, and ambulatory clinics. While inpatient rehabilitation principles are widely standardized, outpatient programs display significant variability influenced by healthcare models, local environments, economic constraints, and available resources. This narrative review aims to explore and synthesize the various models of non-inpatient rehabilitation services, evaluating their effectiveness, cost-efficiency, and patient satisfaction. The review also seeks to identify optimal practices and strategies to enhance community-based rehabilitation, alleviate the burden on inpatient facilities, and improve patient outcomes through multidisciplinary and patient-centered approaches. Additionally, the study examines the critical role of a professional program coordinator and the importance of effective clinical communication in outpatient rehabilitation. A comprehensive search of peer-reviewed literature was conducted across multiple databases, focusing on studies that examined community-based rehabilitation models. The findings suggest that community-based rehabilitation programs are generally more cost-effective than inpatient programs, with their success being heavily dependent on the intensity and timing of interventions. Multidisciplinary approaches and high-intensity rehabilitation have shown promise in improving patient quality of life, though their effectiveness varies by condition. Despite limited research, the involvement of a Physical and Rehabilitation Medicine (PRM) physician as a program coordinator appears vital for ensuring continuity of care. Moreover, effective clinical communication is essential, impacting all aspects of patient care and interprofessional collaboration, with continuous adaptation required to meet the evolving needs of diverse patient populations.

Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain

Background & Objective: Low back pain (LBP) is an ever-increasing menace in the young men as well as women. Many factors causing it have been identified, the most common being improper spinal posture. LBP has been targeted by physicians, anesthetists, surgeons and rehabilitation medicine specialists. We compared the effects of Kinesio Taping and dry needling on pain reduction and disability improvement in patients diagnosed with mechanical chronic LBP. Method: A randomized control trial (RCT) was conducted at Rawal General and Dental Hospital and Al-Nafees hospital in Islamabad from January 2020 to October 2021. Probability-based sampling method was used to select participants for the study (simple random sampling). Thirty patients, aged 18 to 75 y were included. Sample size was calculated with Epitools. The selected patients were divided in two groups i.e., 15 patients in the Kinesio taping group (KT group) and 15 in the dry needling group (DN group). Two patients in the needling group were dropped. Numeric Pain Rating Scale (NPRS) and Roland-Morris Disability Index Questionnaire (RMDQ) were used to assess the pain and the disability at baseline, two weeks post-intervention and four weeks post-treatment. Chi-Square test was use to find association. Results: The mean age of the patients was 39.60 ± 13.69 y for KT group and 37.15 ± 12.54 y for DN group. The mean BMI for KT group was 27.15 ± 6.70 kg/m2 and for DN group 27.52 ± 5.13 kg/m2. Before treatment, there were no differences between the groups for NPRS and RMDQ. Both dry needling and Kinesio taping produced significant improvements in NPRS and RMDQ after two and four weeks of treatment (P < 0.05). However, statistical analysis results showed that there was no association between pain and disability in patient with non-specific low back pain. (P > 0.05). Conclusion: Both, Kinesio taping and dry needling, significantly reduced pain and disability after two- and four-weeks treatment in patients with low back pain, but there was no statistical differences between the pain and disability in both groups. Keywords: Disability; Dry Needling; Kinesio Tape; Low Back Pain; Numeric Pain Rating Scale; Physiotherapy Citation: Asad A, Irshad A, Hassan T, Kiran Q, Kouser S, Hassan F. Comparative analysis of Kinesio taping and dry-needling: effects on pain and disability in patients with mechanical low back pain. Anaesth. pain intensive care 2024;28(5):933−938; DOI: 10.35975/apic.v28i5.2561 Received: April 26, 2024; Reviewed: July 16, 2024; Accepted: July 18, 2024

Primary prevention of venous thromboembolic complications in spinal cord injury: modern concepts

Venous thromboembolism is a common complication following spinal cord injury that can significantly aggravate a pre-existing condition and lead to a death. Patients who suffer acute spinal cord injury have a higher prevalence of venous thromboembolism than patients who suffer other traumatic injuries with sparing of the spinal cord. It is important for physical medicine and rehabilitation specialists to have knowledge аbout primary prevention of venous thromboembolism in patients with acute, subacute and chronic spinal cord injury. This article provides a brief overview of typical venous thromboembolism frequency (leg deep vein thrombosis and pulmonary embolism), pathogenesis peculiarities, venous thromboembolism risk factors and diagnostic considerations. The main attention is given to the primary thromboprophylaxis (methods and duration) depending on the spinal cord injury period and the spinal cord injury level. Further studies are required to clarify the optimal prophylaxis methods and protocols to prevent venous thromboembolism following spinal cord injury.

Regular Physical Activity Seems to Eliminate Lower Limb Perfusion Asymmetries in Sedentary Non-Healthy Older Individuals.

Perfusion asymmetries have been associated with vascular pathology. Physical activity is a component of vascular health. Here, we investigate the impact of a thirty-day regular home-based physical activity program in older individuals with multiple age-related comorbidities. Eleven participants of both sexes were included. Skin perfusion was assessed in both feet by laser Doppler flowmetry (LDF, for deeper perfusion) and polarized light spectroscopy (PSp, for superficial perfusion). At baseline, participants had significant perfusion differences between right and left feet (p = 0.005 with LDF; p = 0.028 with PSp), which disappeared with activity and reappeared in recovery. After 30 days, both feet showed significant perfusion increases as assessed with LDF (p = 0.005) compared to D0. At this point, the perfusion asymmetry observed at D0 was no longer present. However, the superficial perfusion asymmetry assessed by PSp persisted at D30 (p = 0.028). Data show that regular physical activity positively altered the lower limb perfusion pattern. Systolic pressure and mean arterial pressure were also significantly reduced at D30. These impacts seem to be directly related to the physical activity program introduced in the day-by-day routines of these participants. These also encourage further research on the role of symmetry-asymmetry in prevention, treatment, and rehabilitation in vascular medicine.

Telerehabilitation as a Teaching–Learning Tool in Physical Medicine and Rehabilitation Residency Training in the Philippines

Background:Prepandemic, Physical Medicine and Rehabilitation (PM&R) residency training curricula in the Philippines did not include telerehabilitation. The impact of virtual care on residents’ competencies during the pandemic has not been evaluated locally.Objective:The objective of the study is to determine residents’ ability to achieve PM&R competencies through telerehabilitation.Methods:This mixed-methods study included an original survey among residents and a focus group discussion with training/administrative staff.Findings:Residents reported professionalism, interpersonal/communication skills, and medical ethics/public health as the top three competencies facilitated by telerehabilitation, while procedural skills were the least facilitated. Training/administrative staff perceived telerehabilitation could be incorporated into PM&R training curricula.Conclusions:Telerehabilitation contributed to residents’ achievement of training competencies and learning of PM&R topics/skills.

A National Cross-Sectional Survey of EMG Physician Volume.

This study presents results from a survey of physicians performing electrodiagnostic studies to assess average volume. We also assessed how different factors (trainees, technologists, age of the physician, and case complexity) affected volume. Productivity is an important factor for physicians across practice settings. However, unlike evaluation and management services for neurologists, there are no published data for benchmarks of average volume of electrodiagnostic studies. A 34-question survey was designed collecting information on demographics, electrodiagnostic study volume, technologists, trainees, referrals, and case complexity. The anonymous survey was disseminated through a QR code or hyperlink to multiple online neurology, physical medicine and rehabilitation, electromyography, and neuromuscular forums. The primary outcome was EMG volume including number of EMGs per half-day and EMG volume per year. We conducted bivariate association analysis between primary outcomes and respondent characteristics using the Pearson χ2 test. Multivariable regression models determined factors associated with each of our outcome variables. A total of 201 respondents initiated the survey. 71% were certified in adult neurology, 19.6% in physical medicine and rehabilitation, and 2.7% in pediatric neurology. 37.5% practiced in academic medicine. The remaining respondents were from private practice, group, solo, hospital employed, or other. 83% of respondents allotted a dedicated half-day to performing EMGs. The median number of EMGs scheduled during a half-day was within 3-4 (45%). 30% and 7% scheduled 5-6 or more than 7 patients per half-day, respectively. The median number of EMGs performed per year was within 251-500 (37%). This national, cross-sectional survey evaluates average metrics of EMG volume. Our survey showed that the median number of EMGs annually lies between 251 and 500 studies (37%). In addition, for those respondents who allotted a dedicated half-day to performing EMGs, the median number of EMG studies scheduled per half-day lies between 3 and 4 studies (45%). In multivariate analysis, respondent characteristics of age of the physician (older than 45), working with nerve conduction technologists, and holding the position of EMG director were associated with increased EMG volume.

Survey on the Current Status of Elderly Health Services in 1,305 Medical Institutions in Guangxi.

To investigate the current status of elderly health services in medical institutions at all levels within Guangxi Province, China. Using a purposeful sampling method, a questionnaire survey was conducted from July 24, 2023 to October 24, 2023 on the general situation, human resources, rehabilitation medicine, nursing services, and the development of hospice care at 1305 medical institutions in Guangxi. Among the surveyed 1305 medical institutions in Guangxi, 172 (13.18%) had established departments of geriatrics, while 293 (22.45%) boasted departments of rehabilitation medicine. Furthermore, 909 (69.66%) of these institutions offered annual free physical examination services to individuals aged 65 and above. Notably, a total of 362 medical institutions, encompassing both comprehensive hospitals and grassroots hospitals, were recognized as elderly-friendly institutions, accounting for 31.4% of the surveyed sample.The highest demand for talents in medical institutions at all levels included specialized physicians/general practitioners (74.6%), traditional Chinese medicine practitioners (63.1%), rehabilitation therapists (56.1%), and specialized nurses for the elderly (41.7%). A total of 1038 medical institutions conducted popular science activities on elderly health, accounting for 79.5% of the total, focusing mainly on disease prevention (89.21%), nutritional diets (84.68%), rational medication use (79.77%), physical exercise (68.21%), and mental health (60.79%). Only 88 medical institutions provided hospice care services, accounting for 6.7% of the total. Guangxi medical institutions' elderly services are inadequate. Geriatrics and rehab departments are scarce, talent is lacking, and hospice care is underdeveloped. As aging accelerates, the country and society must support elderly care. Governments should introduce talent incentives, and medical institutions should enhance services, foster a positive work environment, and advance Guangxi's elderly health agenda.

Proposed categories for reporting of service organization in rehabilitation in clinical trials: a discussion paper.

The lack of standardized reporting for crucial organizational factors in rehabilitation poses a significant barrier to understanding their impact on patient outcomes in clinical trials and meta-analyses. Based on the categories in the International Classification of Service Organization in Rehabilitation (ICSO-R 2.0), we aimed to develop reporting standards specifically for organizational factors in clinical trials. A comprehensive two-step process was conducted. In Step 1, important categories were identified. The identification was based on previous results from a Delphi survey with international stakeholder participation, two systematic literature reviews and results from focus groups with users in Germany, Indonesia and Norway. Step 2 involved the necessary reduction of categories and the proposal of reporting specifications, achieved through two voting rounds among key researchers, stakeholders and users. The suggested minimum reporting set comprises Context and Setting as well as Quality assurance and management. The Context and Setting is proposed to include whether the intervention is delivered by Hospital, Community or Other service providers. The Mode of delivery is proposed to be specified as Inpatient, Outpatient, In-home, or Tele-rehabilitation. Furthermore, the Level of specialization (Primary/Secondary) and the Phase of service delivery Acute, Subacute or Long-term rehabilitation services should be reported. The Quality assurance and management should be reported as Yes or No, with the option Yes requiring description of the quality assurance applied in the methods section. This study proposed a compulsory and standardized reporting of organizational factors in clinical trials to facilitate the generation of scientific evidence regarding effective service provision and delivery in rehabilitation medicine. Authors are encouraged to consider the proposed reporting set to testing, criticism, and modification to enhance its applicability and robustness.

De-novo Peripheral Neurological Complications Following COVID-19 Vaccinations

Abstract Background Following the COVID-19 virus epidemic, extensive, coordinated international research had led to the rapid development of effective vaccines. Although COVID-19 vaccines were considered the best way to achieve collective safety and control mortality, they had the potential to induce a plethora of peripheral nervous system diseases (PNS). Aim of the Work The aim of this study was to analyze the changes in peripheral nervous system in case of post COVID-19 vaccinations by using electrophysiological modalities. This study identified a specific peripheral neurological risk profile for each vaccine and a clinical profile for those who more vulnerable to develop neurological complications after COVID-19 vaccines. Patients and Methods This study was conducted on twenty-five patients who started to develop de-novo peripheral neurological complications after COVID-19 vaccination. The patients were enrolled from the outpatient clinic of Rheumatology, Rehabilitation and Physical medicine as well as neurology department of Ain Shams University hospitals. Results Twenty-five reported cases of peripheral nervous system (PNS) affection manifesting after receiving COVID-19 vaccines had been analyzed in this work. Thirteen (52%) were previously infected with SARS-CoV-2 infection. Mostly, cases manifested after receiving AstraZeneca 15 (60%) and Pfizer 5 (20%) vaccines. Affected individuals usually presented following the first dose 16 (64%). Furthermore, the most frequently reported symptom was paresthesia (52%). The side-effects severity was greater after the AstraZeneca vaccine (88.89%). Moreover, several manifestations of PNS affection were observed, but the Guillain-Barre-Syndrome (GBS) was of higher incidence (48%). Conclusion This is one of comprehensive reviews discussing the new onset of clinical presentation of various peripheral neurological adverse events following the four most commonly available COVID-19 vaccines, confirmed by using electrodiagnostic studies.

Predicting Swallowing Recovery in Subacute Stroke Patients via Temporal and Spatial Parameters of Videofluoroscopy.

The purpose of this study was to identify the temporal and spatial parameters of videofluoroscopic swallowing study (VFSS) that could predict the recovery of swallowing function in subacute stroke patients. We included 102 patients who were admitted to the Department of Rehabilitation Medicine between 2019 and 2022. Patients were classified into good and poor prognosis groups according to whether they had restored prestroke swallowing function or were able to consume sufficient nutrition via oral feeding to meet their body's needs. Univariate and multivariate regression analyses were used to identify the predictors. Calibration and discrimination were tested using the Hosmer-Lemeshow test and area under the curve (AUC), respectively. Of the 102 included patients, 51 had a good prognosis for swallowing function within 6 months of onset. The final multivariate regression model included three significant factors: laryngeal closure duration (LCD) (OR: 0.998; 95% CI: 0.996-0.999; p < 0.05), maximum width of the upper esophageal sphincter opening (MWUESO) (OR: 1.251; 95% CI: 1.073-1.458; p < 0.05), and pharyngeal residual grade (PRG) (p < 0.05). The shorter LCD and larger MWUESO were positive predictors of good swallowing function outcomes, while higher PRG was a negative predictor of good outcomes. The AUC for PRG, MWUESO, and LCD were 0.767 (p < 0.05), 0.738 (p < 0.05), and 0.681 (p < 0.05), respectively. Identifying prognostic factors for the recovery of swallowing function in patients with poststroke dysphagia is essential for developing treatment strategies. The findings of this study may provide an important reference for developing appropriate therapeutic interventions to promote the recovery of swallowing function in stroke patients.