Conference Objectives
At the end of the conference, participants will be able to:
- Discuss process and benefits for distinction accreditation in PMR programs and health systems
- Describe organization and outcomes of integrated and collaborative care programming in PMR
- Identify skills and opportunities for fostering leadership among the PMR community
Speaker Conflict Of Interests
| First Name | Last Name | Date | Section | Session | COIs | Will make therapeutic recommendations |
|---|---|---|---|---|---|---|
| McKyla | McIntyre | Achieving Your Leadership Goals: A Workshop For Learners |
|
NO | ||
| Steve | Mann | 27/05/2023 | MSK Education in Canadian Medical Schools - What's essential? |
|
NO | |
| Karen | Ethans | 27/05/2022 | Treatment of Multi-focal Spasticity of the Lower Limbs- Bringing Back the Old to Join the New! |
|
YES | |
| Alice | Kam | May 15, 2023; June 26, 2023; Sept 11, 2023 | Linking Theories to Practice: Clinician Teacher Competency in Physiatry | NO | ||
| Andrei | Krassioukov | 24/05/2023 | CAPM&R |
|
NO | |
| Jaime | Yu | 45047 | CAPMR Annual Meeting, workshop |
|
NO | |
| Amanda | Mayo | 26/05/2023 | Amputee SIG | NO | ||
| Jody | Young | 25/05/2023 | Navigating Complex Trauma Rehabilitation: A Military Perspective | NO | ||
| Jason | Peeler | 27/05/2023 | MSK Education In Canadian Medical Schools - What's Essential? | NO | ||
| Markus | Besemann | 25 05 2023 | Navigating Complex Trauma Rehabilitation: A Military Perspective |
|
NO | |
| Robert | Simpson | 45073 | Burnout, Mindfulness and Compassion in Physical Medicine and Rehabilitation |
|
NO | |
| Paul | Winston | 24/05/2023 | Shoulder Symposium | |||
| Larry | Robinson | 24/05/2023 | EMG Pre-Conference Course | NO | ||
| Nimish | Mittal | 25/05/2023 | Supercharged Advanced Management Of Shoulder Conditions | Advanced Neuroablative Options For Shoulder Pain In Glenohumeral Arthritis | NO | |
| Elizabeth | Condliffe | 25/05/2023 | Robotic Mobility Aids: Finding the right fit for patients |
|
NO | |
| Anna | McCormick | 25/05/2023 | Robotic Mobility Aids: Finding the right fit for patients. | NO | ||
| Jessica | Murphy | 27/05/2023 | The Use Of Mobile Health Technology In The Treatment Of Post-Concussion Symptoms | NO | ||
| Stephanie | Plamondon | 25/05/2023 | At the intersection of Art and Science: The Compelling Case for Music Therapy and Digital Music Medicine in Neurorehabilitation (and Workshop: Robotic Mobility Aids: Finding the right fit for patients |
|
NO | |
| Gihan | Perera | 27/05/2023 | The Use Of Mobile Health Technology In The Treatment Of Post-Concussion Symptoms | NO | ||
| Gabriella | Ghanem | 27/05/2023 | The Use Of Mobile Health Technology In The Treatment Of Post-Concussion Symptoms | NO | ||
| Ryan | Kelly | 27/05/2023 | The use of mobile health technology in the treatment of post concussion syndrome | NO | ||
| Courtney | Frengopoulos | 27/05/2023 | The Use Of Mobile Health Technology In The Treatment Of Post-Concussion Symptoms | NO | ||
| Colleen | O'Connell | 27/05/2023 | CAPMR Annual Scientific Meeting 2023 |
|
NO | |
| Sean | Dukelow | 5/26/2023 | CanStroke Recovery Trials Network |
|
NO | |
| Amanda | Mayo | 26/05/2023 | Amputee SIG | NO | ||
| Amanda | Mayo | 26/05/2023 | Amputee SIG | NO | ||
| Alice | Kam | 45071 | Linking Theories to Practice: Clinician Teacher Competency in Physiatry | NO | ||
| Stephanie | Plamondon | 25/05/2023 | At the intersection of Art and Science: The Compelling Case for Music Therapy and Digital Music Medicine in Neurorehabilitation (and Workshop: Robotic Mobility Aids: Finding the right fit for patients | At The Intersection Of Art And Science: Music Therapy And Digital Music In Neurorehabilitation | NO | |
| Alice | Kam | 45071 | Linking Theories to Practice: Clinician Teacher Competency in Physiatry | Linking Theories To Practice: Clinician Teacher Competency In Physiatry | NO | |
| Paul | Winston | 25/05/2023 | Shoulder Symposium |
|
YES | |
| Caitlin | Cassidy | 25/05/2023 | Cerebral Palsy and Rehabilitation Across the Lifespan - Not Just for Kids! | Cerebral Palsy And Rehabilitation Across The Lifespan - Not Just For Kids | ||
| Diane | LeBlanc | 27/05/2023 | 71st Annual Scientific Meeting | Onflict Is Inevitable: Lets Put It To Use & Dare, Prepare, Ambush | NO | |
| Stephanie | Plamondon | 26/05/2023 | Paper of the Year First Place | NO | ||
| Katherine | Lowings | 25/05/2023 | At the intersection of Art and Science: The Compelling Case for Music Therapy and Digital Music Medicine in Neurorehabilitation (and Workshop: Robotic Mobility Aids: Finding the right fit for patients | NO | ||
| Nicolas | Fernandez | 25/05/2023 | Linking Theories to Practice… Clinician Training for Competency in Physiatry |
|
NO | |
| Amra | Saric | 27/05/2023 | Specialty Committe report to CAPMR |
|
NO | |
| Anita | Mountain | 45073 | CAPM&R 71st Annual Scientific Meeting |
|
NO | |
| Colleen | O'Connell | 27/05/2023 | CAPMR Annual Scientific Meeting 2023 | Als: Advances In Treatment And Care |
|
NO |
| Jennifer | McDonald | 24/05/2023 | US Guided Injections and Supercharged Advanced Management of Shoulder Conditions | NO | ||
| Nimish | Mittal | 25/05/2023 | Advanced neuroablative procedures for shoulder pain and arthritis | NO | ||
| Andrew | Haig | 25/5/2023 | CAPMR 71st Annual Meeting | |||
| Jordan | Farag | 24/05/2023 | US Guided Injections | NO | ||
| christine | short | 24/05/2023 | Exploration Of The Formation Of A Leadership SIG | Exploration Of The Formation Of A Leadership Sig | NO | |
| Caitlin | Cassidy | 25/05/2023 | Cerebral Palsy and Rehabilitation Across the Lifespan...It's Not Just for Kids! | Cerebral Palsy And Rehabilitation Across The Lifespan...it's Not Just For Kids! |
|
NO |
| Thomas | Miller | 24/05/2023 | Pre Conference EMG Course |
|
NO | |
| Julio | Furlan | 27/05/2023 | Cerebral Concussion And Other Traumatic Brain Injuries: Pearls And Oysters In Clinical Practice And Research | Cerebral Concussion And Other Traumatic Brain Injuries: Pearls And Oysters In Clinical Practice And Research |
|
NO |
| Najam | Mian | 24/05/2023 | ​ Workshop: US Guided injections | NO | ||
| Arun | Gupta | 24/05/2023 | US Guided Injections | |||
| Arun | Gupta | 24/05/2023 | US Guided Injections | Us Guided Injections | NO | |
| David | Berbrayer | 25/05/2023 | Paediatric SIG | |||
| David | Berbrayer | 25/05/2023 | Pediatric SiG | NO | ||
| Mary | Halpine | 25/05/2023 | Resident Career Planning | NO | ||
| Devon | Rubin | 24/05/2023 | EMG Pre-conference | NO | ||
| Mary | Halpine | 25/05/2023 | Resident Career Planning | NO |
Abstracts
Abstract
| Title | Abstract | Keywords | Authors | Tags |
|---|---|---|---|---|
| A Comparison of the Effectiveness and Procedural Characteristics of Cervical Facet Joint Radiofrequency Neurotomy Using a Multitined (Trident) Cannula versus Conventional Monopolar Cannula |
Background: cervical facet radiofrequency neurotomy (CRFN) is a common procedure used to treat refractory cervical facet pain. The traditional method uses a monopolar cannula and a parallel approach to the medial branch nerves of the facet joints. The development and configuration of a multitined (Trident) cannula allows for a perpendicular approach to the medial branch nerves that may carry potential procedural and safety advantages over the traditional method. The effectiveness and procedural characteristics of Trident CRFN have not been described or compared to the standard monopolar cannula.
Objective: compare the effect of fluoroscopic guided CRFN using a Trident cannula and perpendicular approach to the conventional monopolar cannula with parallel approach on pain, disability, and quality of life. Compare the procedural characteristics of total procedure time and fluoroscopic exposure time of the two approaches.
Methods:Design: retrospective registry data audit of prospective CRFN cohort performed at two Alberta community multidisciplinary chronic musculoskeletal pain clinics between 2003-2009 (monopolar) and 2016-2021 (Trident).
Selection criteria: facetogenic neck pain confirmed by ≥50% pain relief following dual or single medial branch block(s).
Interventions: first time fluoroscopically guided CRFN targeting the same facet joint(s) performed with either the conventional monopolar cannula with a parallel approach to the nerve or with the Trident cannula and a perpendicular approach to the nerve by the same interventional physiatrist. Lesion temperature was 80°C and duration was two minutes.
Outcome measures: Effectiveness of CRFN: Pre-and three-month post-CRFN numerical rating scale of pain intensity and Pain Disability Quality-Of-Life Questionnaire-Spine score
Procedural characteristics: total procedure and fluoroscopy exposure time.
Data analysis: linear mixed models to assess the interactive effect of group (type of cannula) over time for each of the primary outcome measures. Procedure time and fluoroscopic exposure time were evaluated via linear regression.
Results: 147 people were included in the study (mean age = 56.9 ± 12.4 (SD) years; 57% female).When controlling for age, working status, number of levels performed and baseline pain, there was a significant group time effect, with people receiving cervical RFN using the Trident cannula reporting a greater reduction in pain [F(1,288) = 12.4, p < 0.001] and PDQQ scores [F(1,288) = 9.01, p = 0.003] over time compared to those performed with the monopolar cannula. CRFN was quicker to perform [12.1 min (± 5.4) vs 35.0 min (± 14.3), p<0.001]; with less fluoroscopy time required [(34.7 sec (± 16.6) vs. 100.4 sec(± 61.4), p<0.001] with the Trident cannula per facet joint performed.
Conclusions: There was a significantly greater reduction in perceived pain, disability, and quality of life disruption, as well as reduced procedure time and less fluoroscopic exposure in those who received CRFN with the Trident cannula. CRFN with the Trident cannula and perpendicular approach appears to be a more effective, quick, and safe (less radiation) procedure than the traditional monopolar cannula with parallel approach.
|
interventions, physiatry, pain |
|
|
| A National Virtual Physiatry Quality Improvement Forum to Enhance Resident QI Education |
Objective: Formative feedback is recognized as an important component of resident quality improvement (QI) education, yet opportunities for feedback are limited in many Canadian physiatry residency programs due to small numbers of QI experts within individual institutions. An annual National Virtual Physiatry Resident QI Forum was created with the aim of enhancing Canadian physiatry residency QI education by bringing together physiatry residents working on QI projects with QI experts from across Canada.
Methods: All Canadian physiatry residency programs were invited to have their residents present their QI projects at the forum. Members of the Canadian Association of Physical Medicine and Rehabilitation (CAPMR) QI Special Interest Group were invited to participate as QI experts. The QI forum was held on Zoom with two breakout rooms to allow for small group discussion. Residents presented their QI projects to peers and physiatry faculty with QI expertise. Project feedback was provided with the goals of identifying actionable steps towards more robust application of QI concepts and tools, enhancing QI project success, and identifying suitability for academic dissemination. The participants completed an anonymized survey to evaluate satisfaction and perceived value of the virtual forum in improving their current QI education.
Results: 16 residents and 13 faculty members from 7 Canadian physiatry programs participated in the virtual forum. Survey completion rate was 11/16 (69%) for residents and 6/13 (46%) for faculty. Almost all participants (94%) were satisfied with the QI forum and felt it enhanced their program's own QI curriculum. 76% felt more knowledgeable and confident in applying QI concepts and tools. 100% felt there was sufficient time allocated for interaction. Qualitatively, residents found the feedback on the scope of their project, knowledge translation strategies, publication considerations, project communication, and project write-up to be particularly helpful. In addition, the QI form provided a "safe space" to share QI work and helped to generate ideas for future QI projects, while providing residents the opportunity to learn about the QI process from start to finish. Lastly, participants appreciated being able to connect with and learn from other physiatrists and residents from across Canada, indicating its value as an informal physiatry networking event. Future recommendations for improving the QI forum include having the opportunity to see all projects, attaching a QI educational session to the forum, and bringing awareness of the forum to the broader CAPMR community.
Conclusion: A National Virtual Resident QI forum is a feasible and simple solution to enhance resident QI training with high levels of satisfaction and perceived value amongst the participants. With increased familiarity with virtual platforms since the COVID-19 pandemic, the concept of bringing QI experts together virtually to provide formative feedback on QI projects can be considered in similar residency programs.
|
formative feedback, internship and residency, curriculum, quality improvement, physical medicine and rehabilitation |
|
2nd place, quality improvement |
| A qualitative study of resident experiences of vulnerability in postgraduate medical education |
Context: Vulnerability plays an important role in residency education. Although vulnerability can help to facilitate learning and growth, expressing vulnerability in competency-based educational contexts can be challenging. As such, this study aims to understand residents' experiences of vulnerability and identify the factors that influence vulnerability in residency education.
Methods: Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Themes were identified and their relationships were examined using the constant comparative method of analysis.
Results: Three themes were developed to represent participants' experiences of vulnerability in residency: (a) Courage in the face of uncertainty, (b) Worth the risk?, and (c) A double-edged sword. Vulnerability was described as a relational process shaped by personal, social, and contextual influences. Residents viewed vulnerability as a fundamental cornerstone of learning and growth, that can be both valuable and challenging. Given the risks and uncertainties involved, residents engaged in reflective processes before expressing vulnerability. The sociocultural context of residency (e.g., assessment approaches, views on professionalism) influenced residents' intentions to engage in vulnerability. For instance, tensions existed between expressing vulnerability to foster learning and demonstrating competence to achieve entrustment. Social agents, such as clinical teachers and peers, shaped both the experience of, and outcomes derived from, vulnerability. The positive or negative influence of vulnerability on professional and personal outcomes was thus contingent on the nature of the task, and the social and environmental contexts in which it was experienced.
Conclusion: This study positions residents as active agents in their learning, who reflect on the potential benefits and risks of vulnerability. The results can inform how vulnerability can be understood and experienced in residency education. These findings capture the nuance and complexity of vulnerability in residency and the need to create supportive learning environments that leverage the value of vulnerability while acknowledging its risks.
|
Competency-based education, Graduate medical education, Internship and residency, Interpersonal relations, Social environment |
|
3rd place, education |
| Achilles tendons change shape after 21 days of bedrest |
Context/objective: Following a period of immobility, the Achilles tendon is at-risk of rupture once returning to activity, but clinical risk indicators are lacking. Whether an alkalinized whey protein diet influences Achilles tendon rupture vulnerability is unknown. We assessed morphometric changes in Achilles tendon before, during, and following 21 days bedrest and evaluated whether whey protein diet could counteract immobility-associated changes.
Design: Prospective randomized control trial with cross-over design evaluating two groups (control versus intervention), registered on clinicaltrials.gov (NCT01655979). All participants provided written informed consent. Both groups underwent seven days of environmental and dietary adaptation, followed by 21 days of 6° head-down tilt (HDT) bedrest (24 hours/day) and 5 days of within-institution reambulation.
Setting: German Aerospace Center in Cologne, Germany
Participants: Ten healthy male volunteers.
Intervention: Alkalinized whey-supplemented diet - 0.6g of whey protein/kg body weight/day and 90mmol of KHCO3/day.
Outcome measures: Measurement of width, depth, and cross-sectional area at 2, 4,and 6 cm from the insertion of the Achilles tendon on the calcaneus, as well as tendon volume calculation, using magnetic resonance (MR) imaging. Time points included baseline data collection (BDC), bedrest day 10 and 20 (HDT10, HDT20), reambulation day 3 and 28 (R3, R28)
Results: Results are summarized in Tables 1 and 2. There was an increase in width at 2cm from HDT10 (mean 15.6[14.6, 16.7]) versus R3 (17.1[16.4, 17.8]; p=0.005) and R28 (16.9[16.0, 17.7]; p=0.005). There was also an increase from HDT20 (15.7[14.6, 16.7]) to R3 (p=0.045). For width at 4cm, there was a decrease from BDC (12.4[11.8,12.9]) to HDT10 (11.4[10.9,12.0]; p=0.003), with recovery at the proceeding timepoints. For depth at 4cm, there was a decrease from the immobilization periods to the recovery periods that exceeded BDC: R3 (5.3[5.0,5.5]) versus BDC (5.5[5.2,5.8]; p=0.030) and R28 (5.3, [5.0,5.5]) versus BDC (p=0.039). CSA and volume did not change at any level. The diet intervention did not show any consistent effect on Achilles tendon dimensions.
Conclusions: Following two consecutive periods of 21 days bedrest, Achilles tendons demonstrated characteristic changes in shape, without volume change on MR. The observed shape change may constitute a risk of rupture at remobilization, detectable with serial MR imaging.
|
Tendons, Bed Rest, Magnetic Resonance Imaging |
|
|
| Addressing Illicit Substance Use in an Inpatient Rehabilitation Setting: A Case Study. |
Objectives: Illustrate a case of illicit substance use in a rehabilitation inpatient setting in Winnipeg, Manitoba. Discuss risks associated with inpatient substance use. Review current hospital policies at our site and current rehabilitation literature on this topic.
Context: A 25 year female T2 AIS A secondary to MRSA epidural abscess from rural Manitoba was admitted to inpatient rehabilitation in December 2021 following evacuation of abscess and laminectomy. After six months in rehab, the patient's rehabilitation gains plateaued, and she become designated as ALC. Multiple discharge barriers existed, including her family's inability to accommodate her complex care needs. A rural hospital site declined repatriation citing the same reason. She required full-time use of a power wheelchair for mobility, a two-person assist for mechanical lift transfers, and full assistance for bladder and bowel care. The patient declined placement to group housing.
Results: While the patient was ALC, ward staff reported multiple events of her being off the ward for prolonged periods, contributing to adverse events in her care. Scheduled medication doses were missed. She developed infection from unknown sources requiring antibiotic therapy. She developed multiple new signs and symptoms requiring added work up and pharmacotherapy, including nausea, auditory hallucinations, tachycardia, and poor sleep. The ICU was consulted multiple times for management of autonomic dysreflexia from unknown triggers. At team rounds, it was suggested that a random drug screen be performed. The urine screen was positive for amphetamines and was suspected as the cause for her symptoms. With patient consent, addiction services were consulted but she frequently was off the ward during their visits.
Discussion: Issues with inpatient illicit drug use are multiple, including direct harm, incorrect workup and treatments, interactions, use of hospital resources, and safety of staff and other inpatients. This is balanced with patient autonomy. There is a paucity of published literature of management of inpatient substance use in rehab settings. No formal policies at our center exist regarding inpatient illicit substance use.
Conclusions: Hospital policymakers should implement comprehensive harm reduction strategies while ensuring patient respect and empathy. Many hospitals do not have policies about in-hospital illicit substance use and, if they do, clinicians are often unaware of them. More research is needed to better understand and manage in-hospital illicit substance use.
|
Inpatients, Rehabilitation, Spinal Cord Injuries, Substance-Related Disorders |
|
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| All falls are not created equal: Exploring the concept of a "Therapeutic Fall" in ABI Rehab |
Context: Despite efforts towards a just culture, providers still feel shame when their patients fall and often adopt an excessively custodial approach to mobility. This is problematic in ABI Rehab where falls may be a natural outcome for patients striving towards greater independence. For this reason, through this project, we sought to propose an alternative narrative in which falls are not seen as something to be avoided at all costs. Instead, patients who understand and consent to the risks of falling would collaborate with their team to take goal-oriented risks during their rehabilitation. If a fall takes place in this context, it would be considered a "therapeutic fall" rather than an adverse event.
Methods: We worked with an advisory group of patients, providers, and leaders to develop, pilot, and evaluate the concept of a "therapeutic fall" on two large ABI rehab units at Toronto Rehabilitation Institute. We defined a therapeutic fall as a fall that occurs during a higher-risk activity that a patient has chosen to participate in as part of their recovery. Interventions included holding interprofessional educational workshops for providers on pilot units, developing a standardized therapeutic falls shared decision-making form, integrating therapeutic falls into unit huddles and team rounds, and developing provider, patient, and family education resources and posters. Data on the project's outcome, process and balancing measures were recorded and analyzed during the study period from January to December 2022.
Results: Staff engagement for this initiative was very high with 96% of the interprofessional team attending the training workshops. The therapeutic falls pathway also became well integrated into team structures and processes. Twenty-one patients were started on the pathway during the study period, which met the target of >10% of patients being provided with the chance for shared decision-making about mobility. Of these patients, there were 5 therapeutic falls with no repeat falls or falls of harm. There was no special cause variation in the total number of falls before or during the pilot portion of the study.
Conclusion: Our aim is to facilitate a care environment where values and potential conflicts about the benefits and challenges of risk-taking are recognized through shared decision-making with patients, families, and providers. This project proposes that patients living with brain injury can make shared decisions about risk in collaboration with their healthcare team to lay the foundation for a more prepared and safe discharge.
|
Accidental Falls, Quality Improvement |
|
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| An arm and a leg: A case report of atypical Neuralgic Amyotrophy |
Context: Neuralgic amyotrophy (NA) is a rare condition classically described in the upper limb; in rare cases, lower extremity involvement has been described. To our knowledge, NA has never been described in a lower limb following a contralateral upper limb presentation.
Findings: A 60-year-old woman with a history of hypertension and dyslipidemia was diagnosed with NA in the setting of right upper limb axonotmesis of the ulnar nerve distal to the flexor digitorum profundus. Her symptoms onset suddenly 6 months prior with severe pain in her right shoulder followed by weakness in her right hand. She was referred for assessment of surgical options in our multidisciplinary peripheral nerve clinic; on the date of assessment, she reported new, sudden onset severe burning pain in her left lateral knee 1 month prior, followed by a severe left drop. She had no systemic symptoms. Electrodiagnostic testing (EDX) confirmed axonotmesis of the right ulnar and left fibular nerves with no evidence of demyelination; EDX of the contralateral arm and leg were normal.In light of this new involvement, the differential diagnosis shifted from NA to mononeuritis multiplex. Bloodwork, including extended autoimmune workup, was normal. Sural nerve biopsy was normal. Chest radiography was normal. CT chest, abdomen, pelvis, and lower extremity CT angiography were normal. MRI cervical spine was noncontributory. Nerve ultrasound showed hourglass abnormalities for right ulnar and left fibular nerves at non-compression sites, consistent with NA. SEPT9 genetic testing is pending. According to all the findings, vasculitis was excluded and a diagnosis of NA was made.To improve her recovery, she underwent surgical decompression of the right ulnar nerve at the elbow, in the forearm, and at Guyon's canal with a concurrent anterior interosseous end-to-side nerve transfer and decompression of the left fibular nerve distal to the head of the fibula.
Conclusion: This case illustrates the importance of keeping in mind NA in the differential diagnosis of mononeuritis multiplex. In addition to diagnostic challenges, this case also raises questions of how to optimally manage persistent axonotmesis from NA.
|
Electrodiagnosis, Mononeuritis multiplex, Neuralgic amyotrophy |
|
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| Associations Between Somatic Symptom Disorder and Mild Traumatic Brain Injury: A Systematic Review |
Context: Somatic symptom disorder (SSD) is characterized by a significant focus on a symptom such as pain, weakness or abnormal movement to the level that it disrupts function and results in major distress. While there is no known mechanism for SSD, an interplay between somatization symptoms and mild traumatic brain injury (mTBI) has been identified by previous literature.
Objective: Complete a comprehensive systematic review of the associations between mTBI and somatization symptom disorders and report key findings.
Methods: Searches for SSD and mTBI and related terms were performed and then combined in the following databases on January 10th, 2023: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, PsycINFO, Embase, and Scopus. The following criteria had to be met for inclusion: (a) human participants; (b) assessed with a measure of somatization; (c) mild traumatic brain injury; (d) published in a peer-reviewed journal; (e) completed by January 10th, 2023
The following data was extracted: participant characteristics (age, sex, history of trauma as provided), injury characteristics (mechanism, time since injury, history of previous mTBI), mTBI assessment scores, somatization assessment scores, and assessment scores for any other psychiatric conditions (depression, anxiety, post-traumatic stress disorder). Each of these studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network (SIGN) criteria checklist for cohort studies.
Results: Of twenty-nine included studies, ten studies found associations between atypical seizure-like symptoms (e.g., psychogenic non-epileptic seizures) and increased mTBI symptom burden. Thirteen studies found associations between other atypical symptoms (e.g., pain, numbness, visual disturbances) and mTBI symptom burden. Furthermore, three studies found associations between individuals with previous somatization disorders and increased mTBI symptom burden. The three remaining studies included did not find evidence for an association between somatization and mTBI. When considering the quality of evidence, many studies had a risk of bias rating of unacceptable (10/29) and few were considered high quality (4/29).
Conclusion: Studies have shown a relationship between symptoms of somatization and mTBI indicating the potential comorbidity of these disorders. However, there are a limited number of high-quality studies currently available and as such, further research on this topic is needed.
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brain concussion, conversion disorder |
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2nd place, systematic review |
| Case Report: Addressing problematic sexual behaviours through exploration of sexual health goals for individual with severe TBI |
Context: Persons with moderate-to-severe traumatic brain injury (TBI) can experience challenging behaviours, including problematic sexual behaviours. This case report illustrates how the introduction of a safe, patient-centered self-stimulation plan addressed the problematic sexual behaviours of a woman with a severe TBI and underscores the importance and relevance of comprehensive assessment and treatment of sexual health goals and concerns as part of individualized interdisciplinary inpatient TBI rehabilitation.
Findings: 43-year-old woman was admitted for inpatient TBI rehabilitation 11 months after severe TBI from a car accident. At admission, she was in persistent post-traumatic amnesia (PTA), Ranchos Los Amigos level 4-5, had left hemiplegia, and was dependent for all activities of daily living. Challenging behaviours were observed daily including verbal and physical aggression, refusing care and/or therapies, and sexual behaviours of explicit sexual comments, sexual touching of self and others, and attempts at self-stimulation in public. Behaviours were tracked and documented; over 21 days, there were 5.6 severe sexual behaviours/week on average. Due to their severity, the sexual behaviours interfered with care by staff and deterred family from visiting. Consequently, a sexual behaviour plan was devised together with the substitute decision-maker using Sexual Rehabilitation Framework and guidelines for sexual health and intimacy in care facilities resulting in a plan for self-stimulation using a vibrator privately twice weekly with support from Occupational Therapy and Nursing. In the 21 days after introduction, severe sexual behaviours decreased to 0/week. Sexual behaviours recurred during a 2-week period when the patient's vibrator was nonfunctional and resolved with replacement of the device. Additional clinical observations included increased care and therapy participation and improved social interactions.
Conclusion: When the sexual health concerns of individuals with TBI are addressed, it can result in meaningful improvements in sexually inappropriate behaviours and facilitate progress in rehabilitation. Yet only a small portion of healthcare providers report discussing sexuality during rehabilitation. This case report highlights the utility and potential benefits of comprehensively addressing patient-centered sexual health goals during inpatient TBI rehabilitation. Further research is needed to better understand the optimal timing and impact of sexual health intervention in this area.
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neurological rehabilitation, psychomotor agitation, sexual behaviour, sexual dysfunction, traumatic brain injury |
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| Collaborative Resident-Led Ultrasound Curriculum: Interdisciplinary Teaching Session Overview |
Purpose: To outline a resident-led teaching session on knee ultrasound for Physical Medicine and Rehabilitation (PM&R) residents at the University of Manitoba (U of M), in collaboration with the University's anatomy lab. The session aimed to provide residents with practical experience in identifying anatomic structures via ultrasound and in ultrasound-guided injections.
Context: Ultrasound (US) is being used increasingly in physiatry clinical practice for diagnostic and therapeutic purposes. Traditionally, US training has not been a significant part of the Canadian PM&R curriculum. A resident-led musculoskeletal US curriculum has recently been implemented at the U of M.
Methods: One designated PM&R resident lead provided pre-readings, gave a presentation outlining the session objectives, and performed a live demonstration for the PM&R resident audience. Six residents were divided into three junior-and-senior-resident pairs. Each pair shared a hand-held ultrasound device. Residents scanned structures on each other following a protocol created by the lead resident. The knee was divided into anterior, posterior, medial, and lateral compartments, with 30 minutes afforded to each compartment for sonographic identification. Anatomists with experience in ultrasound circulated to provide support throughout the session. The final 45 minutes of the session was devoted to US-guided knee injection. Following a demonstration by the lead resident, the group practiced injecting saline into the suprapatellar recess on a soft-embalmed cadaver. Pre- and post-session reflection questionnaires were completed by the resident lead. Post-session peer-feedback surveys were completed by the remaining five residents.
Results: The resident lead expressed that preparing the session enhanced learning in anatomy and ultrasound. The soft-embalmed cadaver was an instrumental resource. Lack of prior clinical exposure was identified as the main challenge. Four peer-feedback surveys were submitted. All resident learners felt more confident about their anatomic knowledge and ultrasound scanning skills following the session. None expressed concerns about the resident lead's expertise in the subject.
Conclusion: The resident-led session established a model for PM&R US learning that incorporates anatomy, sonographic identification, and US-guided intervention. Interdisciplinary collaboration and use of soft-embalmed cadavers are valuable to achieving these goals. Given the novelty of these sessions in resident curriculum, formative feedback should be obtained following every teaching session.
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Medical Education, Physical and Rehabilitation Medicine, Cadaver |
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| Decreasing wait times and improving access to stroke rehabilitation outpatient occupational therapy using cost-effective organizational and structural changes: a quality improvement project |
Introduction: Decreased wait times to therapy services is a common goal amongst stroke rehabilitation facilities as it enhances patient outcomes. However, cost-effective solutions that utilize existing resources to address wait time issues may be overlooked in favour of more obvious, but costly, solutions such as hiring more staff. Due to provincial occupational therapy (OT) shortages, we were unable to increase OT full-time equivalents (FTEs) at our tertiary outpatient stroke rehabilitation center. The wait time for outpatient OT was 34-45 days between 2019-21, far from the Canadian Stroke Best Practice Recommendations target of within 48 hours following discharge from an acute care hospital. We aimed to determine cost-effective solutions, utilizing existing resources, to increase access and decrease wait times to outpatient stroke rehabilitation.
Methods: We performed a quality improvement project using an on-going iterative approach, derived from the Model for Improvement Framework from May 2021 to December 2022. Retrospectively, patient baseline wait-time data was analyzed for the years 2019-2021. Contributing factors for delayed access were identified using a Fishbone diagram, and a Driver diagram organized these factors into key change categories with potential change items proposed. High-yield change items were identified and were tested starting in October 2021 with data collected on number of referrals, number of FTE OTs, wait-times for stroke patients referred from acute care, and patient satisfaction. Run charts were created to visualize the changes in wait-times and referrals over time.
Results: Prioritized change items identified included engagement and coordination with acute care, referral triaging and prioritization, a direct-access interprofessional stroke rehabilitation clinic, and introducing group-based OT sessions. Total referrals to outpatient OT doubled in 2022 from 128 (2019), 114 (2020), 144 (2021) to 374 (2022). OT referrals for stroke patients direct from acute care increased from 15 (2019), 26 (2020), 9 (2021) to 48 (2022). OT wait times decreased from an average of 45 days (2019), 44 days (2020), 34 days (2021) to 11 days (2022) for stroke patients directly referred from acute care. Total FTE OTs slightly increased from 2.2 (2019-21) to 2.3 (January 2022), then decreased to 1.3 (Sept 2022-Dec 2022). 83% of patients felt the wait time for their first therapy appointment was "Not Too Long" in 2022.
Conclusion: A low-cost structured approach using a formalized quality improvement framework can both improve access and decrease wait-times for outpatient stroke rehabilitation services with good patient satisfaction, despite a decrease in total therapy staffing and increased referral volumes.
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Occupational Therapists, Outpatients, Quality Improvement, Stroke Rehabilitation, Waiting Lists |
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| Effect of botulinum neurotoxin (BoNT) in muscle contracture (MC) presenting with electrical myotonia- A case study. |
Context: 36 years old man presented with severe hip and knee flexor MC of lower extremities without a definite neurological diagnosis. He was born premature by 6 weeks Micrognathia, cleft palate, swallowing difficulties, ear infections and physical and intellectual delay were recorded in early infancy. Genetic studies were negative for 2P or 2Q deletion syndromes. As a teenager, he was ambulant for short distances with assistance, but lost the ability to walk after a fall. MRI of head was negative for new pathology and clinical findings for upper motor neuron syndrome or spasticity were negative. There was no record of clinical myotonia. Goal was set to increase the knee extension (KE) for comfortable seating in a chair
Mthod: The hip fixed flexion was measured as 40 degrees on right and 30 degrees on left. Passive KE was 15 degrees from fully flexed position on both sides. OnabotulinumtoxinA (ONA) was injected in psoas major, semitendinosus, semimembranosus, biceps femoris and hip adductors at an interval varying from 3-4 months. KE was measured before each treatment. The dose of ONA was 600-700 units used in 9 sessions. The toxin was changed to AbobotulinumtoxinA for next 7 sessions and the dose used was 1800- 2000 units. EMG monitored injections were done which recorded waxing and wanning myotonic discharges in all muscles examined, consistent with muscle disease (MD) such as myotonic dystrophy (DM)
Results: Both toxins helped to relieve the muscle contracture. After 2 years of treatment the KE increased to an angle of 120 degrees (-60 degrees from full extension) on both sides with maximum stretch. Comfortable seating in a customized chair was achieved. Myotonia was decreased but did not disappear in the treated muscles.The genetic study for DMII was negative
Discussion: There is no previous report of use or effectiveness of BoNT in contractures in MD presenting with myotonia or DM. Acetylcholine (Ach) plays an important role in Channelopathies (CHP) in maintaining hyper polarization (HP) of muscle membrane. Blocking of Ach likely reduces the HP of muscle membrane and sustained muscle contractility
Conclusion: The role of BoNT in reducing myotonia, muscle spasms and sustained contractility in MD and CHP needs to be further explored.
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Butulinum Toxin, channelopathy, contracture, myotonia, muscle disease |
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| Electrodiagnostic Reporting Preferences of Referring Physicians: An Exploratory Survey |
Context: Electrodiagnostic (EDX) studies, consisting of nerve conduction studies (NCS) and needle electromyography (EMG), play a crucial role in the evaluation of patients with neuromuscular and peripheral nerve disorders. Electromyographers work in close collaboration with referring physicians, oftentimes through referral and consultation letters. However, there is variation in the format and content of EDX reports to referring physicians, which might complicate communication and clinical decision-making for physicians and patients. Accurate and succinct communication of test results is critical to patient safety, so that important results are neither lost nor miscommunicated.
Objective: To explore EDX reporting preferences of referring physicians in order to improve the quality of communication and subsequent patient care.
Methods: An online survey was developed, exploring specialty type and preferences for data reporting, data summary/interpretation, and diagnostic impression. A purposive sampling strategy was used to recruit physicians in the authors' professional networks who had previously referred patients for EDX studies. Quantitative and qualitative survey data underwent descriptive statistical analysis and thematic analysis, respectively.
Results: There was a total of 40 respondents, consisting of non-surgical specialists (_n_ = 22), surgical specialists (_n_ = 12), and family physicians (_n_ = 6). The majority of respondents indicated that the data summary/interpretation and diagnostic impression sections of an EDX report were most critical to their needs; important elements included differential diagnosis, prognosis, and management recommendations. A considerably smaller proportion of respondents comprised of primarily non-surgical and surgical specialists indicated numeric data as critical to their needs, preferring this data to be formatted as bullet points or tables without NCS waveforms. Regarding the format of EDX reports, the majority of respondents preferred bullet point rather than paragraph formatting of the data summary/interpretation and diagnostic impression sections. These preferences were corroborated in the thematic analysis of text responses, which also highlighted the importance of the clarity and consistency of EDX reports.
Conclusion: The results of this exploratory survey suggest that physicians who refer patients for EDX studies prefer reports that emphasize the interpretation of EDX data and a clear diagnostic impression, particularly in bullet point format. This project highlights the importance of optimizing communication between electromyographers and referring physicians to ultimately improve patient care. Future research should explore larger sample sizes to ascertain any subgroup differences and investigate the impact of different reporting styles using relevant outcome measures (i.e. clinical utility, physician satisfaction).
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Communication, Electrodiagnosis, Electromyography, Nerve Conduction Studies |
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| Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps tendonitis – a prospective study |
Running title: Evaluation of ultrasound diagnosis in long head of biceps tendonitis: a prospective studyAnterior shoulder pain could lead to functional limitation and represent a high cost for the society. However, the diagnosis of the etiology of the pain remained challenging for clinicians. As a result of the improvement in the quality in the imaging of ultrasound (US) technology, its use in the diagnosis of the long head of biceps (LHB) tendinopathy needs to be assessed.
OBJECTIVETo compare the clinical and ultrasound (US) accuracy in the diagnosis of LHB tendonitis to the gold standard shoulder surgery.DESIGNAn experimental, prospective, double-blind multicenter study was conducted to assess clinical, US and arthroscopic evaluations of patients with LHB-suggestive anterior shoulder pain. Function was reported using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical exam included range of motion (ROM) and shoulder specific tests (Speed, Yergason, O'Brien, Upper Cut, and palpation of the bicipital groove). Then, an US-certified physiatrist performed the quantitative and qualitative US measurements of the LHB tendon. Finally, a direct visualization of the LHB was performed through an open or arthroscopic shoulder surgery.PARTICIPANTSAdults with LHB tendonitis-suggestive anterior shoulder pain exempt from major shoulder ROM limitations, rheumatologic disease, recent joint infiltration, upper limb fracture, shoulder neoplasia, shoulder prosthesis, and complete rupture of the (LHB).RESULTSPreliminary results of 45/100 patients awaiting shoulder surgery (64% men), with a mean age of 55±15 years-old, were included in the study. Dedicated provocative tests were compared to gold-standard shoulder arthroscopy and showed Sensitivity (Sn), Specificity (Sp), positive (LR+) and negative (LR-) likelihood ratio as follows; Clinical specific tests showed a range of Sn: 35-58%, Sp: 36-57%, LR+: 0.52-1.05, LR-: 0.96-1.48. Moreover, qualitative LHB tendonitis diagnosis on shoulder US revealed Sn: 60% Sp: 36% LR+: 0.93 and LR-: 1.12 while combining both dedicated tests (Speed and Uppercut tests) and US showed Sn: 47% Sp: 38% LR+: 0.75 and LR-: 1.42. Finally, quantitative shoulder US analysis of LHB diameter at the rotator interval demonstrated Sn: 4%, Sp: 100%, LR+: 0 LR-: 0.96, LHB maximal diameter showed Sn: 8% Sp: 100% LR+: 0 LR-: 0.92, LHB thickness (>23mm) showed Sn: 74% Sp: 15% LR+: 0.87 and LR-: 1.70, while LHB maximal surface at rotator interval (>10mm) showed Sn: 83% Sp: 15% LR+: 0.98 and LR: 1.13 and LHB maximal surface (>10mm) was Sn: 72% Sp: 15% LR+: 0.85 LR-: 1.13.CONCLUSIONIn agreement with previous studies, clinical examination alone yielded poor diagnostic accuracy in LHB tendonitis. Up to now, taken separately, US qualitative and quantitative measures were not predictive of the LHB tendonitis diagnosis. Nonetheless, the LHB diameter at the rotator interval and the maximal diameter were 100% specific to LHB tendonitis. More research is needed to integrate the information brought by every test altogether to reproduce the clinician analysis process. |
Biceps tendonitis, Shoulder examination, Shoulder arthroscopy, Shoulder ultrasound, Ultrasound |
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| Exploring Undergraduate Medical Curriculum on Caring for Adults and Children with Physical, Cognitive, and other Disabilities |
Introduction: Currently, the undergraduate MD curriculum across Canada provides learners with a basic understanding of the provision of healthcare through a sociocultural lens. There is recognition that this approach provides a learning opportunity for enhancing communication, access, and care for a diverse population. However, education dedicated to teaching students how to care for patients with disabilities is deficient. Physical medicine and rehabilitation specialists see a large proportion of patients with various types of disabilities and is a speciality underrepresented in undergraduate medical curriculum. Literature suggests that Canadian medical students lack confidence when caring for patients with disabilities thus understanding gaps in curriculum is imperative to generate a strong cohort of medical professionals able to work with patients of diverse populations.Objective: The aim if this study is to assess opinions held by medical students and to understand best teaching practices to improve teaching methods for future learners. It is hypothesized that medical students at any level of their training will have had limited dedicated curriculum and clinical experience towards care of patients with disabilities. Due to lack of teaching in this area, students may have low levels of confidence in their skills towards care of many patients seen by PM&R specialistsMethods: To explore current values, beliefs, and knowledge held by medical students at the University of Saskatchewan 10-question survey was sent to the MD classes of 2025-2022 (n~400). The survey included both qualitative and quantitative parameters which was used with a map of the current MD undergraduate curriculum demonstrating where content and skills are included regarding disability education to assess gaps in knowledge of students.Results: Students broadly suggested that most of their knowledge and experiences working with this population come from opportunities outside the MD curriculum. Survey responses conclude that Students lack confidence eliciting a history from, preforming a physical exam, counselling, making clinical decisions, and connecting co-morbidities from different systems for adults and children with physical, cognitive, and other disabilities. Furthermore, students' express interest in enhancing their knowledge to better support patients with disabilities and many students have thoughts on where this education should be incorporated into the curriculum. Overall, survey responses strongly suggest that students want more dedicated curriculum in this area.Conclusion: To best prepare medical students to appropriately care for patients with disabilities, there needs to be a longitudinal integrated disability curriculum integrated with PM&R dedicated teaching for students to gain exposure and confidence to provide optimal, comprehensive healthcare for this population. |
Curriculum development, Disability education, Medical education, Undergraduate medical education, Special needs |
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| Eye on the prize: Is there a recognition gap for women physiatrists in Canada? |
Context: Across many disciplines and jurisdictions, including medicine, women are substantially less likely to receive awards and recognition than men. To date, this prospective gender gap has not been explored for Canadian physiatrists.
Objective: To characterize the gender distribution of Canadian national award recipients in Physical Medicine and Rehabilitation.
Design/methods: Annual Canadian Association of Physical Medicine and Rehabilitation (CAPM&R) award recipients were analyzed and recipients' gender assigned by independent reviewers based on reviewers' knowledge of the individual, searching public professional websites for pronouns and photographs, or traditional name associations if no other information was found. Thirty years of data (1992-2021) from seven award categories was included. Medical student awards were excluded from analysis. The gender distribution of Canadian physiatrists by year was compiled from the Canadian Institute for Health Information. Data were analyzed using descriptive statistics. A linear mixed effects model was used to evaluate the effect of gender on the likelihood of winning an award while controlling for the gender distribution of all Canadian physiatrists and the number of award recipients that year.
Results: Over 30 years, a total of 164 awards were presented by the CAPM&R; 73 winners (44.5%) were women. The annual number of awards increased from 1 in 1992 to 11 in 2021. The overall proportion of women physiatrists in Canada increased from 21.4% in 1992 to 39.6% in 2021. By decade, the proportion of women award winners increased from 30% in 1992-2001, to 34.6% in 2002-2011, and 49.2% in 2012-2021. Women were underrepresented in Award of Merit and Paper of the Year in which 28.6% and 29.4% of recipients were women, respectively. Women were overrepresented in the Meridith Marks Award and the Abstract Competition in which 62.5% and 54.5% of recipients were women, respectively. The proportion of women physiatrists in Canada had little impact on the number of women award recipients but the number of awards that were distributed had a dramatic impact, with the proportion of women winners increasing concurrently with the Abstract Competition awards. Overall, being a woman was associated with a 2.5% reduction in the likelihood of winning an award.
Conclusions: The gender gap in CAPM&R awards has narrowed over time primarily as a result of an increase in the total number of awards being distributed. However, being a woman is associated with a reduced likelihood of winning an award.
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Awards and prizes, Disparity, Gender equity, Physical Medicine & Rehabilitation |
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| Femoral Neuropathy after Total Hip Arthroplasty: An Illustrative Case of Guided Neurorehabilitation |
Context: Direct anterior approach total hip arthroplasty (DATHA) increases the risk of femoral neuropathy (FN); recovery depends on severity of nerve injury. This case illustrates the importance of comprehensive assessments and electrodiagnostic studies (EDX) in guiding neurorehabilitation to optimize FN axonotmesis outcomes post-DATHA through an additive, staged approach: 1) diagnosis of nerve injury severity and education; 2) neuronal regrowth and neuroplasticity; 3) isometric and range of motion; 4) stimulation and strengthening; 5) endurance.
Findings: 57yo healthy male underwent DATHA for left degenerative hip osteoarthritis. Post-operatively, he had weakness of left quadriceps MRC 0/5 and numbness over saphenous and medial femoral cutaneous territories. He was diagnosed with FN. Despite his weakness, he ambulated with a 4-wheeled walker. Clinical examinations at 2- and 8-week post- DATHA showed no improvement in strength.4-months post DATHA, he had MRC 1/5 for quadriceps and his sensation was unchanged. EDX showed absent saphenous and medial femoral cutaneous SNAPS. Needle EMG of proximal rectus femoris (RF) had denervation and a single small polyphasic nascent unit with no additional volitional motor units in quadriceps; he was diagnosed with FN axonotmesis (stage1). Given the presence of a nascent unit, he started biofeedback, cortical visualization and mental imagery (stage 2).7- months post- DATHA, he could ambulate with a cane, quadriceps MRC was 2/5. Needle EMG showed nascent and maturing motor units in RF, and reduced recruitment. Given his improvements in strength, he progressed to stage 2-3; with the addition of gravity eliminated active ROM, isometric contractions, and dynamic assisted orthoses.10-months post DATHA, clinical exam and EMG were unchanged, aside from nascent units in vastus lateralis and medialis. He advanced to stage 3-4, with the addition of neuromuscular stimulation and concentric strengthening. When quadriceps MRC is 3+/5 and maturing motor units are seen on needle EMG, addition of eccentric strengthening and body weight exercises will begin (stage 5).
Clinical relevance: As per Sir Sydney Sunderland, axonal regrowth occurs at approximately 1mm a day. Nascent units, indicative of muscle fibre reinnervation, are susceptible to injury, requiring time for maturation before appreciable improvements in muscle strength. A dynamic protocol to avoid excessive fatigability of newly reinnervated motor units post-axonotmesis, as described, can maximize outcome.
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rehabilitation, diagnosis, education, injury |
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| Gripping surprises in the EMG lab: A case report about navigating surprise presentations. |
Clinical relevance: One of the most frequent referrals to the EMG laboratory for upper limb complaints stems from a common neurologic complaint – hand paresthesia. Given the ubiquitousness of Carpal Tunnel Syndrome, such cases prompt the non-specific referral for "R/O CTS". This case illustrates that as physiatrists, even the most simple-appearing referral should prompt a full history, physical and neurophysiological examination; approaching these cases with genuine curiosity results in appropriate assessment and potentiates investigation of a broader differential than originally planned when scanning the referral question.Today, we offer a case through which a surprise presentation to a common clinical question resulted in more clinical mystery than conclusions. We hope to use this case to interact with our audience to identify further studies and find solutions, to the benefit of our mutual learning, and to patient outcomes.
Case: A 40-year-old right-handed bass guitarist was referred for query carpal tunnel syndrome (CTS) for a 6-month history of left-handed hand cramping with guitar playing and gripping, in the absence of classic CTS sensory symptoms. On exam, there is marked bilateral thenar wasting with bony abnormalities, 0/5 abductor pollicis brevis (APB) power bilaterally, 5/5 First dorsal interosseus (FDI) power bilaterally. Sensory exam revealed reduced pinprick sensation over right digit 2, and left digit 5. Electrodiagnostic studies found a normal Combined Sensory Index (CSI) on the symptomatic left hand, and abnormal on the asymptomatic right. Motor studies to the APB were non-recordable bilaterally. Left-sided ulnar studies revealed significant slowing, localized across the elbow. EMG revealed chronic changes to the ulnar-innervated muscles below the elbow and normal findings to median innervated muscles. The patient returned two-months later and had resolution of his ulnar mononeuropathy at the elbow with conservative management. Despite this, he had ongoing left-handed cramping and unchanged pattern of bilateral thenar wasting. What further electrophysiologic and diagnostic testing would you suggest?
Conclusion: Broadening differential diagnoses, and avoiding anchoring, are necessary to avoid misdiagnosis and mismanagement in the EMG laboratory, even for seemingly simple cases.
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Clinical Skills, Electrodiagnosis, Electromyography, Neurophysiology |
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| Impact of Botulinum Toxin Injection Delays Due to the Covid-19 Pandemic on Spasticity Treatment in Patients with Cortical Stroke |
Context, objective: The objective of this paper is to evaluate how the COVID-19 pandemic has affected the frequency and doses of botulinum toxin (BoNT) injection in patients with cortical stroke treated for spasticity before and after March 2020 at a community-based spasticity clinic in Vancouver. The study hypothesizes that a COVID-19 lockdown mediated interruption between two botulinum toxin injections would lead to a subsequent dose increase on follow-up.
Design: The frequency of visits for botulinum toxin injections with respective doses in each muscle was retrospectively reviewed for ten patients with cortical stroke. The study measured baseline and follow-up BoNT doses, which can be considered a proxy for disease burden. Additionally, the study measured the frequency of injections before and after the start of the COVID-19 pandemic.
Setting and participants: All patients with cortical stroke who visited the spasticity clinic in New Westminster during the month of February and were followed up both before and after the onset of the COVID-19 pandemic were included in the study.
Results: The COVID-19 pandemic negatively impacted medical facilities and rehabilitation services worldwide, including toxin services that deliver BoNT treatments for spasticity. On average, the BoNT holiday lasted for 309 days with the pre-pandemic normal interval between two injections being 204 days. The study found that the BoNT doses injected post-lockdown significantly increased by an average of 43 IU (p=0.03). The study did not identify a significant effect of the duration of the BoNT holiday on the increase in BoNT doses. There was no significant difference in the mean interval between injections in the pre- and post-COVID-19 lockdown periods.
Conclusion: Patients required a subsequent dose increase after a prolonged interruption of injections during the COVID-19 lockdown, independent of the duration of the BoNT holiday. Future studies are warranted to explore this finding, to confirm this dose elevation, and to explore possible causes such as global deconditioning or comorbidities mediated by the lockdown. The dosage increase was found to be independent of the duration of the BoNT holiday, suggesting that the paradigm of regular injections of BoNT should be questioned. Specific evaluation for each patient is required at every visit, and external factors other than the specific duration between two botulinum injections are the main reason to adjust botulinum treatment.
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Botulinum toxin, COVID-19, Post-stroke, Spasticity |
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| Impact of Martial Arts-Based Interventions on Social, Cognitive, and Physical Function of People with Autism Spectrum Disorder: A Scoping Review Protocol | Context; Autism spectrum disorder (ASD) is a neurodevelopmental disorder marked by difficulties in social communication and repetitive behaviors. Cognitive symptoms such as executive dysfunction and physical symptoms like poor coordination, balance, motor skills, proprioception, and sensory integration may also affect individuals with ASD. Physiatrists are positioned to take a holistic approach in maximizing functional outcomes including recommending exercise-based interventions such as martial arts. Objective; This scoping review aims to map the existing literature on the impact of martial arts on the social, cognitive, and physical function of people of all ages with ASD. Methods; This scoping review will be conducted according to guidance from the Joanna Briggs Institute. The search strategy was developed with assistance from an information scientist. The following databases will be searched: PubMed, Embase, CINAHL, ERIC, Scopus, and Sociological Abstracts. Eligibility criteria include articles evaluating effects of any martial art on persons of any age diagnosed with ASD as per the DSM-3, DSM-4, or DSM-5. Studies published prior to 1980 will be excluded as contemporary understanding of ASD which recognizes social communication deficits, restricted interests, and repetitive behaviors as cardinal features was first presented in the Diagnostic and Statistical Manual of Mental Disorders-3rd (DSM-3) published in 1980. Abstract screening, full-text review, and data extraction will be completed independently and in duplicate. Extracted data will include type of martial art, length of intervention, sample demographics and social, cognitive, and physical functional outcomes. Effects of martial arts training on functional and health outcomes of people with ASD will be narratively synthesized. Results; The preliminary literature search was conducted February 22, 2023 and returned 31 results. Screening and data extraction will occur March to April 2023. Results of the scoping review are expected to be available May 2023. Conclusion; This scoping review will provide evidence on outcomes of martial arts-based interventions as a potential therapeutic modality to enhance social, cognitive, and physical functioning amongst people with ASD. | Martial Arts, Autism Spectrum Disorder, Social, Cognitive, Physical |
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| Improving Physical Medicine & Rehabilitation (PM&R) Awareness in Postgraduate Medical Education: Results of a Cross-Sectional Survey of Postgraduate Medical Learners |
Introduction: There is poor awareness oPM&R among physicians and medical trainees impacting patient access to services. Much of the data available regarding PM&R awareness and educational intervention are in undergraduate medical education. There is a paucity of data for the postgraduate population. Identifying gaps in PM&R awareness, and subsequently providing education to fill these gaps could help increase integration of PM&R specialists, thereby improving patient care. This study aimed to explore postgraduate learners' understanding of PM&R's scope of practice.
Methods: Postgraduate medical learners at an Ontario institution were invited, via email, to participate. The online survey collected data on trainee understanding and awareness of the specialty of PM&R, their referral patterns to PM&R, along with their interest in learning more about the specialty. The survey was adapted from that of a similar study at the same institution that surveyed medical students' knowledge regarding interventional radiology. Counts and percentages, using Excel, were used to summarize results.
Results: Eighty-one trainees responded, most were junior (69.1%), in Family (28%) or Internal Medicine (19%) and learned about PM&R in pre-clerkship (42%). Participants had a good to reasonable understanding of the scope of PM&R. Stroke (67%), chronic pain (49%), MSK inpatient (48%), and ABI inpatient (44%) were the most well-known services; however, the majority of trainees did not regularly refer to PM&R (61%). Presentations, clinical days and accessible information (online and offline) were suggested.
Conclusion: This is the first study of the authors' knowledge that explores resident learners' understanding of PM&R in the intended local and regional context. The results from this study will act as a foundation to guide future research and quality improvement interventions to increase awareness and subsequent referrals to PM&R
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Physical Medicine and Rehabilitation, Awareness, Interdisciplinary, Survey, Postgraduate Medical Education |
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| Improving tensor bandaging technique on an amputee rehabilitation unit to optimize residual limb edema |
Introduction: Post-operative edema management, such as tensor wrapping, of an amputated residual limb is of upmost importance to decrease complications and can improve prosthetic fitting success when done properly.1,2 Figure-eight tensor bandage application has been described to decrease edema formation and improve mobilization in limb loss patients.1,3 However, when incorrectly applied, figure-of-eight bandaging can lead to pressure injuries, tissue necrosis, and/or poor residual limb shape.4 The goal of this quality improvement project was to improve rehabilitation clinician knowledge of figure-of-eight tensor wrapping importance and technique on an impatient amputee rehabilitation unit.
Methods: An educational video explaining the figure-of-eight tensor wrap step-by-step was developed and made available to nurses and nursing students of an amputee rehabilitation unit, and made available on the educational portal of the hospital. Engaging with stakeholders, the need for hands-on experience was reported. The next PDSA was supplementing video viewing with in-person demonstrations by a Physiotherapist Assistant and having participants practice of tensor wrapping technique on a simulated residual limb model (Medical Science Human Lower Stump Bandaging Simulator Teaching Manikin – Nasco Lifeform Simulator). The team members (nurses, physiotherapists, physiotherapist assistants, occupational therapists, physicians, and their respective students) were recruited to watch the video and answer the survey on a voluntary basis, while explaining that this was an opportunity to improve patient care. Pre-and post-educational intervention surveys were distributed to all participating team members. Descriptive and qualitative analyses were used to interpret the impact of the intervention.
Results: Twenty-eight team members watched the educational video and completed the associated survey. More than 50% of participants were nurses. Of the other participants, 14% were physiotherapists, 7% were occupational therapists, 7% were physiotherapist assistants, and 18% were health care students from all those domains. Sixty-eight percent of the responders had received prior training, but only 21% were applying tensor bandaging as part of their routine clinical activities. Before watching the video, 57% of the team members were not comfortable with the figure-eight tensor technique. After watching the video, no team members felt uncomfortable, and 39% felt extremely comfortable applying tensors bandaging. Eighty-nine percent of the responders felt that this education video was extremely useful to team members who were new to amputee care, and 57% felt that it would be very useful for team members that have been caring for amputee patients on an inpatient amputee unit. Fourteen participants had the opportunity to do the simulation with the Physiotherapist Assistant after watching the education video. Of those, 86% found that the simulation was very or extremely useful to have even after watching the video. There weren't any participants who did not find the simulation useful. Of those who did not have the opportunity of doing the simulation session after watching the video, five mentioned it would have been very or extremely useful to have.
Conclusion: Figure-eight tensor wrapping of amputee residual limb is an under taught and infrequently used technique in amputee care. Integrating a short video to the educational portal allowed team members to become more comfortable with the technique. An educational video and low-cost simulation model may be helpful in limb loss care to reduce residual limb complications, but more research is needed to determine the impact on patient care outcomes.
References: 1. Bryant G. Stump care. Am J Nurs. 2001;101(2): 67-71.2. HAYES DD. How to wrap a below-the-knee amputation stump. Nursing2022. 2003;33(2): 28.3. O'Keeffe B. Prosthetic rehabilitation of the upper limb amputee
Indian journal of plastic surgery: official publication of the Association of Plastic Surgeons of India. 2011;44: 246-252.4. Finnie A. Bandages and bandaging techniques for compression therapy. Br J Community Nurs. 2002;7(3): 134-142.
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Keywords: Amputees, Bandages, Edema, Educational Status, Extremities |
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| More than just a pain in the neck? A prospective cohort study on the impact of post-concussion cervicogenic headache on recovery |
Background: Each year, 1 in 10 Canadians aged 13 to 18 seek medical attention for a sport-related concussion (1). Up to 30% of these youth will have a variety of persistent symptoms, including daily headache, for more than one month (1). Despite concussion being defined as a mild traumatic brain injury, concurrent injury to the cervical spine is a potential source of common, persistent symptoms, including headache (2). Cervicogenic headache (CGH) is caused by referred pain from the trigeminal and upper three cervical spinal nerves, to the head (3, 4). Differences in cervical muscle strength development, ligamentous laxity, head-body proportions, and cervical spine mobility may place adolescents at an increased risk of post-concussion CGH (5). CGH has four diagnostic physical exam maneuvers (5). We aim to utilize these physical exam maneuvers to identify cervicogenic headache within a group of adolescents with post-concussion headaches, and to determine whether this is correlated to recovery following sport-related concussion, compared to those with other headache phenotypes.
Objectives: To identify cervicogenic headache in adolescents with post-concussion headache using four validated physical exam maneuvers, and to determine whether cervicogenic headache is associated with a prolonged recovery and headache symptom burden.
Design: Prospective cohort study.
Setting: Acute Sport Concussion Clinic (ASCC) in Calgary, Alberta, Canada
Participants: This study includes a convenience sample of patients, who attended the University of Calgary Sport Medicine Centre Acute Sport Concussion Clinic after sustaining a suspected concussion
Inclusion criteria: Aged 13-18, diagnosed with sport-related concussion during the initial four weeks of injury, completed the Sport Concussion Assessment Tool (SCAT) at time of diagnosis
Exclusion criteria: Diagnosis of headache disorder or migraines prior to sustaining concussion, no headache symptoms at initial visit post-concussion (0/6 on SCAT Likert scale).
Interventions: 4 physical exam maneuvers were used to diagnose cervicogenic vs. non-cervicogenic headache, and split them into two groups. Headache severity scores and days to clearance to return to sport were compared in both groups.
Outcome measures: Two outcome measures were used: headache severity scale, obtained from 7-point Likert symptom scale on the Sport Concussion Assessment Tool (SCAT5), and days to medical clearance to return to sport.
Results: Pending
Conclusion: Pending. This study will help provide information on the impact of cervicogenic post-concussion headaches on recovery.
Funding acknowledgement: N/A
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brain concussion, brain injury, headache, post-traumatic headache |
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| Neurogenic Heterotopic Ossification: a novel mouse model |
Background: About 900,000 individuals suffer a traumatic spinal cord injury (SCI) every year. SCI severely impacts quality of life and increases the risk for debilitating sequelae. Heterotopic ossification (HO) is an increasingly recognized debilitating complication of SCI, which is the abnormal formation of bone in soft tissues. Due to the knowledge gap in HO pathophysiology, current treatments are non-specific and complicated by off-target effects.
Objective: Our goal is to develop a clinically relevant murine model of SCI-associated HO to study the pathogenic mechanism and test novel therapies.
Design: Ten-week-old C57BL/6J female mice were subjected to a spinal cord transection to induce a SCI, followed with a musculotendinous injury (MTI) by crushing the left quadriceps musculotendinous tissue. Mice were euthanized after 1 and 4 weeks and high-resolution micro-CT scans of mouse hindlimbs were then used for quantitative analysis of mineralized tissue. Samples were then embedded in methyl methacrylate and consecutive 5µm sections were stained with Von Kossa to show tissue mineralization, alkaline phosphatase (ALP) for osteoblast activity, and tartrate-resistant acid phosphatase (TRAP) for osteoclast activity. Histomorphometry using ImageJ was used to quantify the percent positive area.
Results: Quantitative micro-CT analysis at 1 week showed significantly higher ectopic mineral volume (in 107 µm3) in SCI+MTI in comparison to the SCI alone group (6.93 ± 2.6 vs. 0.31 ± 0.02, p = 0.02214). The ectopic mineral volume kept increasing and, at 4 weeks, it is significantly higher than that of SCI alone (14.9 ± 4.87 vs. 0.222 ± 0.023, p<0.0001). Moreover, trabecular bone volume/tissue volume (BV/TV) of distal femoral metaphysis showed a significant decrease at 4 weeks in the SCI+MTI group in comparison to MTI alone (p = 0.0007) while no statistically significant difference was noted between SCI+MTI and SCI alone at 4 weeks post-injury. ALP and TRAP staining corroborated the colocalization of osteoblast and osteoclast activity at the loci of ectopic mineralization. In SCI+MTI, the percent ALP positive area at 4 weeks post-injury was significantly higher in comparison to 1-week post-injury (mean ± SE: 4.7 ± 0.59 vs. 0.15 ± 0.052, p = 0.0286). In contrast, quantification of TRAP positive staining in SCI+MTI groups did not show a statistically significant difference between 1- and 4-weeks post-injury.
Conclusion: Our model represents a novel preclinical model of SCI-induced HO to study its pathogenic mechanism and assess novel therapies.
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Heterotopic Ossification, Spinal Cord Trauma, Polytrauma, Translational Science, Bone Mineralization |
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1st place, original research |
| Pain in pregnancy: A retrospective chart review to inform patient education initiatives |
Context: Navigating pain management during pregnancy is challenging due to patient misconceptions, a lack of access to evidence-based recommendations, and health care provider discomfort and lack of knowledge. A specialized program with a multidisciplinary clinician team was developed at an acute care hospital with high-risk obstetrics to support individuals with pain impacting their daily function during pregnancy. Patient education is an integral part of any pain management plan, however appropriate evidence-based resources are not readily available for this population. The objective of this project was to complete a chart review to define our patient population including reason for referral, diagnosis, and whether opioid management was required, to develop evidence-based educational resources for the clinic.
Methods: A retrospective chart review was completed for all new consultations completed by the program in 2022. Data collected included the reason for referral, assessment diagnosis, and whether opioid management was required.
Results: During the year of 2022, 81 new consultations were completed. Musculoskeletal causes accounted for 50% of referrals, while 18% were for abdominal pain. Other reasons for referral included medication counselling, headache management and pain related to sickle cell disease. The most common diagnoses after assessment were pelvic girdle pain, low back pain, and fibroids. 71% of patients seen required opioid management.
Conclusion: The most common reason for referral was musculoskeletal pain. Common diagnoses included pelvic girdle pain, low back pain and fibroids resulting in abdominal pain. Referral to assist with opioid management represented a large proportion of individuals seen in the program. This information will inform the creation of accessible and evidence-based educational resources as part of a pain management plan.
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pain management, patient education, pregnancy |
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| Prevalence of Burnout in Trainees in Physical Medicine & Rehabilitation: A Systematic Review |
Context: Burnout, the triad of emotional exhaustion, depersonalization, and decreased sense of personal accomplishment, has recently experienced renewed interest and become an increasingly researched problem amongst physicians. Emerging evidence indicates that Physical Medicine & Rehabilitation (PM&R) physicians are among the most likely to experience burnout; however, studies highlighting and reviewing burnout in PM&R trainees have been limited.
Objective: To evaluate the prevalence of burnout in PM&R trainees.
Methods: Systematic literature searches were conducted in Medline, CINAHL, and EMBASE for peer-reviewed articles published in English prior to March 2023 that reported the prevalence of burnout in PM&R trainees, defined as residents and fellows. Data extracted included year and country of study, prevalence, and severity of burnout, and, if available, risk or protective factors for burnout in PM&R trainees. Data were analyzed using descriptive statistics.
Results: The systematic review yielded 603 results (233 duplicates). 58 full text records were reviewed; 5 met inclusion criteria: 4 surveys of PM&R trainees (total N=874 trainees) and one poster with an unknown study type and population size. 4 studies were from the USA and 1 from Saudi Arabia. All included studies were recently published (2016-2022). Prevalence of burnout ranged from 22.2-83.3%, with a weighted average from included studies with available sample sizes indicating the overall prevalence of burnout is 40% amongst PM&R trainees. Higher prevalence of burnout was reported amongst second- and third-year PM&R residents, female trainees, trainees on rotations with in-hospital call, trainees who worked over 50 hours per week, and trainees who had inadequate time for personal life, family, or studying.
Conclusions: Nearly half of all PM&R trainees experience burnout. These findings suggest urgent action is needed within residency training programs to address burnout. Personal, program, and systemic factors have been associated with an increased prevalence in trainee burnout. Many of these risk factors are distinct from those identified in PM&R physicians. Additional research on interventions and opportunities for burnout prevention and reduction amongst trainees is critical. Moreover, as there are no studies investigating the prevalence of burnout in Canadian PM&R trainees, further research within the Canadian context is imperative.
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Graduate Medical Education, Physical Medicine and Rehabilitation, Residency, Burnout Professional, Review |
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| Quality of Life and Rehabilitation After Acute Neurologic Injury in Rural Canada: A Scoping Review |
Context: In Canada, rural populations experience higher rates of traumatic injuries and have increased barriers to accessing health care than their urban counterparts. This may increase risk of acute disabling neurologic conditions such as traumatic brain injury (TBI), spinal cord injury (SCI), and stroke. People with these conditions can have significant inpatient and outpatient rehabilitation and ongoing medical needs to optimize quality of life in their community.
Objectives: The objective of this review was to characterize research on the quality of life and factors related to rehabilitation of rural Canadians with neurologic injury, specifically stroke, TBI, and SCI, and to identify gaps in the literature.
Methods: Five databases were searched using variations and combinations of the search terms "Canadian," "rural," "stroke," "spinal cord injury," and "brain injury," for peer-reviewed articles that commented on rural Canadian adult inhabitants with the above acquired neurologic conditions. Studies were included if they measured outcomes of quality of life, function, environmental barriers, health-care utilization patterns, or discharge destinations after the disabling event. Articles that exclusively commented on management of the acute disabling events were excluded.
Results: Of 215 papers screened, 11 met the inclusion criteria. Of these, four examined patients with acquired brain injury, two examined patients with stroke, and five examined patients with SCI. Nine studies were cohort or retrospective cohort designs, one was a cross-sectional design, and one was a qualitative study. There were mixed findings of if rural residents were less likely to be discharged to inpatient rehabilitation. Rural residence was associated with higher rehospitalization rates in patients with ABI and SCI. Rural residents with SCI perceived more environmental barriers than their urban counterparts, including lack of access and availability of core health care services. Function was found to be similar between rural and urban residents with stroke and SCI in two studies. Four studies examined quality of life outcomes in rural inhabitants. There were mixed results of psychological distress and depression in urban vs rural populations.
Conclusion: Further studies are needed to assess if rural inhabitants have similar access to outpatient rehabilitation to their urban counterparts. Further studies on health-related quality of life in rural inhabitants with stroke, TBI, and SCI throughout Canada are needed.
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Adult, Rural Population, Quality of Life, Patient Discharge |
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| Renewing Choosing Wisely Canada Recommendations in Physical Medicine and Rehabilitation to Meet Evolving Stewardship Needs |
Objective: Revise the Physical Medicine & Rehabilitation (PM&R) Choosing Wisely Canada (CWC) recommendations to meet the evolving stewardship needs relevant to PM&R and thereby reduce potentially harmful or unnecessary practices in health care delivery.
Methods/design: A committee consisting of members of the Canadian Association of PM&R's Quality Improvement and Patient Safety (QIPS) Special Interest Group (SIG) was formed to update and raise awareness of CWC recommendations for Physical Medicine & Rehabilitation (PM&R). Surveys of the general membership of the Canadian Association of PM&R sought suggestions for revisions to existing PM&R CWC and/or new prospective CWC recommendations. Draft recommendations were revised and refined in consultation with the QIPS SIG membership with an emphasis on resource stewardship, aligning with the CWC mission. Revisions and approval were sought from the SIG leads specific to the updated recommendations' subject matter (e.g., spinal cord injury, acquired brain injury, pain, interventional medicine, and electrodiagnostic medicine).
Results: The updated 2023 CWC recommendations for PM&R recommend avoiding (1) investigating and treating asymptomatic bacteriuria in patients with neurogenic bladder; (2) recommending more than a brief period of physical and cognitive rest after mild traumatic brain injury; (3) starting opioid treatment for chronic noncancer pain without exhausting other approaches; (4) ordering diagnostic imaging for low back pain in the absence of red flags; (5) repeating injections without evaluating patients' responses to them; and, (6) recommending carpal tunnel release without first confirming the diagnosis with ultrasonography or electrodiagnostic testing. 5 of these 6 recommendations are evidence-based refinements of the 2016 iteration of CWC recommendations. One 2016 recommendation, avoid using benzodiazepines for agitation in acute traumatic brain injury, has been removed and replaced with a more relevant recommendation related to interventional pain management to better reflect the mission of CWC.
Conclusion: An extensive consultative process resulted in updated CWC recommendations that address current appropriateness and resource stewardship concerns within PM&R. Moreover, these recommendations align with national opioid and antibiotic stewardship initiatives. Future work will focus on raising awareness and equipping health care providers with quality improvement implementation tools to adopt these recommendations into their practices.
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antimicrobial stewardship, health resources, physical medicine and rehabilitation, quality improvement |
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| Residents' Perceptions of a Novel Virtual Livestream Cadaveric Teaching Series for Musculoskeletal Anatomy Education |
Background: The teaching and learning of musculoskeletal anatomy has consistently been considered difficult for various reasons. Physiatry residents are training to be neuromusculoskeletal experts and require a thorough understanding of musculoskeletal anatomy. Traditional teaching methods have focused on in-person cadaveric sessions, which were inaccessible during the COVID-19 pandemic; therefore, new teaching methods must be developed to address this gap in education.
Objective: This project involved the implementation of virtual livestream musculoskeletal anatomy teaching methodology with cadaveric prosections and evaluated the efficacy of this modality compared to traditional in-person cadaveric teaching.
Methods: An anatomy curriculum for 3 musculoskeletal topics was developed and delivered via livestream to 12 University of Alberta Physiatry residents. Upon completion of the virtual curriculum, residents completed an anonymous survey assessing perceptions of this new virtual livestream cadaveric teaching approach compared to prior experiences with traditional in-person anatomy teaching methods.
Results: A total of 92% of residents responded to the survey, with 9% rating the virtual livestream sessions as equivalent and 73% as better than traditional in-person teaching. Common reasons for these ratings included better visualization of cadaveric anatomy and easy discussion amongst the group. T-test analysis comparing livestream and in-person teaching demonstrated the virtual method was equivalent or better across several domains.
Conclusion: Virtual livestream teaching is a viable method for teaching the important subject of musculoskeletal anatomy. As residency programs transition to hybrid in-person and virtual teaching, educators should consider how to best integrate this approach into future anatomy curricula.
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anatomy, education, musculoskeletal, resident, virtual |
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3rd place, original research |
| Spastic trismus from posterior circulation stroke: A case report |
Background: Trismus is the restriction in the ability to open the mouth, and it can have significant consequences, affecting communication, swallowing, and oral hygiene. Causes of trismus include trauma, post-surgical, malignancy, radiation, and less commonly, from spasticity secondary to brain insults.
Objective: To present a case of spastic trismus secondary to posterior circulation stroke
Case: This is a case of a 28yo male with sickle cell disease and prior stroke who was admitted to hospital with decreased level of consciousness, tetraplegia, and anarthria. He required ICU admission and intubation. MRI brain performed early in his admission demonstrated new bilateral multifocal posterior circulation infarcts involving bilateral thalami, occipital lobes, temporal lobes, midbrain, and pons. The cause of his stroke was secondary to left ventricular thrombus seen on echocardiogram.He required prolonged ICU admission with tracheostomy. He was decannulated 1 month post stroke.He was noted to have severe trismus from masseter spasticity and with less than 1cm intermolar opening. He had complete left sided fascial palsy, significant cognitive deficits, and aphasia (expressive>receptive). He slowly improved functionally by being able to move his extremities and eventually was able to communicate with a communication board and simple words. His trismus and concerns for dysphagia precluded him from oral food intake, thus a gastric feeding tube was inserted. He was eventually able to drink thin water via cup.Two months post stroke, he was assessed by Physiatry who performed botulinum toxin (BT) injections of both masseters with 70 and 30 units in the left and right respectively. Patient's trismus did not improve in the weeks following these injections or with addition of baclofen 15mg TID and gabapentin 300mg TID.Three months post stroke, patient had a video swallowing study showing mild oropharyngeal dysphagia with no signs of aspiration. He was upgraded to full fluid diet with thin liquids.Four months post stroke, he received a repeat BT injection with 50 units into both masseters and 25 units into both temporalis muscles.He was transferred to inpatient stroke rehabilitation following these injections. Despite the repeated injections, his trismus did not improve. He was able to fit small pills through his right intermolar space and was eventually transitioned to pureed diet, and his gastric tube was removed.After discharge from inpatient rehabilitation, he was seen by otolaryngology who did not recommend surgery. He was seen by plastic and reconstructive surgery and is awaiting CT scan of his facial bones to assess candidacy of a mandible coronoidectomy.
Conclusion: We present a case of spastic trismus following a posterior circulation stroke affecting communication and oral intake, refractory to oral spasticity medications and BT injections. Trismus represents a rare but debilitating complication following a brain insult, which can pose challenges with regards to management.
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muscle spasticity, stroke rehabilitation, trismus |
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2nd place, case report / study |
| Spiral Integrated Concussion Curriculum for Residents: A 6-Month Pilot Impact Study |
Context: Resident-focused concussion curricula that measure learner behaviours are currently unavailable. We sought to fill this gap by developing and evaluating a Spiral Integrated Concussion Curriculum (SICC).
Methods: Our curriculum followed Kern's (2016) approach to curriculum design and was piloted iteratively by delivering two-hour academic half-days (AHDs) and three half-day clinical rotations to first and second-year family medicine residents at seven residency sites.The short-term impacts of AHDs were evaluated with pre- and post-knowledge tests.The long-term impacts of SICC were evaluated through two residency sites utilizing a mixed-method evaluation with pre-/post-test design and qualitative interviews about the learners' experience. Surveys were used to measure knowledge and confidence pre-AHD and six-months-post-AHD. Interviews at six months qualitatively explored behaviour change and competency perception.
Results:Short-term impacts: Our concussion curriculum had a participation rate of 80%, n=114 out of 141 participants for AHDs. Curriculum knowledge assessment immediately pre and post-AHD demonstrated statistically significant positive change (n=33), pre-intervention (M = 10.5, SD = 1.6) and post-intervention (M = 11.1, SD = 1.7), t(32) = 2.1, p = 0.042).
Long-term impacts: At six months, curriculum evaluation demonstrated sustained positive behavioural change (5 out of 6 residents reported using the study guide) at six months. Residents at the first site (n=5) had a knowledge decrease of 3.33% (p>0.05). Residents at the second site (n=7) had a knowledge increase of 11.58% (p>0.05). Residents at both sites had an increase in confidence (first site: 30% (p=0.025); second site: 62.79% (p=0.0014)). Valued programme elements included concussion diagnosis and management, Curriculum Guide as a resource, and an organized curricular structure.
Conclusion: This SICC enriches resident learning and fosters sustained knowledge improvement and behavioural change at six months post-intervention. Phase 1 of our study concluded that a SICC is a promising solution to improving concussion education in residency programs.
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Curriculum, Medical Education, Brain concussion |
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| Telerehabilitation Beyond the Pandemic: Development and Launch of the Toronto Rehab Telerehab Toolkit Version 2.0 Using Qualitative Methodology |
Context: The COVID-19 pandemic necessitated rapid implementation and scale-up of virtual rehabilitation, also known as telerehab. As a result, our team developed the Toronto Rehab (TR) Telerehab Toolkit, a free resource for clinicians that provided a guiding framework for improving access to telerehab and that shared our knowledge and lessons learned from the early phases of the pandemic.The toolkit contains resources around 4 implementation domains: Getting Started, Preparing Patients and Carers, Implementing Telerehab, and Evaluation and Monitoring; Version 1.0 was downloaded 494 times by users from 16 different countries across North America, Europe, Asia, South America and the Middle East.
Methods: In order to improve the TR Telerehab Toolkit, we sought perspectives of clinicians, research and education professionals on their experiences with its implementation and use. We utilized a qualitative descriptive approach consisting of telephone or videoconference supported interview or focus groups with 22 participants in total.
Results: Participants in our evaluation indicated that the Toolkit helped them demonstrate the importance of telerehab to their organizations, helped establish a telerehab community of practice, and provided them with the credibility to implement or advance telerehab within their own organization.Specific recommendations for improving the Toolkit included adding practical content and media, as well as more information on how to adapt clinical assessments virtually, and how to address liability concerns.
Discussion: In response to feedback received, we developed Version 2.0 of the Toolkit, which includes updated written content and a series of practical "how-to" videos with 3 main themes:
1) videos for patients and carers:"What Is Telerehab?", "How to Prepare for Your First Telerehab Session" and "Consent and Privacy in Telerehab",2) videos for providers:"Keeping Patients Safe", "Deciding Among Virtual, In-Person and Hybrid Models" and "Remote Monitoring", and3) Videos on how to assess and treat patients in the telerehab setting including cognition, balance and mobility, speech, swallowing, ADLs and IADLs.From Nov 2022 – March 2023, Version 2.0 was downloaded 120 times, and our videos were watched 1100 times on YouTube.Conclusions: Use of qualitative methodology allowed us to develop an updated Telerehab Toolkit that better incorporates the needs of its users. Future directions include developing additional multimedia content, exploring telerehab safety and understanding future technology in telerehab.
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telerehabilitation, telemedicine |
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| The importance of timely access to electrodiagnostic testing in inpatient rehabilitation, as demonstrated by a case of closely synchronous bilateral foot drop. |
Context: A 60-year-old female with a complex medical history including Ehlers-Danlos syndrome was admitted to the inpatient Acquired Brain Injury Rehabilitation service at Hennick Bridgepoint Hospital, after undergoing a PCOMM aneurysm repair two weeks prior. On admission, she endorsed a few-day history of new numbness and tingling in the left lateral leg with footdrop. Two weeks later, she suddenly developed similar symptoms in the contralateral leg, including a dense foot drop, without an identifiable trigger or new injury. She was transferred to the Emergency Department for further investigation, where an MRI revealed multilevel spondylosis of the lumbosacral spine. The Spine service queried a diagnosis of bilateral lumbosacral polyradiculopathy and offered surgical decompression, but the patient elected to defer surgery until she could discuss treatment further with her inpatient rehabilitation team. She was seen in EMG clinic three days later.
Findings: In clinic, she endorsed persisting bilateral foot drop with numbness and paresthesiae in her anterolateral legs radiating to the dorsal aspects of the feet. She denied back pain, clear radicular symptoms, or bowel/bladder symptoms. On examination, she exhibited a bilateral high steppage gait, with 1/5 MRC grade strength in bilateral ankle/great toe dorsiflexion and ankle eversion. Aside from mild give-way weakness in ankle inversion bilaterally, she had otherwise full lower extremity strength. Reflexes were present and symmetric. Electrodiagnostic evaluation revealed features consistent with bilateral fibular neuropathies at the fibular head, with conduction block. Needle EMG did not find further features suggestive of a significant lumbosacral radiculopathy or other causes of bilateral foot drop.
Conclusion/clinical relevance: Closely synchronous bilateral foot drop is rare but may occur due to central and peripheral causes. In this patient, electrodiagnostic evaluation was able to identify bilateral fibular neuropathies localized to the fibular heads, and in conjunction with imaging, ruled out polyradiculopathy or a central cause. Considering these findings, spine surgery was no longer felt to be indicated, and a targeted management plan was recommended. This case highlights the importance of timely access to NCS/EMG testing in the inpatient rehab setting, as it directly influenced management, and potentially prevented a likely unnecessary spinal surgery in a patient with multiple comorbidities.
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Electromyography, Peroneal Neuropathies |
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| The use of electronic questionnaires among persons with mild traumatic brain injury: A feasibility study |
Context: Many clinics have implemented electronic or computerized systems for gathering clinical and research information. This can be problematic for individuals with mild traumatic brain injury (mTBI) as a result of light sensitivity and other types of visual dysfunction.
Objective: The aim of this study is to assess the feasibility of using electronic questionnaires in persons acutely post mTBI.
Design/methods: Participants were recruited from a sports medicine clinic located in Ontario, as part of a larger prospective study. Patients were eligible for inclusion if they were 16 years of age or older and assessed within 14 days of their injury and were excluded if they had significant cognitive dysfunction or dementia. Participants were asked to complete a series of ten electronic questionnaires at the time of their initial recruitment. These were delivered by email using the REDCap clinical informatics system for participants to complete at home using their own device. The feasibility questionnaire consisted of 11 questions; depending on the answers provided, participants were presented with up to six additional questions. Data was analyzed using descriptive statistics.
Results: A total of 25 participants (56% male, mean age 26 ± 11.6 years) completed the questionnaires and were included in the analysis. Most participants reported being satisfied with the electronic questionnaires (22/25) and were disinterested in alternatives to the electronic format. Three participants reported being unable to complete the questionnaires in a single sitting as a result of symptom exacerbation. Four participants reported experiencing an exacerbation of their post concussive symptoms as a result of completing the electronic questionnaires and specifically reported worsening of headache (n=3), neck pain (n=1) and fatigue (n=1). Using a scale from 0 to 10, where 0 is no symptoms and 10 is the worst possible symptom severity, participants reported an average overall symptom severity of 2 ± 0.8 before beginning the electronic questionnaires which increased to an average of 6 ± 1.5 after questionnaire completion; participants reported that it took an average of 32 ± 17.0 minutes for their overall symptom severity to return to their baseline.
Conclusion: Despite being associated with a temporary exacerbation in post concussive symptom severity, there is demand for the use of electronic questionnaires among persons acutely post mTBI and this format is acceptable to the majority of persons in this patient population.
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Brain Concussion, Feasibility Studies, Surveys and Questionnaires |
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| The use of nabilone in paroxysmal laryngospasm: a case report |
Context: Paroxysmal laryngospasm is characterized by episodes of involuntary spasms of the laryngeal muscles, lasting a few seconds to minutes, leading to coughing, inspiratory stridor, and transient upper-airway obstruction1.A 52-year-old female with secondary progressive multiple sclerosis (MS) began experiencing spontaneous paroxysmal laryngospasms, up to four to five times daily. This was extremely distressing and had a negative impact on her quality of life. Recent brain MRI showed typical demyelinating lesions including a lesion in the ventral aspect of the medulla. Her medications for lower limb spasticity included regular chemo-denervation injections as well as maximum doses of baclofen and pregabalin. Given that she did not experience symptoms of acid reflux, a proton pump inhibitor was not initiated. She was assessed by ENT and flexible laryngeal endoscopy was unremarkable. Botulinum toxin injection under EMG guidance into the larynx, an effective management option for laryngospasm2, was recommended. Potential risks associated with this include inability to protect her airway (with induced paralysis of one side of the larynx) and interference with the timing (every 3-4 months) of her chemo-denervation regimen for her lower limb spasticity which she relied on for improved mobility. Few oral medications were tried while she was on the waitlist for a joint ENT and Neurology clinic appointment for EMG-guided botulinum toxin injection. Diazepam did not alleviate her laryngospasms and was discontinued3. She was started on a trial of nabilone (dose titration to 1.5mg twice daily). Nabilone was associated with a clinically significant reduction in the frequency of laryngospasms to zero to twice weekly. She decided against a trial of botulinum toxin.To our knowledge, this is the first case of the use of nabilone for the successful treatment of paroxysmal laryngospasms in MS.
Findings: Laryngospasm is a disabling symptom that is reported to occur in neurological diseases such as X-linked spinobulbar muscular atrophy and amyotrophic lateral sclerosis3,4. The exact prevalence in MS is unknown and there are a lack of treatment guidelines. Current guidelines for first-line treatment are aimed at reducing gastric reflux1. Our patient had a demyelinating lesion of the medulla which contains the nucleus of the vagus nerve. This nerve is implicated in the pathophysiology of laryngospasm as the larynx receives both motor and sensory innervation via its branches5. Therefore, in this patient, laryngospasm is likely an upper motor neuron sign secondary to this lesion. This case highlights that the pathophysiology of laryngospasm in MS is not solely due to gastric reflux and therefore, effective management may require treatment aimed at reducing muscle tone and spasticity.
Conclusion/clinical relevance: Evidence from this report suggests that nabilone may be a safe and effective treatment option for paroxysmal laryngospasms in MS, and that the conduction of additional research studies should be considered.
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Cannabinoids, Drug Therapy, Laryngismus, Multiple Sclerosis |
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| Virtual reality: An engaging educational modality for Canadian neurology and physiatry residents and fellows |
Context: Simulation-based learning is increasingly recognized to play a fundamental role in the training of the next generations of physicians. It has demonstrated its value in improving care in various settings, especially in hands-on procedures and acute care. Botulinum toxin type A (BoNT-A) injections, as first-line treatments for focal dystonia and spasticity, are commonly performed by neurologists and physiatrists. There has been positive feedback from trainees on simulation-based trainings for BoNT-A injections. Compared to live simulations, virtual-reality (VR) technology offers a cost-effective, interactive simulation-based learning that enables trainees to practice skills in a safe and controlled environment at their convenience. In this study, we examine the value of VR-based simulation in training neurology and physiatry professionals to perform BoNT-A injections for cervical dystonia and upper limb spasticity. The study objective was to assess the perceived value of VR simulation-based learning as a complementary educational modality for Canadian neurology and physiatry residents and fellows.
Methods: Canadian neurology and physiatry residents, fellows, and faculty members were invited to participate in programs involving VR tool. A variety of clinical presentations of cervical dystonia and upper limb spasticity could be selected to practice identification of the involved muscles and BoNT-A injections into the targeted muscles. The software program would indicate if the correct muscles and dosages had been used. At program's completion, participants were invited to fill a survey to report on their learning experience. This study was conducted and supported by industry.
Results: A total of 29 participants completed the survey. All participants agreed (48%) or strongly agreed (52%) that the VR tool is an engaging way to review functional anatomy of the neck and upper limb. Ninety-seven percent agreed that the VR tool is a nice complement to current learning activities (assigned readings and lectures, conferences, cadaver labs, etc.). Sixty-two percent of the residents and faculty responders agreed that the technology should be a standard component of anatomy teaching programs.
Conclusion: VR simulation-based learning is recognized by Canadian neurology and physiatry residents, fellows and faculty as an engaging educational technology to review the functional anatomy of the neck and upper limb. They also believe that the use of VR should be a standard component of their program curriculum.
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anatomy, education, learning, students, virtual reality |
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| We've got game: feasibility of exergaming therapy during inpatient neurorehabilitation |
Context: Individuals with traumatic brain injuries and spinal cord injuries often require extensive rehabilitation to regain function of limbs. Traditional treatments lack external stimuli leading to boredom and reduced motivation during therapy. A handheld exergaming device has shown success in at home rehabilitation of persons with chronic stroke. This pilot study investigates the feasibility of applying this device as therapy in hospitalized persons with upper limb impairments caused by a neurological condition or injury. The goal of the study was to gain an understanding of the satisfaction with GripAble within the inpatient population, and to explore outcomes measured through the device.
Setting: Stan Cassidy Centre for Rehabilitation inpatient unit.
Participants: 9 inpatients diagnosed with a neurological condition causing impairment of at least one upper limb.
Interventions: GripAble upper limb rehabilitation device.
Methods: A qualitative research design was used. Participants underwent a minimum of three training sessions a week using GripAble and were able to utilize the device outside of standardize therapy time if desired. Check in points with were at baseline, week 2 and week 4. The primary outcome was the QUEST 2.0 device subsection, a patient reported outcome measure validated for assessing satisfaction with assistive devices. Secondary outcomes were a Technology Acceptance Model detailing perceived usefulness, user acceptance and ease of use, as well as direct devices measurements such as grip strength, range of motion, and amount of use.
Results: Three participants withdrew from the study. Reasons for withdrawing were early discharge, health complications unrelated device use, and device frustration combined with lack of use. Themes considered most important to participants in an upper limb therapeutic device were ease of use, effectiveness, and weight. All participants remaining at week 4 had satisfaction with the ease of use, durability, and security of the device. Additionally, participants unanimously stated enjoyment using GripAble and felt they would recommend it to others receiving upper limb rehabilitation. Analysis of additional comments found the primary areas of concern were related to device weight and technological issues.
Conclusion: GripAble had high levels of patient satisfaction. An area to consider for improvement within the device is a reduction in weight. These preliminary results are supportive of the feasibility of a larger scale investigation into therapeutic outcomes within this patient population.
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Exergaming, Inpatients, Neurorehabilitation, Patient Satisfaction, Physical Therapy |
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| Wound Care Wednesday: Implementation of Interdisciplinary Pressure Injury Rounds |
Background: Stage 3, 4, and unstageable pressure injuries (PIs) are patient safety 'never events'. Persons with acute spinal cord injury (SCI) and/or moderate-to-severe acquired brain injury (ABI) are at risk of experiencing such an event because 20-50% of this population develop a PI during hospitalization. In part, PIs are more likely to develop related to neurologic impairment and decreased skin sensation. Although prevention is ideal, for patients admitted to rehabilitation with PIs, addressing their wounds is critical for participation and successful community reintegration. A standardized approach to assess, document, and treat these wounds is crucial.
Stakeholders: Inpatients who arrived with or developed impaired skin integrity, Clinical Nurse Specialist (CNS), Wound Care CNS, Physiatrists, Hospitalists, Unit Lead Nurse, Nurses, Occupational Therapists, Physiotherapists, and Unit Coordinator.
Objective: To describe the implementation of weekly interdisciplinary PI walk-through-rounds in a 30-bed inpatient ABI/SCI rehabilitation unit of an academic rehabilitation hospital.
Methods: Single centre observational quality improvement initiative. Chart audits for photographs, measurements, and interdisciplinary rounds review assessed compliance.
Intervention: Weekly interdisciplinary wound care rounds dubbed "Wound Care Wednesday" were implemented to facilitate consistent assessment, documentation, and treatment plan adherence, and to prevent complications such as wound infections for stage 3, 4, and unstageable PIs. Iterative changes to the program included pre-rounds nursing huddles to ensure all inpatients with stage 3, 4, and unstageable PIs would be ready for assessment on time, improved hospital-based equipment for photographing PIs, and simplified documentation through measurements documented within the weekly photographs.
Impact: Key stakeholders implemented a consistent "Wound Care Wednesday" program starting December 2021. Each week, inpatients with stage 3, 4, or unstageable PIs were assessed, their wound(s) measured and photographed, and their PI care plan reviewed by the entire interdisciplinary team. Benefits included an overall improvement in skin integrity for all inpatients with PIs during their rehabilitation stay, as determined by photographs and PI measurements; increased engagement amongst nurses and other key stakeholders about PI care; and increased patient awareness of the importance of PI prevention and care.
Conclusions: Prevention is key, but this interdisciplinary intervention meaningfully improved the care of severe PIs.
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Pressure Injury, Interdisciplinary collaboration, wound care, prevention, wound infection |
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| "Please Don't Cancel" Participant Reported Impact of the Virtual 'NeuroSask: Active and Connected' Program for People with Neurological Conditions |
Objective: Neurological conditions account from more than half of Canadians requiring chronic care. Development of a self-management skillset is a critical component supporting those with chronic health conditionsThe 'neurosask: Active and Connected' is a virtual chronic disease management program offering neuro-physiotherapist lead 'active' exercise twice a week, and knowledge exchange 'connect' sessions with guests. In response to restricted services and supports for people with neurological conditions, NeuroSask was launched May 2020. The program aims to provide seated physical activity, social interaction, and access to specialist expertise in neurological conditions and neurorehabilitation. The objective of this study was to evaluate the NeuroSask program from the participants' perspectives.
Methods: A qualitative approach was used to analyze open-ended responses to feedback surveys. All participants registered for the NeuroSask program were invited to complete optional surveys (Survey Monkey) circulated by email at 3 different time points post-program launch: 10 weeks, 1 year, and 2 years. Questions were co-designed by multi-stakeholder team members. Reflexive thematic analysis was completed by Authors 1, 2, and 3, with coding conducted in NVivo 12 Plus.
Participants: Participants registered online for NeuroSask at https: //rehabscience.usask.ca/neurosask/. Participants identifying as living with a neurological condition were included in the analysis.
Results: Survey response rates were as follows: 10-week survey 260/793, one year survey 326/1224, and 2-year survey 434/1989. The majority of participants reported being in the age categories of 40-59 years or above 60 years. 70% of participants reported a diagnosis of multiple sclerosis and 30% reported other neurological conditions. 75% of participants were female. All ten provinces were represented, with 45% of participants living outside of a large city. Three main themes, and eight corresponding subthemes were identified highlighting the perceived impact and key components of the NeuroSask program: Theme 1 "together in a positive and encouraging environment" (subthemes 1a: connection, 1b: empowerment); Theme 2 "access to enthusiastic qualified leaders from home" (subthemes 2a: leader characteristics, 2b: accessibility, 2c: program logistics); Theme 3 "being able to enjoy everyday life" (subthemes 3a: symptom benefits and beyond, 3b: carry-over, 3c: keep going, please don't cancel).
Conclusion: Participants reported that the combination of exercise followed by knowledge exchange between participants and experts helped to combat isolation and create a sense of empowerment. The NeuroSask virtual program was perceived as beneficial for fostering community and connection in an accessible, positive environment. The perceived benefits extended beyond symptom management to participant reported improvements in function, daily life, and disease experience.
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chronic disease, exercise, neurological rehabilitation, self-management, telerehabiliation |
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Medical Student Research Contest
| Title | Abstract | Keywords | Authors | Tags |
|---|---|---|---|---|
| BCI-Activated Electrical Stimulation in Children with Perinatal Stroke and Hemiparesis: A Pilot Study |
Background: Perinatal stroke (PS) causes most hemiparetic cerebral palsy (CP) and results in lifelong disability. Children with severe hemiparesis have limited rehabilitation options. Brain Computer Interface-activated functional electrical stimulation (BCI-FES) of target muscles may enhance upper extremity function in hemiparetic adults. We conducted a pilot clinical trial to assess the safety and feasibility of BCI-FES in children with hemiparetic CP.
Methods: Thirteen participants (mean age=12.2 years, 31% female) were recruited from a population-based cohort
Inclusion criteria were: (1) MRI-confirmed PS, (2) disabling hemiparetic CP, (3) age 6-18 years, (4) informed consent/assent. Those with neurological comorbidities or unstable epilepsy were excluded
Participants attended two bci sessions: training and rehabilitation. They wore an EEG-BCI headset and two forearm extensor stimulation electrodes. Participants' imagination of wrist extension was classified on EEG, after which muscle stimulation and visual feedback were provided when the correct visualization was detected.
Results: No serious adverse events or dropouts occurred. The most common complaints were mild headache, headset discomfort and muscle fatigue. Children ranked the experience as comparable to a long car ride and none reported as unpleasant. Sessions lasted a mean of 87 minutes with 33 minutes of stimulation delivered. Mean classification accuracies were (M=78.78%, SD=9.97) for training and (M=73.48, SD=12.41) for rehabilitation. Mean Cohen's Kappa across rehabilitation trials was M=0.43, SD=0.29, range=0.019-1.00, suggesting BCI competency.
Conclusions: BCI-FES was well-tolerated and feasible in children with hemiparesis. This paves the way for clinical trials to optimize approaches and test efficacy.
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BCI, FES, Stroke, Rehabilitation |
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| Patient Reported Outcome Measures in Adult Spinal Muscular Atrophy: A Scoping Review and Graphical Visualization of the Evidence |
Background: Spinal Muscular Atrophy (SMA) is a hereditary neuromuscular disease with an estimated prevalence of 1/10 000 births. SMA is increasingly recognized as a multi-system disease with a need to study additional under-recognized health domains such as quality of life, fatigue, bulbar function, respiratory function, and independence.
Objective: Identify and assess reported evidence from the literature investigating Patient Reported Outcome Measures (PROMs) in adults with SMA. Develop a novel method drawing from network theory to graphically depict the literature and supporting evidence.
Methods: A scoping review was completed following PRISM-ScR, COSMIN and JBI scoping review guidelines. Literature investigating PROMs in adult SMA or neuromuscular disease was identified from peer-reviewed and grey databases. A network graph was derived from extracted data.
Results: 5292 articles were retrieved, 81 articles met inclusion criteria; corresponding to 31 unique PROMs. Only two PROMs were developed specifically for SMA. Few PROMs were comprehensive. Most PROMs were incompletely validated.
Conclusions: PROMs are emerging tools for monitoring and assessing adults with SMA. Despite their potential benefits, additional validation studies should be completed prior to their use for clinical decision-making. Network graphics may represent a technique to aid in the visualization of evidence supporting a scoping review.
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Patient Reported Outcome Measures, Adult, Spinal Muscular Atrophy, Neuromuscular Diseases, Quality of Life |
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Resident Essay Contest
| Title | Abstract | Keywords | Authors | Tags |
|---|---|---|---|---|
| Cog-First: Cognitive assessment of Lariboisiere |
Contexte: Après une lésion cérébrale, notamment un traumatisme crânien, il existe un défaut de dépistage des troubles cognitifs et donc d'orientation vers des structures de rééducation spécialisée.
Objectif: Afin d'améliorer la filière de soin et d'éviter la persistance de séquelles cognitives non dépistées, nous avons développé COG-First.
Description du logiciel: COG-First est un logiciel innovant sur tablette tactile permettant une évaluation brève (environ 20 minutes) et en autonomie des fonctions exécutives, de la mémoire et de l'attention.
Premiers résultats et perspectives: Les premiers résultats de l'étude de faisabilité sont encourageants et une version béta est disponible. La normalisation en cours (plus de 400 sujets sains déjà évalués). Nous avons déployé le logiciel à l'hôpital Lariboisière et prévoyons d'étudier le devenir fonctionnel des patients à un an. Nous prévoyons de créer une version anglophone et de réaliser une étude pilote au Canada. Nous réaliserons également une étude de validation avec comparaison avec le Montreal Cognitive Assessment.
Conclusion: COG-First est un outil prometteur pour le dépistage précoce des troubles cognitifs chez les patients atteints de lésions cérébrales. La collaboration franco-canadienne autour de ce projet permettra d'enrichir les connaissances et d'améliorer la prise en charge des patients cérébrolésés.
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Brain injury, cognitive assessment, Neuro-rehabilitation |
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| Genicular Nerve Radiofrequency Ablation: A Narrative Review |
Intro: Osteoarthritis (OA) is a leading cause of musculoskeletal pain and disability, and most commonly effects the knee joint. Various treatment modalities are available for symptomatic Knee OA (KOA), with varying efficacy, duration of relief and long term side effects. End stage KOA is often treated with Total Knee Arthroplasty which may subject patients to long waitlists, surgical/anesthetic related complications, and postoperative pain. Genicular Nerve Radiofrequency Ablation (GN RFA) is a non-operative, low resource therapy for KOA that can efficiently and effectively reduce patient reported pain and improve function.
Objective: This narrative review will provide an overview of the mechanisms of RFA, indications and determinants of successful GN RFA, sensory innervation of the knee joint, and review the current literature associated with GN RFA.
Methods: A search of PubMed and Medline databases was completed using a combination of medical subject headings (MeSH). 12 studies were included; 7 Randomized Control Trials, 3 Randomized Cross-over Trials, 1 Prospective Observational Study and 1 Prospective Cohort Study.
Conclusion: GN RFA is an effective, cost efficient, minimally invasive treatment for patients with symptomatic KOA. Additional long term studies are needed to further characterize the efficacy, long term risks and benefits of GN RFA.
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Genicular Nerve, Knee Osteoarthritis, Radiofrequency Ablation, Neurolysis |
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2nd place |
Resident Research Contest
| Title | Abstract | Keywords | Authors | Tags |
|---|---|---|---|---|
| Cryoneurolysis of the tibial nerve for focal spasticity in an ambulatory patient: A Case Report |
Context, objective: Spasticity of the flexor digitorum longus is a common presentation among patients with multiple sclerosis. The resulting toe curling can result in increased risk of falls, heightened energy expenditure during gait, lowered gait speed, and can lead to pain. A new minimally invasive treatment called Cryoneurolysis has been developed for addressing focal spasticity through percutaneous means.
Design, setting and participants: A single patient with multiple sclerosis is treated with cryoneurolysis of the tibial and superficial peroneal nerves to FDL and dorsum of the foot cutaneous innervation. The patient is followed for three months and 12 months. Spasticity severity, gait comfort, and patient reported outcomes are collected at each follow-up.
Results: Spasticity severity as per medical evaluation and patient report has improved. Neuropathic pain on the dorsum of the foot has also improved. The patient's confidence in their gait has improved and their independence maintained.
Conclusion: Cryoneurolysis of the tibial nerve and superficial peroneal nerve.may be an effective novel treatment for spasticity causing toe curling and neuropathic pain in patients with multiple sclerosis.
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cryoneurolysis, multiple sclerosis, neuropathic pain, spasticity, toe curling |
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| Design and validation of a wearable tool for prosthetic gait analysis in unilateral transtibial amputees |
Context: Gait deviations are common in prosthesis users living with lower limb amputations. Recognition of such gait deviations may lead to prosthesis adjustments to improve gait efficiency and reduce falls risk. Current gait analysis methods typically rely on expensive laboratory-based equipment which limits the average prosthesis user from accessing this technology. Inertial measurement unit (IMU) sensors have emerged as a viable alternative for gait analysis due to their low cost, portability, and ease of use. In order to gain insight into prosthesis-assisted gait in ambulatory outpatients, our research team developed a novel wearable device (NWD) that utilizes an IMU and can be temporarily affixed to a standard prosthesis shank (30mm diameter).
Objective: To compare the performance of a novel wearable device to video-based gait analysis in detecting the following spatiotemporal characteristics of prosthesis-assisted gait: cadence, step count, and time spent in stance or swing phase for the affected limb.
Design: Observational validation study.
Setting: Outpatient amputee physiotherapy clinic.
Participants: Three participants with unilateral transtibial amputations (age 52 +/- 5, days since amputation 124 +/- 8) provided written informed consent to participate. Participants completed a questionnaire about their current prosthesis and usage habits prior to assessment. All three participants recruited were male, two required amputations due to peripheral vascular disease while the other participant sustained a traumatic amputation.
Interventions: The NWD was affixed to the prosthesis shank. After a familiarization period, participants walked in a linear 20-meter path ten times at a self-selected speed with walking aids if required. A video camera and IMU recorded the gait task.
Outcome measures: Gait was assessed using video gait analysis (VGA) and the NWD. Cadence, step count, and the ratio of stance to swing phase was measured using visual observation (VGA) and custom Matlab code (NWD). For all three outcome measures the VGA and NWD measurements were comparatively assessed using Pearson correlation coefficient in order to capture and validate trends within participant trials. Significance was considered to be p< 0.01.
Results: 539 steps were recorded across all participants. There was significant correlation between VGA and NWD across all parameters. The Pearson correlation coefficients were as follows: cadence (0.47, p<0.01), step count (0.96, p<0.01), ratio of stance to swing phase (0.39, p<0.01).
Conclusion: A novel wearable prosthetic gait assessment tool has been designed, implemented, and validated against video gait assessment in measuring spatiotemporal parameters of gait. Future directions will investigate the capacity to detect specific gait deviations, as well as record in outpatient settings.
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amputees, wearable electronic devices, lower extremity, prostheses and implants |
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| Effects of Mindfulness-based interventions on cognition in people with multiple sclerosis: A systematic review and meta-analysis of randomized controlled trials | Cognitive impairment affects up to 65% of people with multiple sclerosis (PwMS); information processing speed, memory, and executive functions are the most commonly impaired. Cognitive impairments undermine functional independence and quality of life in PwMS Objective: The objective of this study is to synthesize existing randomized controlled trials (RCT) based evidence on the effects of Mindfulness-based interventions (MBIs) for improving cognitive function in PwMS
Methods: In April 2022, we systematically searched six major electronic databases including, AMED, CINAHL, Cochrane, EMBASE, MEDLINE, and PsycINFO, using medical subject headings and keywords. Using pre-defined criteria, two independent reviewers screened titles, abstracts, and extracted data for included studies. Eligible studies included RCTs assessing the effects of MBIs in any PwMS, reporting validated outcome measures of cognitive functioning. Meta-analysis was performed, where possible, using a random effects model, effect sizes summarized as Standardized Mean Difference (SMD). Narrative synthesis was undertaken as per the Preferred Reporting Items for Systematic Reviews and Meta-analysis (PRISMA) guidance
Prospero id:(CRD42021286429)Results: Ten eligible RCTs were identified, total n=586 PwMS. Participant ethnicity, socio-economic status, comorbidity, and disability level were infrequently reported. MBIs included both standardized and tailored interventions, treatment duration lasting 4-10 weeks, delivered in-person. A variety of measures of cognitive functioning, objective and subjective, were reported. Four studies (236 PwMS) were included in our meta-analysis, where pooled results suggested MBIs effectively improved scores on the Paced Auditory Serial Addition Test (PASAT)-2 (SMD 0.37; 95% CI 0.05-0.70; I2 60%; p=0.03), whereas improvements were of borderline significance on the PASAT-3 (SMD=0.26; 95% CI -0.02-0.53; I2 51%; p=0.07) and although trending to positive were statistically insignificant on the Symbol Digits Modality Test (SDMT) (SMD=0.25; 95% CI -0.15-0.66; I2 0%; p=0.21).
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Mindfulness, Multiple Sclerosis, Cognitive Function, Systematic Review, Meta-analysis |
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| Imaging modalities for atraumatic shoulder hypermobility: A scoping review |
Context: Atraumatic shoulder hypermobility is characterized by an abnormal increase in glenohumeral joint range of motion and pathological laxity of its supporting structures. This condition is associated with higher likelihood of sustaining shoulder injuries and negative impacts on quality of life. The clinical work-up is predominantly subjective and clinical tests are often limited as shoulder hypermobility is considered a dynamic phenomenon. Objective radiographic evidence has the potential to assist in timely diagnosis to better guide management.
Objective: To review the literature on imaging modalities and techniques used to characterize atraumatic shoulder hypermobility.
Methods: MEDLINE, EMBASE, SPORTDiscus, Cochrane Library, and Web of Science were searched up to February 2023 for any primary study investigating imaging findings seen in atraumatic shoulder hypermobility. Variations of the following key terms were used: "shoulder", "laxity", "instability", and "diagnostic imaging". A broad definition of joint hypermobility was used given lack of consensus regarding its definition. Patients with unidirectional instability or prior shoulder surgery were excluded. Data was extracted for study characteristics, imaging characteristics, and radiographic outcomes.
Results: Magnetic resonance arthrography (MRA), ultrasound, fluoroscopy, magnetic resonance imaging, or electromyography were the imaging modalities used to examine patients with shoulder hypermobility with or without multidirectional shoulder instability (MDI). Statistically significant differences in parameters related to increased capsular redundancy, altered glenohumeral anatomy, and increased muscle activation were observed in patients with shoulder hypermobility compared to healthy controls. Studies using MRA consistently demonstrated increased capsular cross-sectional area (CSA). Some evidence demonstrated increased acromiohumeral distance (AHD) via ultrasound as well as increased glenocapsular (GC) ratio and labrocapsular (LC) distance via MRA. Conflicting evidence exists for differences observed for rotator cuff interval width, glenoid size, and glenoid version.
Conclusion: Increased capsular CSA on MRA is consistently demonstrated in shoulder hypermobility with MDI. There also exists more easily attainable parameters including increased AHD, increased GC ratio, and LC distance. However, further validation is required. The majority of research currently applies to shoulder hypermobility populations with MDI. Further research in shoulder hypermobility populations without MDI is warranted.
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Diagnostic Imaging, Hyperlaxity, Shoulder Instability |
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| The Effectiveness of Intensive Interdisciplinary Rehabilitation in a Patient with Multiple System Atrophy – Parkinsonian Subtype: A Case Report |
Context: Multiple system atrophy (MSA) is a rare progressive neurogenerative disorder with poor prognosis. Treatment generally involves symptom management, rehabilitation and supportive care, as disease-modifying medications do not currently exist. Rehabilitation is an essential part of function and quality of life for patients with MSA, however, very few rehabilitation studies exist to support care decisions. This case report discusses the first interdisciplinary rehabilitation program in the literature for the parkinsonian subtype of MSA (MSA-P).
Findings: A 68-year-old gentleman experienced a significant decline in function and independence over a one-and-a-half-year period, characterized by gait instability, autonomic dysfunction, and hypokinetic dysarthria, ultimately requiring a twenty-four-hour caregiver. He was initially treated for presumed Parkinson's disease; however, he further declined and was admitted to acute care where he was diagnosed with clinically probable MSA-P. The patient was subsequently transferred to a Canadian-based rehabilitation centre, where he participated in an intensive interdisciplinary program over 36 days, including rehabilitation from a physiotherapist, an occupational therapist, and a speech language pathologist. Improvements were noted from admission to discharge in multiple domains, including balance, dexterity, independence in activities of daily living (ADLs), speech and swallowing. From admission to discharge, his Berg Balance Scale (BBS) improved from 14/56 to 30/56, his functional independence measure (FIM) score increased from 61 to 75, and his dominant hand dexterity as measured by the modified Minnesota Rate of Manipulation Test (MRMT) improved by 1 minute 25 seconds. Daily communication and voice strengthening exercises enabled his speech to become more fluent, his voice quality improved, and he developed safe swallowing strategies.
Conclusion/clinical relevance: Rehabilitation is an essential part of function and quality of life for patients with MSA, however, very few rehabilitation studies exist to support care decisions. This case study highlights significant improvements which were noted on validated functional outcome tools. While many inpatient neurological rehabilitation programs exclude patients with neurodegenerative conditions, this case highlights the role of intensive interdisciplinary rehabilitation to provide educational value to patients with MSA and their caregivers, to develop compensation strategies, and to achieve functional improvement which can translate to community living.
Funding acknowledgement: N/A
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Activities of Daily Living, Case Report, Multiple System Atrophy, Rehabilitation |
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Relationship with Industry
We are very pleased to introduce CAPMR Co-Developed, Accredited Symposia and Workshops for our Conference. All Co-developed Accredited Learning Activity sessions are pre-approved by the Conference Organizing Committee, and are accredited by the CAPM&R after complying with the accreditation guidelines of the Royal College of Physicians and Surgeons of Canada (RCPSC) and Canadian Medical Association (CMA). The Conference Organizing Committee has acted as the Program Planning Committee for all accredited sessions, and third-parties (including industry, external planners, or communication companies) are not involved in the program development, in order to maintain objectivity and scientific integrity. The Co-developed Accredited Learning Activities are accredited as part of the Conference program under Section 1 and/or Section 3 of the RCPSC's Maintenance of Certification (MOC) program.
Accreditation
This event is an Accredited Group Learning Activity (Section 1) as defined by the Maintenance of Certification Program of the Royal College of Physicians and Surgeons of Canada, and approved by the Canadian Association of Physical Medicine & Rehabilitation. You may claim a maximum of 20.0 hours (credits are automatically calculated). Through an agreement between the Royal College of Physicians and Surgeons of Canada and the American Medical Association, physicians may convert Royal College MOC credits to AMA PRA Category 1 Credits. Information on the process to convert Royal College MOC credit to AMA credit can be found at www.ama-assn.org/go/internationalcme. Live educational activities recognized by the Royal College of Physicians and Surgeons of Canada as Accredited Group Learning Activities (Section 1) are deemed by the European Union of Medical Specialists (UEMS) eligible for ECMEC®. Through an agreement between the Royal College of Physicians and Surgeons of Canada and the Qatar Council for Healthcare Practitioners, healthcare practitioners participating in the QCHP CME/CPD program may record MOC Section 1 or MOC Section 3 credits as QCHP Category 1 or Category 3 credits.
Sponsors & Exhibitors
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Miscellaneous
Social Events
- Wednesday: Welcome reception at the Delta Hotels Prince Edward.
- Thursday: Fisherman's Wharf World Famous Lobster Suppers | Bussing provided from the Delta and return
- Friday: Golf @ Crowbush, or Biking with Dr. Robinson on the Road or Heather Dow on single track. (no host dinner) | Bussing provided from the Delta and return
- Saturday: PEI Brewing company with a kitchen party dinner | Bussing provided from the Delta. You make your way back to the Delta.
Abstracts
| Add To Website | title | keywords | authors | editor_tags | article_type | Abstract | first_name | last_name | institution |
|---|---|---|---|---|---|---|---|---|---|
| A Comparison of Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape, consisting of a meniscus that has central hypertrophy that leads to the lack of the typical “C”-shaped structure with heterogeneous, circumferentially arranged collagen fibers that are more vulnerable to degeneration. Due to these factors, discoid menisci are more vulnerable to tearing and developing spontaneous symptoms of locking, pain, and effusion. Despite these factors there is a lack of information that is able to determine if discoid meniscus patients are negatively predisposed to poor surgical outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three datbjases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded, with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). In the discoid meniscus group, eight studies (n=292) reported mean Lysholm scores ranging from 78.6-97.3. In the non-discoid meniscectomy group, nine studies (n=519) reported mean Lysholm scores ranging from 53.2-94.0 while in the non-discoid repair group, 17 studies (n=550) reported mean Lysholm scores ranging from 77.1-98.1. In the discoid meniscus group, four studies (n=172) reported mean Tegner scores ranging from 5.9-7.3 while in the non-discoid meniscectomy group, four studies (n=129) reported mean Tegner scores ranging from 3.0-4.8, and in the non-discoid repair group, seven studies (n=207) reported mean Tegner scores ranging from 3.0-5.5. In the discoid meniscus group, three studies (n=66) reported mean IKDC scores ranging from 77.4-96.0 while in the non-discoid meniscectomy group, nine studies (n=260) reported mean IKDC scores ranging from 46.9-85.7, and in the non-discoid repair group, 13 studies (n=426) reported mean IKDC scores ranging from 63.1-94.0.Conclusion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. |
Yuichi | Hoshino | Division of Orthopaedic Surgery, Kobe University | ||
| 0 | A Comparison of Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape, consisting of a meniscus that has central hypertrophy that leads to the lack of the typical “C”-shaped structure with heterogeneous, circumferentially arranged collagen fibers that are more vulnerable to degeneration. Due to these factors, discoid menisci are more vulnerable to tearing and developing spontaneous symptoms of locking, pain, and effusion. Despite these factors there is a lack of information that is able to determine if discoid meniscus patients are negatively predisposed to poor surgical outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded, with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). In the discoid meniscus group, eight studies (n=292) reported mean Lysholm scores ranging from 78.6-97.3. In the non-discoid meniscectomy group, nine studies (n=519) reported mean Lysholm scores ranging from 53.2-94.0 while in the non-discoid repair group, 17 studies (n=550) reported mean Lysholm scores ranging from 77.1-98.1. In the discoid meniscus group, four studies (n=172) reported mean Tegner scores ranging from 5.9-7.3 while in the non-discoid meniscectomy group, four studies (n=129) reported mean Tegner scores ranging from 3.0-4.8, and in the non-discoid repair group, seven studies (n=207) reported mean Tegner scores ranging from 3.0-5.5. In the discoid meniscus group, three studies (n=66) reported mean IKDC scores ranging from 77.4-96.0 while in the non-discoid meniscectomy group, nine studies (n=260) reported mean IKDC scores ranging from 46.9-85.7, and in the non-discoid repair group, 13 studies (n=426) reported mean IKDC scores ranging from 63.1-94.0.Conclusion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. |
Kanto | Nagai | Division of Orthopaedic Surgery, Kobe University | |
| 0 | A Comparison of Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape, consisting of a meniscus that has central hypertrophy that leads to the lack of the typical “C”-shaped structure with heterogeneous, circumferentially arranged collagen fibers that are more vulnerable to degeneration. Due to these factors, discoid menisci are more vulnerable to tearing and developing spontaneous symptoms of locking, pain, and effusion. Despite these factors there is a lack of information that is able to determine if discoid meniscus patients are negatively predisposed to poor surgical outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded, with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). In the discoid meniscus group, eight studies (n=292) reported mean Lysholm scores ranging from 78.6-97.3. In the non-discoid meniscectomy group, nine studies (n=519) reported mean Lysholm scores ranging from 53.2-94.0 while in the non-discoid repair group, 17 studies (n=550) reported mean Lysholm scores ranging from 77.1-98.1. In the discoid meniscus group, four studies (n=172) reported mean Tegner scores ranging from 5.9-7.3 while in the non-discoid meniscectomy group, four studies (n=129) reported mean Tegner scores ranging from 3.0-4.8, and in the non-discoid repair group, seven studies (n=207) reported mean Tegner scores ranging from 3.0-5.5. In the discoid meniscus group, three studies (n=66) reported mean IKDC scores ranging from 77.4-96.0 while in the non-discoid meniscectomy group, nine studies (n=260) reported mean IKDC scores ranging from 46.9-85.7, and in the non-discoid repair group, 13 studies (n=426) reported mean IKDC scores ranging from 63.1-94.0.Conclusion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. |
Darren | de SA | Division of Orthopaedic Surgery, McMaster University Medical Centre | |
| 0 | A Comparison of Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape, consisting of a meniscus that has central hypertrophy that leads to the lack of the typical “C”-shaped structure with heterogeneous, circumferentially arranged collagen fibers that are more vulnerable to degeneration. Due to these factors, discoid menisci are more vulnerable to tearing and developing spontaneous symptoms of locking, pain, and effusion. Despite these factors there is a lack of information that is able to determine if discoid meniscus patients are negatively predisposed to poor surgical outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded, with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). In the discoid meniscus group, eight studies (n=292) reported mean Lysholm scores ranging from 78.6-97.3. In the non-discoid meniscectomy group, nine studies (n=519) reported mean Lysholm scores ranging from 53.2-94.0 while in the non-discoid repair group, 17 studies (n=550) reported mean Lysholm scores ranging from 77.1-98.1. In the discoid meniscus group, four studies (n=172) reported mean Tegner scores ranging from 5.9-7.3 while in the non-discoid meniscectomy group, four studies (n=129) reported mean Tegner scores ranging from 3.0-4.8, and in the non-discoid repair group, seven studies (n=207) reported mean Tegner scores ranging from 3.0-5.5. In the discoid meniscus group, three studies (n=66) reported mean IKDC scores ranging from 77.4-96.0 while in the non-discoid meniscectomy group, nine studies (n=260) reported mean IKDC scores ranging from 46.9-85.7, and in the non-discoid repair group, 13 studies (n=426) reported mean IKDC scores ranging from 63.1-94.0.Conclusion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. |
Prushoth | Vivekanantha | Faculty of medicine, McMaster University | |
| 0 | A Comparison of Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape, consisting of a meniscus that has central hypertrophy that leads to the lack of the typical “C”-shaped structure with heterogeneous, circumferentially arranged collagen fibers that are more vulnerable to degeneration. Due to these factors, discoid menisci are more vulnerable to tearing and developing spontaneous symptoms of locking, pain, and effusion. Despite these factors there is a lack of information that is able to determine if discoid meniscus patients are negatively predisposed to poor surgical outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded, with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). In the discoid meniscus group, eight studies (n=292) reported mean Lysholm scores ranging from 78.6-97.3. In the non-discoid meniscectomy group, nine studies (n=519) reported mean Lysholm scores ranging from 53.2-94.0 while in the non-discoid repair group, 17 studies (n=550) reported mean Lysholm scores ranging from 77.1-98.1. In the discoid meniscus group, four studies (n=172) reported mean Tegner scores ranging from 5.9-7.3 while in the non-discoid meniscectomy group, four studies (n=129) reported mean Tegner scores ranging from 3.0-4.8, and in the non-discoid repair group, seven studies (n=207) reported mean Tegner scores ranging from 3.0-5.5. In the discoid meniscus group, three studies (n=66) reported mean IKDC scores ranging from 77.4-96.0 while in the non-discoid meniscectomy group, nine studies (n=260) reported mean IKDC scores ranging from 46.9-85.7, and in the non-discoid repair group, 13 studies (n=426) reported mean IKDC scores ranging from 63.1-94.0.Conclusion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. |
Yi (David) | Diao | Faculty of medicine, McMaster University | |
| 0 | A Comparison of Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape, consisting of a meniscus that has central hypertrophy that leads to the lack of the typical “C”-shaped structure with heterogeneous, circumferentially arranged collagen fibers that are more vulnerable to degeneration. Due to these factors, discoid menisci are more vulnerable to tearing and developing spontaneous symptoms of locking, pain, and effusion. Despite these factors there is a lack of information that is able to determine if discoid meniscus patients are negatively predisposed to poor surgical outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded, with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). In the discoid meniscus group, eight studies (n=292) reported mean Lysholm scores ranging from 78.6-97.3. In the non-discoid meniscectomy group, nine studies (n=519) reported mean Lysholm scores ranging from 53.2-94.0 while in the non-discoid repair group, 17 studies (n=550) reported mean Lysholm scores ranging from 77.1-98.1. In the discoid meniscus group, four studies (n=172) reported mean Tegner scores ranging from 5.9-7.3 while in the non-discoid meniscectomy group, four studies (n=129) reported mean Tegner scores ranging from 3.0-4.8, and in the non-discoid repair group, seven studies (n=207) reported mean Tegner scores ranging from 3.0-5.5. In the discoid meniscus group, three studies (n=66) reported mean IKDC scores ranging from 77.4-96.0 while in the non-discoid meniscectomy group, nine studies (n=260) reported mean IKDC scores ranging from 46.9-85.7, and in the non-discoid repair group, 13 studies (n=426) reported mean IKDC scores ranging from 63.1-94.0.Conclusion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. |
Dan | Cohen | Division of Orthopaedic Surgery, McMaster University Medical Centre | |
| 0 | A Comparison of Post-Operative Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | previous version went to peer review | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape that is more vulnerable to tearing due to central hypertrophy, a lack of the typical “C”-shaped structure, and circumferentially arranged collagen fibers. Due to these factors, patients with discoid menisci are more likely to developing spontaneous symptoms of locking, pain, and effusion. However; it is unknown whether these morphological factors predispose discoid meniscus patients to poor post-operative outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Primary literature describing clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded. Included studies ranged from fair to very good quality with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). Post-operative mean Lysholm scores were similar between the discoid meniscus group (eight studies, n = 292, means = 78.6-97.3), the non-discoid meniscectomy group (nine studies, n = 519, means = 53.2-94.0), and the non-discoid repair group (17 studies, n = 550, means = 77.1-98.1). Post-operative mean Tegner scores were similar between the discoid meniscus group (four studies, n = 172, means = 5.9-7.3), the non-discoid meniscectomy group (four studies, n = 129, means = 3.0-4.8), and the non-discoid repair group (seven studies, n = 207, means = 3.0-5.5). Post-operative mean IKDC scores were similar between the discoid meniscus group (three studies, n = 66, means = 77.4-96.0), the non-discoid meniscectomy group (nine studies, n = 260, means = 46.9-85.7), and the non-discoid repair group (13 studies, n = 426, means = 63.1-94.0)Conclusion + Discussion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. Discoid meniscus procedures are likely as satisfactory as non-discoid meniscus procedures, therefore a change in practice is not warranted. |
Dan | Cohen | Division of Orthopaedic Surgery, McMaster University Medical Centre |
| 0 | A Comparison of Post-Operative Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | previous version went to peer review | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape that is more vulnerable to tearing due to central hypertrophy, a lack of the typical “C”-shaped structure, and circumferentially arranged collagen fibers. Due to these factors, patients with discoid menisci are more likely to developing spontaneous symptoms of locking, pain, and effusion. However; it is unknown whether these morphological factors predispose discoid meniscus patients to poor post-operative outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Primary literature describing clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded. Included studies ranged from fair to very good quality with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). Post-operative mean Lysholm scores were similar between the discoid meniscus group (eight studies, n = 292, means = 78.6-97.3), the non-discoid meniscectomy group (nine studies, n = 519, means = 53.2-94.0), and the non-discoid repair group (17 studies, n = 550, means = 77.1-98.1). Post-operative mean Tegner scores were similar between the discoid meniscus group (four studies, n = 172, means = 5.9-7.3), the non-discoid meniscectomy group (four studies, n = 129, means = 3.0-4.8), and the non-discoid repair group (seven studies, n = 207, means = 3.0-5.5). Post-operative mean IKDC scores were similar between the discoid meniscus group (three studies, n = 66, means = 77.4-96.0), the non-discoid meniscectomy group (nine studies, n = 260, means = 46.9-85.7), and the non-discoid repair group (13 studies, n = 426, means = 63.1-94.0)Conclusion + Discussion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. Discoid meniscus procedures are likely as satisfactory as non-discoid meniscus procedures, therefore a change in practice is not warranted. |
Prushoth | Vivekanantha | Faculty of medicine, McMaster University |
| 0 | A Comparison of Post-Operative Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | previous version went to peer review | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape that is more vulnerable to tearing due to central hypertrophy, a lack of the typical “C”-shaped structure, and circumferentially arranged collagen fibers. Due to these factors, patients with discoid menisci are more likely to developing spontaneous symptoms of locking, pain, and effusion. However; it is unknown whether these morphological factors predispose discoid meniscus patients to poor post-operative outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Primary literature describing clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded. Included studies ranged from fair to very good quality with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). Post-operative mean Lysholm scores were similar between the discoid meniscus group (eight studies, n = 292, means = 78.6-97.3), the non-discoid meniscectomy group (nine studies, n = 519, means = 53.2-94.0), and the non-discoid repair group (17 studies, n = 550, means = 77.1-98.1). Post-operative mean Tegner scores were similar between the discoid meniscus group (four studies, n = 172, means = 5.9-7.3), the non-discoid meniscectomy group (four studies, n = 129, means = 3.0-4.8), and the non-discoid repair group (seven studies, n = 207, means = 3.0-5.5). Post-operative mean IKDC scores were similar between the discoid meniscus group (three studies, n = 66, means = 77.4-96.0), the non-discoid meniscectomy group (nine studies, n = 260, means = 46.9-85.7), and the non-discoid repair group (13 studies, n = 426, means = 63.1-94.0)Conclusion + Discussion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. Discoid meniscus procedures are likely as satisfactory as non-discoid meniscus procedures, therefore a change in practice is not warranted. |
Yi (David) | Diao | Faculty of medicine, McMaster University |
| 0 | A Comparison of Post-Operative Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | previous version went to peer review | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape that is more vulnerable to tearing due to central hypertrophy, a lack of the typical “C”-shaped structure, and circumferentially arranged collagen fibers. Due to these factors, patients with discoid menisci are more likely to developing spontaneous symptoms of locking, pain, and effusion. However; it is unknown whether these morphological factors predispose discoid meniscus patients to poor post-operative outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Primary literature describing clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded. Included studies ranged from fair to very good quality with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). Post-operative mean Lysholm scores were similar between the discoid meniscus group (eight studies, n = 292, means = 78.6-97.3), the non-discoid meniscectomy group (nine studies, n = 519, means = 53.2-94.0), and the non-discoid repair group (17 studies, n = 550, means = 77.1-98.1). Post-operative mean Tegner scores were similar between the discoid meniscus group (four studies, n = 172, means = 5.9-7.3), the non-discoid meniscectomy group (four studies, n = 129, means = 3.0-4.8), and the non-discoid repair group (seven studies, n = 207, means = 3.0-5.5). Post-operative mean IKDC scores were similar between the discoid meniscus group (three studies, n = 66, means = 77.4-96.0), the non-discoid meniscectomy group (nine studies, n = 260, means = 46.9-85.7), and the non-discoid repair group (13 studies, n = 426, means = 63.1-94.0)Conclusion + Discussion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. Discoid meniscus procedures are likely as satisfactory as non-discoid meniscus procedures, therefore a change in practice is not warranted. |
Darren | de SA | Division of Orthopaedic Surgery, McMaster University Medical Centre |
| 0 | A Comparison of Post-Operative Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | previous version went to peer review | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape that is more vulnerable to tearing due to central hypertrophy, a lack of the typical “C”-shaped structure, and circumferentially arranged collagen fibers. Due to these factors, patients with discoid menisci are more likely to developing spontaneous symptoms of locking, pain, and effusion. However; it is unknown whether these morphological factors predispose discoid meniscus patients to poor post-operative outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Primary literature describing clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded. Included studies ranged from fair to very good quality with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). Post-operative mean Lysholm scores were similar between the discoid meniscus group (eight studies, n = 292, means = 78.6-97.3), the non-discoid meniscectomy group (nine studies, n = 519, means = 53.2-94.0), and the non-discoid repair group (17 studies, n = 550, means = 77.1-98.1). Post-operative mean Tegner scores were similar between the discoid meniscus group (four studies, n = 172, means = 5.9-7.3), the non-discoid meniscectomy group (four studies, n = 129, means = 3.0-4.8), and the non-discoid repair group (seven studies, n = 207, means = 3.0-5.5). Post-operative mean IKDC scores were similar between the discoid meniscus group (three studies, n = 66, means = 77.4-96.0), the non-discoid meniscectomy group (nine studies, n = 260, means = 46.9-85.7), and the non-discoid repair group (13 studies, n = 426, means = 63.1-94.0)Conclusion + Discussion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. Discoid meniscus procedures are likely as satisfactory as non-discoid meniscus procedures, therefore a change in practice is not warranted. |
Kanto | Nagai | Division of Orthopaedic Surgery, Kobe University |
| 0 | A Comparison of Post-Operative Clinical Outcomes of Discoid versus Standard Meniscus Tear Procedures: A Systematic Review | ["discoid", "meniscus", "clinical outcomes", "meniscectomy", "Lysholm"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Yuichi Hoshino, Kanto Nagai, Darren de SA | previous version went to peer review | Abstract |
Context:The discoid meniscus is a congenital deformity of the meniscus shape that is more vulnerable to tearing due to central hypertrophy, a lack of the typical “C”-shaped structure, and circumferentially arranged collagen fibers. Due to these factors, patients with discoid menisci are more likely to developing spontaneous symptoms of locking, pain, and effusion. However; it is unknown whether these morphological factors predispose discoid meniscus patients to poor post-operative outcomes.Objective:To compare postoperative clinical outcomes of discoid meniscus tear procedures such as saucerization and saucerization with stabilization with those of non-discoid meniscus tears such as meniscectomy or repair in skeletally mature patients with no concomitant injuries.Methods:Three databases MEDLINE, PubMed and EMBASE were searched from inception to July 3rd, 2022 for literature describing patient reported outcome measures after meniscus surgery in discoid or non-discoid meniscus tears. Primary literature describing clinical outcome data on Lysholm, Tegner, IKDC, revision rate, and complications were recorded. Included studies ranged from fair to very good quality with MINORS and Detsky scores used to perform quality assessment.Results:A total of 44 studies comprising 3795 patients were included in this review with a mean age of 39.7 years (range:** 9.0-64.4). Post-operative mean Lysholm scores were similar between the discoid meniscus group (eight studies, n = 292, means = 78.6-97.3), the non-discoid meniscectomy group (nine studies, n = 519, means = 53.2-94.0), and the non-discoid repair group (17 studies, n = 550, means = 77.1-98.1). Post-operative mean Tegner scores were similar between the discoid meniscus group (four studies, n = 172, means = 5.9-7.3), the non-discoid meniscectomy group (four studies, n = 129, means = 3.0-4.8), and the non-discoid repair group (seven studies, n = 207, means = 3.0-5.5). Post-operative mean IKDC scores were similar between the discoid meniscus group (three studies, n = 66, means = 77.4-96.0), the non-discoid meniscectomy group (nine studies, n = 260, means = 46.9-85.7), and the non-discoid repair group (13 studies, n = 426, means = 63.1-94.0)Conclusion + Discussion:Discoid saucerization procedures with or without stabilization leads to similar Lysholm scores, Tegner activity scores, IKDC scores and revision rates compared with non-discoid meniscectomy or repair procedures. Discoid meniscus procedures are likely as satisfactory as non-discoid meniscus procedures, therefore a change in practice is not warranted. |
Yuichi | Hoshino | Division of Orthopaedic Surgery, Kobe University |
| 0 | A case report on management of acute baclofen withdrawal following emergent intrathecal baclofen pump explant: the role of benzodiazepines, the other GABA agonist | ["Baclofen [D02.241.081.114.500.350.100]", "GABA Agonists [D27.505.519.625.240.200]", "gamma-Aminobutyric Acid [D02.241.081.114.500.350]", "Multiple Sclerosis [C20.111.258.250.500]", "Nervous System Diseases [C10]"] | Danielle Rioux, Alex Whelan | 1st place, case report / study | Abstract |
Context:Surgically implanted intrathecal baclofen (ITB) pumps are used for the management of refractory spasticity in pediatric and adult patients with functionally impairing lower extremity tone. There is a risk of acute, life-threatening baclofen withdrawal with pump and/or catheter dysfunction. Reported signs and symptoms of acute baclofen withdrawal on ITB include pruritus, hypertonicity, labile blood pressure, hyperthermia, mental status changes, rhabdomyolysis, acute kidney injury, seizures, coma and death. There is little literature on the presentation and management of acute baclofen withdrawal.Findings:We describe a case of a 53-year-old patient with secondary progressive Multiple Sclerosis. This patient had longstanding severe lower extremity spasticity that was managed with 800 mcg of ITB per day. She presented to ER with dehiscence and wound infection of her ITB pump site. She was admitted to the surgical service, and her pump/catheter system was removed. In anticipation of acute baclofen withdrawal, she was started on oral baclofen 20 mg four times/day. She developed a suspected generalized seizure within 24 hours of admission, with altered level of consciousness. Physiatry was consulted for management of suspected acute baclofen withdrawal. In addition to the reported seizure, the patient had complaints of severe pruritus, with increased tone and diaphoresis. She was started on diazepam 5 mg IV q6h, which was weaned to discontinuation over a week. The Infectious Disease and Plastic Surgery teams were consulted for wound management. With initiation of IV diazepam, she had no further seizures and her pruritus resolved, which remained that way after her benzodiazepines were stopped. Her mental status gradually improved. Her creatinine and creatine kinase remained stable, with no evidence of acute kidney injury or rhabdomyolysis. She was eventually transferred to tertiary rehabilitation for optimization of function in the setting of increased tone.Clinical relevance:Acute baclofen withdrawal is a rare life-threatening complication that can be seen with ITB pump/catheter malfunction. Our case highlights several points, including that oral baclofen may not be sufficient for management, pruritus is an important symptom to recognize for evolving withdrawal, acute withdrawal is not always immediate but can develop within 24 hours of system removal, and benzodiazepines may be a suitable treatment for acute management. |
Danielle | Rioux | Division of Physical Medicine and Rehabilitation, Dalhousie University |
| 0 | A case report on management of acute baclofen withdrawal following emergent intrathecal baclofen pump explant: the role of benzodiazepines, the other GABA agonist | ["Baclofen [D02.241.081.114.500.350.100]", "GABA Agonists [D27.505.519.625.240.200]", "gamma-Aminobutyric Acid [D02.241.081.114.500.350]", "Multiple Sclerosis [C20.111.258.250.500]", "Nervous System Diseases [C10]"] | Danielle Rioux, Alex Whelan | 1st place, case report / study | Abstract |
Context:Surgically implanted intrathecal baclofen (ITB) pumps are used for the management of refractory spasticity in pediatric and adult patients with functionally impairing lower extremity tone. There is a risk of acute, life-threatening baclofen withdrawal with pump and/or catheter dysfunction. Reported signs and symptoms of acute baclofen withdrawal on ITB include pruritus, hypertonicity, labile blood pressure, hyperthermia, mental status changes, rhabdomyolysis, acute kidney injury, seizures, coma and death. There is little literature on the presentation and management of acute baclofen withdrawal.Findings:We describe a case of a 53-year-old patient with secondary progressive Multiple Sclerosis. This patient had longstanding severe lower extremity spasticity that was managed with 800 mcg of ITB per day. She presented to ER with dehiscence and wound infection of her ITB pump site. She was admitted to the surgical service, and her pump/catheter system was removed. In anticipation of acute baclofen withdrawal, she was started on oral baclofen 20 mg four times/day. She developed a suspected generalized seizure within 24 hours of admission, with altered level of consciousness. Physiatry was consulted for management of suspected acute baclofen withdrawal. In addition to the reported seizure, the patient had complaints of severe pruritus, with increased tone and diaphoresis. She was started on diazepam 5 mg IV q6h, which was weaned to discontinuation over a week. The Infectious Disease and Plastic Surgery teams were consulted for wound management. With initiation of IV diazepam, she had no further seizures and her pruritus resolved, which remained that way after her benzodiazepines were stopped. Her mental status gradually improved. Her creatinine and creatine kinase remained stable, with no evidence of acute kidney injury or rhabdomyolysis. She was eventually transferred to tertiary rehabilitation for optimization of function in the setting of increased tone.Clinical relevance:Acute baclofen withdrawal is a rare life-threatening complication that can be seen with ITB pump/catheter malfunction. Our case highlights several points, including that oral baclofen may not be sufficient for management, pruritus is an important symptom to recognize for evolving withdrawal, acute withdrawal is not always immediate but can develop within 24 hours of system removal, and benzodiazepines may be a suitable treatment for acute management. |
Alex | Whelan | Division of Physical Medicine and Rehabilitation, Dalhousie University |
| 0 | A prospective cross-sectional study on the potential association between untreated moderate-to-severe sleep apnea and increased number of silent episodes of autonomic dysreflexia during sleep in individuals with subacute or chronic spinal cord injury | ["spinal cord injury", "sleep-related breathing disorders", "autonomic dysreflexia", "cardiovascular dysfunction", "sleep apnea"] | Julio C Furlan, Eldon Loh, Mark I Boulos | Abstract |
Context/objective:Sleep-related breathing disorders (SRBDs) are common but under-recognized medical conditions among individuals with spinal cord injury (SCI). Catecholaminergic and sympathetic alterations related to SRBDs play a key role in the pathophysiology of cardiovascular disorders in non-disabled people. Individuals with SCI commonly experience cardiovascular dysfunction, including low baseline blood pressure, orthostatic hypotension and episodes of autonomic dysreflexia (AD) and, hence, any impact of SRBD on cardiovascular function after SCI is important to characterize. This study is focused on the potential association between moderate-to-severe SRBDs and more severe cardiovascular dysfunction following SCI.Design:Herein we present the preliminary data from an ongoing prospective cross-sectional study. The diagnosis of SRBD was established using a home-based/hospital unattended sleep screening test that quantifies the apnea-hypopnea index (AHI). Moderate-to-severe SRBD was defined as an AHI ≥ 15 events per hour. Episodes of AD were defined as a sudden increase in systolic blood pressure (BP) of at least 20 mmHg. For the purpose of this study, we did not count episodes of AD during sleep that were caused by triggers other than hypopnea or apnea.Setting:This study included individuals living with SCI in the community and admitted to a tertiary spinal cord rehabilitation centre in Canada.Participants:This study included English-speaking adults with subacute or chronic (≥1 month after SCI onset), cervical or high-thoracic (T6 or more cranial), complete or incomplete SCI, who reported clinical warning symptoms and/or signs suggestive of SRBDs.Intervention:None.Results:This study included 45 individuals (14 females and 31 males with ages from 20 to 84 years and mean age of 57.0 years) with motor complete (AIS-A: 11, or AIS-B: 11) or incomplete (AIS-C: 8, or AIS-D: 16) SCI at cervical (n=38), or high thoracic levels, who reported symptoms and signs suggestive of SRBD. Time from SCI onset varied from 1.5 months to 52 years (mean time: 49.4 months). Their mean apnea-hypopnea index (AHI) was 16.0 events per hour with an AHI range of 0.8 to 51.7 events per hour. The AHI was not associated with systolic BP (mean +/- SEM: 122.0+/-2.2 mmHg; p=0.903), diastolic BP (72.6+/-3.0 mmHg; p=0.639), mean arterial pressure (90.1+/-2.4 mmHg; p=0.714), and heart rate (70.6+/-1.4 bpm; p=0.669) during sleep. However, the AHI was significantly and positively correlated with the number of silent episodes of AD (mean +/- SEM:** 3.6+/-0.4; Rsqr=0.220, p=0.001) during sleep, after excluding other causes of AD.Conclusions:The results of this cross-sectional study suggest, for the first time, that more severe SBRBs are associated with frequent silent episodes of AD during sleep among individuals living with a cervical or high-thoracic SCI. Future research is needed to assess the effects of continuous positive airway pressure (CPAP) therapy on cardiovascular dysfunction following SCI. |
Julio C | Furlan | Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto; Division of Physical Medicine and Rehabilitation, Toronto Rehabilitation Institute, University Health Network; Department of Medicine, Division of Physical Medicine and Rehabilitation, KITE Research Institute, University Health Network | |
| 0 | A prospective cross-sectional study on the potential association between untreated moderate-to-severe sleep apnea and increased number of silent episodes of autonomic dysreflexia during sleep in individuals with subacute or chronic spinal cord injury | ["spinal cord injury", "sleep-related breathing disorders", "autonomic dysreflexia", "cardiovascular dysfunction", "sleep apnea"] | Julio C Furlan, Eldon Loh, Mark I Boulos | Abstract |
Context/objective:Sleep-related breathing disorders (SRBDs) are common but under-recognized medical conditions among individuals with spinal cord injury (SCI). Catecholaminergic and sympathetic alterations related to SRBDs play a key role in the pathophysiology of cardiovascular disorders in non-disabled people. Individuals with SCI commonly experience cardiovascular dysfunction, including low baseline blood pressure, orthostatic hypotension and episodes of autonomic dysreflexia (AD) and, hence, any impact of SRBD on cardiovascular function after SCI is important to characterize. This study is focused on the potential association between moderate-to-severe SRBDs and more severe cardiovascular dysfunction following SCI.Design:Herein we present the preliminary data from an ongoing prospective cross-sectional study. The diagnosis of SRBD was established using a home-based/hospital unattended sleep screening test that quantifies the apnea-hypopnea index (AHI). Moderate-to-severe SRBD was defined as an AHI ≥ 15 events per hour. Episodes of AD were defined as a sudden increase in systolic blood pressure (BP) of at least 20 mmHg. For the purpose of this study, we did not count episodes of AD during sleep that were caused by triggers other than hypopnea or apnea.Setting:This study included individuals living with SCI in the community and admitted to a tertiary spinal cord rehabilitation centre in Canada.Participants:This study included English-speaking adults with subacute or chronic (≥1 month after SCI onset), cervical or high-thoracic (T6 or more cranial), complete or incomplete SCI, who reported clinical warning symptoms and/or signs suggestive of SRBDs.Intervention:None.Results:This study included 45 individuals (14 females and 31 males with ages from 20 to 84 years and mean age of 57.0 years) with motor complete (AIS-A: 11, or AIS-B: 11) or incomplete (AIS-C: 8, or AIS-D: 16) SCI at cervical (n=38), or high thoracic levels, who reported symptoms and signs suggestive of SRBD. Time from SCI onset varied from 1.5 months to 52 years (mean time: 49.4 months). Their mean apnea-hypopnea index (AHI) was 16.0 events per hour with an AHI range of 0.8 to 51.7 events per hour. The AHI was not associated with systolic BP (mean +/- SEM: 122.0+/-2.2 mmHg; p=0.903), diastolic BP (72.6+/-3.0 mmHg; p=0.639), mean arterial pressure (90.1+/-2.4 mmHg; p=0.714), and heart rate (70.6+/-1.4 bpm; p=0.669) during sleep. However, the AHI was significantly and positively correlated with the number of silent episodes of AD (mean +/- SEM:** 3.6+/-0.4; Rsqr=0.220, p=0.001) during sleep, after excluding other causes of AD.Conclusions:The results of this cross-sectional study suggest, for the first time, that more severe SBRBs are associated with frequent silent episodes of AD during sleep among individuals living with a cervical or high-thoracic SCI. Future research is needed to assess the effects of continuous positive airway pressure (CPAP) therapy on cardiovascular dysfunction following SCI. |
Eldon | Loh | Department of Physical Medicine and Rehabilitation, Western University | |
| 0 | A prospective cross-sectional study on the potential association between untreated moderate-to-severe sleep apnea and increased number of silent episodes of autonomic dysreflexia during sleep in individuals with subacute or chronic spinal cord injury | ["spinal cord injury", "sleep-related breathing disorders", "autonomic dysreflexia", "cardiovascular dysfunction", "sleep apnea"] | Julio C Furlan, Eldon Loh, Mark I Boulos | Abstract |
Context/objective:Sleep-related breathing disorders (SRBDs) are common but under-recognized medical conditions among individuals with spinal cord injury (SCI). Catecholaminergic and sympathetic alterations related to SRBDs play a key role in the pathophysiology of cardiovascular disorders in non-disabled people. Individuals with SCI commonly experience cardiovascular dysfunction, including low baseline blood pressure, orthostatic hypotension and episodes of autonomic dysreflexia (AD) and, hence, any impact of SRBD on cardiovascular function after SCI is important to characterize. This study is focused on the potential association between moderate-to-severe SRBDs and more severe cardiovascular dysfunction following SCI.Design:Herein we present the preliminary data from an ongoing prospective cross-sectional study. The diagnosis of SRBD was established using a home-based/hospital unattended sleep screening test that quantifies the apnea-hypopnea index (AHI). Moderate-to-severe SRBD was defined as an AHI ≥ 15 events per hour. Episodes of AD were defined as a sudden increase in systolic blood pressure (BP) of at least 20 mmHg. For the purpose of this study, we did not count episodes of AD during sleep that were caused by triggers other than hypopnea or apnea.Setting:This study included individuals living with SCI in the community and admitted to a tertiary spinal cord rehabilitation centre in Canada.Participants:This study included English-speaking adults with subacute or chronic (≥1 month after SCI onset), cervical or high-thoracic (T6 or more cranial), complete or incomplete SCI, who reported clinical warning symptoms and/or signs suggestive of SRBDs.Intervention:None.Results:This study included 45 individuals (14 females and 31 males with ages from 20 to 84 years and mean age of 57.0 years) with motor complete (AIS-A: 11, or AIS-B: 11) or incomplete (AIS-C: 8, or AIS-D: 16) SCI at cervical (n=38), or high thoracic levels, who reported symptoms and signs suggestive of SRBD. Time from SCI onset varied from 1.5 months to 52 years (mean time: 49.4 months). Their mean apnea-hypopnea index (AHI) was 16.0 events per hour with an AHI range of 0.8 to 51.7 events per hour. The AHI was not associated with systolic BP (mean +/- SEM: 122.0+/-2.2 mmHg; p=0.903), diastolic BP (72.6+/-3.0 mmHg; p=0.639), mean arterial pressure (90.1+/-2.4 mmHg; p=0.714), and heart rate (70.6+/-1.4 bpm; p=0.669) during sleep. However, the AHI was significantly and positively correlated with the number of silent episodes of AD (mean +/- SEM:** 3.6+/-0.4; Rsqr=0.220, p=0.001) during sleep, after excluding other causes of AD.Conclusions:The results of this cross-sectional study suggest, for the first time, that more severe SBRBs are associated with frequent silent episodes of AD during sleep among individuals living with a cervical or high-thoracic SCI. Future research is needed to assess the effects of continuous positive airway pressure (CPAP) therapy on cardiovascular dysfunction following SCI. |
Mark I | Boulos | Department of Medicine, Division of Neurology, University of Toronto; Department of Neurology, Sunnybrook Health Sciences Centre | |
| 0 | Applications of Machine Learning in Prognostication of mTBI: A Systematic Review | ["Artificial intelligence", "Brain Injury", "Brain Concussion", "Machine learning", "Post-concussion syndrome"] | Patrick Yao, Pranjan Gandhi, Eric P McMullen, Marlin Manka, Jason Liang | Abstract |
Context:Concussion or mild traumatic brain injury (mTBI) comprise 70-90% of all traumatic brain injuries. Post concussion syndrome (PCS) is a clinical diagnosis with a myriad of definitions including those from DSM-IV or ICD-10, but generally refers to the presence of symptoms that last beyond the anticipated recovery timeline of concussion. As clinical data becomes more available through the increasing integration of electronic health records and digitization of information, artificial intelligence and machine learning (ML) remains at the forefront of innovation in medicine. To our knowledge, there has been no attempt made to synthesize the literature surrounding the use of ML in prognosticating recovery or complications from mTBI or PCS.Objective:To conduct a systematic review to review the current state of the research and application of ML in prognosticating patients presenting with or being diagnosed with mTBI.Methods:IEEE Xplore, Ovid’s Medline and Embase, APA PsycInfo, and Scopus databases were searched for studies using the terms ML and mTBI on February 3, 2023 from inception, and imported into the systematic review software, Covidence. Included studies were those that had a primary outcome of predicting post-mTBI prognosis or sequalae. Studies where the objective was mainly classification or analyzed outcomes after the acute mTBI presentation were excluded. The PROBAST Risk of Bias for Predictive Models assessment tool was used for assessing the risk of bias and applicability.Results:568 studies were initially screened and 35 were carried into full text screening. 11 studies met final inclusion and exclusion criteria and had their data extracted. The studies ranged in objective from predicting sports related concussion recovery, psychological comorbidity development and general post-concussion syndrome classification risk stratification. The performance of models was generally strong (AUC: 0.57-0.87). Support Vector Machine and Artificial Neural Network were the most popular modeling techniques employed. Studies in this review made limited attempts to compare their models to existing decision making tools and clinical judgment.Conclusion:Current prognostication of mTBI with ML is limited in its application. There are a number of promising models and research that are being produced. Further comparison to tools such as the KITE UHN Concussion calculator should be undertaken to solidify potential clinical use. |
Marlin | Manka | Department of Computer Science, Western University | |
| 0 | Applications of Machine Learning in Prognostication of mTBI: A Systematic Review | ["Artificial intelligence", "Brain Injury", "Brain Concussion", "Machine learning", "Post-concussion syndrome"] | Patrick Yao, Pranjan Gandhi, Eric P McMullen, Marlin Manka, Jason Liang | Abstract |
Context:Concussion or mild traumatic brain injury (mTBI) comprise 70-90% of all traumatic brain injuries. Post concussion syndrome (PCS) is a clinical diagnosis with a myriad of definitions including those from DSM-IV or ICD-10, but generally refers to the presence of symptoms that last beyond the anticipated recovery timeline of concussion. As clinical data becomes more available through the increasing integration of electronic health records and digitization of information, artificial intelligence and machine learning (ML) remains at the forefront of innovation in medicine. To our knowledge, there has been no attempt made to synthesize the literature surrounding the use of ML in prognosticating recovery or complications from mTBI or PCS.Objective:To conduct a systematic review to review the current state of the research and application of ML in prognosticating patients presenting with or being diagnosed with mTBI.Methods:IEEE Xplore, Ovid’s Medline and Embase, APA PsycInfo, and Scopus databases were searched for studies using the terms ML and mTBI on February 3, 2023 from inception, and imported into the systematic review software, Covidence. Included studies were those that had a primary outcome of predicting post-mTBI prognosis or sequalae. Studies where the objective was mainly classification or analyzed outcomes after the acute mTBI presentation were excluded. The PROBAST Risk of Bias for Predictive Models assessment tool was used for assessing the risk of bias and applicability.Results:568 studies were initially screened and 35 were carried into full text screening. 11 studies met final inclusion and exclusion criteria and had their data extracted. The studies ranged in objective from predicting sports related concussion recovery, psychological comorbidity development and general post-concussion syndrome classification risk stratification. The performance of models was generally strong (AUC: 0.57-0.87). Support Vector Machine and Artificial Neural Network were the most popular modeling techniques employed. Studies in this review made limited attempts to compare their models to existing decision making tools and clinical judgment.Conclusion:Current prognostication of mTBI with ML is limited in its application. There are a number of promising models and research that are being produced. Further comparison to tools such as the KITE UHN Concussion calculator should be undertaken to solidify potential clinical use. |
Eric P | McMullen | Michael G. DeGroote School of Medicine, McMaster University | |
| 0 | Applications of Machine Learning in Prognostication of mTBI: A Systematic Review | ["Artificial intelligence", "Brain Injury", "Brain Concussion", "Machine learning", "Post-concussion syndrome"] | Patrick Yao, Pranjan Gandhi, Eric P McMullen, Marlin Manka, Jason Liang | Abstract |
Context:Concussion or mild traumatic brain injury (mTBI) comprise 70-90% of all traumatic brain injuries. Post concussion syndrome (PCS) is a clinical diagnosis with a myriad of definitions including those from DSM-IV or ICD-10, but generally refers to the presence of symptoms that last beyond the anticipated recovery timeline of concussion. As clinical data becomes more available through the increasing integration of electronic health records and digitization of information, artificial intelligence and machine learning (ML) remains at the forefront of innovation in medicine. To our knowledge, there has been no attempt made to synthesize the literature surrounding the use of ML in prognosticating recovery or complications from mTBI or PCS.Objective:To conduct a systematic review to review the current state of the research and application of ML in prognosticating patients presenting with or being diagnosed with mTBI.Methods:IEEE Xplore, Ovid’s Medline and Embase, APA PsycInfo, and Scopus databases were searched for studies using the terms ML and mTBI on February 3, 2023 from inception, and imported into the systematic review software, Covidence. Included studies were those that had a primary outcome of predicting post-mTBI prognosis or sequalae. Studies where the objective was mainly classification or analyzed outcomes after the acute mTBI presentation were excluded. The PROBAST Risk of Bias for Predictive Models assessment tool was used for assessing the risk of bias and applicability.Results:568 studies were initially screened and 35 were carried into full text screening. 11 studies met final inclusion and exclusion criteria and had their data extracted. The studies ranged in objective from predicting sports related concussion recovery, psychological comorbidity development and general post-concussion syndrome classification risk stratification. The performance of models was generally strong (AUC: 0.57-0.87). Support Vector Machine and Artificial Neural Network were the most popular modeling techniques employed. Studies in this review made limited attempts to compare their models to existing decision making tools and clinical judgment.Conclusion:Current prognostication of mTBI with ML is limited in its application. There are a number of promising models and research that are being produced. Further comparison to tools such as the KITE UHN Concussion calculator should be undertaken to solidify potential clinical use. |
Pranjan | Gandhi | Michael G. DeGroote School of Medicine, McMaster University | |
| 0 | Applications of Machine Learning in Prognostication of mTBI: A Systematic Review | ["Artificial intelligence", "Brain Injury", "Brain Concussion", "Machine learning", "Post-concussion syndrome"] | Patrick Yao, Pranjan Gandhi, Eric P McMullen, Marlin Manka, Jason Liang | Abstract |
Context:Concussion or mild traumatic brain injury (mTBI) comprise 70-90% of all traumatic brain injuries. Post concussion syndrome (PCS) is a clinical diagnosis with a myriad of definitions including those from DSM-IV or ICD-10, but generally refers to the presence of symptoms that last beyond the anticipated recovery timeline of concussion. As clinical data becomes more available through the increasing integration of electronic health records and digitization of information, artificial intelligence and machine learning (ML) remains at the forefront of innovation in medicine. To our knowledge, there has been no attempt made to synthesize the literature surrounding the use of ML in prognosticating recovery or complications from mTBI or PCS.Objective:To conduct a systematic review to review the current state of the research and application of ML in prognosticating patients presenting with or being diagnosed with mTBI.Methods:IEEE Xplore, Ovid’s Medline and Embase, APA PsycInfo, and Scopus databases were searched for studies using the terms ML and mTBI on February 3, 2023 from inception, and imported into the systematic review software, Covidence. Included studies were those that had a primary outcome of predicting post-mTBI prognosis or sequalae. Studies where the objective was mainly classification or analyzed outcomes after the acute mTBI presentation were excluded. The PROBAST Risk of Bias for Predictive Models assessment tool was used for assessing the risk of bias and applicability.Results:568 studies were initially screened and 35 were carried into full text screening. 11 studies met final inclusion and exclusion criteria and had their data extracted. The studies ranged in objective from predicting sports related concussion recovery, psychological comorbidity development and general post-concussion syndrome classification risk stratification. The performance of models was generally strong (AUC: 0.57-0.87). Support Vector Machine and Artificial Neural Network were the most popular modeling techniques employed. Studies in this review made limited attempts to compare their models to existing decision making tools and clinical judgment.Conclusion:Current prognostication of mTBI with ML is limited in its application. There are a number of promising models and research that are being produced. Further comparison to tools such as the KITE UHN Concussion calculator should be undertaken to solidify potential clinical use. |
Jason | Liang | Toronto Rehabilitation Institute, University Health Network; Division of Physical Medicine and Rehabilitation, University of Toronto | |
| 0 | Applications of Machine Learning in Prognostication of mTBI: A Systematic Review | ["Artificial intelligence", "Brain Injury", "Brain Concussion", "Machine learning", "Post-concussion syndrome"] | Patrick Yao, Pranjan Gandhi, Eric P McMullen, Marlin Manka, Jason Liang | Abstract |
Context:Concussion or mild traumatic brain injury (mTBI) comprise 70-90% of all traumatic brain injuries. Post concussion syndrome (PCS) is a clinical diagnosis with a myriad of definitions including those from DSM-IV or ICD-10, but generally refers to the presence of symptoms that last beyond the anticipated recovery timeline of concussion. As clinical data becomes more available through the increasing integration of electronic health records and digitization of information, artificial intelligence and machine learning (ML) remains at the forefront of innovation in medicine. To our knowledge, there has been no attempt made to synthesize the literature surrounding the use of ML in prognosticating recovery or complications from mTBI or PCS.Objective:To conduct a systematic review to review the current state of the research and application of ML in prognosticating patients presenting with or being diagnosed with mTBI.Methods:IEEE Xplore, Ovid’s Medline and Embase, APA PsycInfo, and Scopus databases were searched for studies using the terms ML and mTBI on February 3, 2023 from inception, and imported into the systematic review software, Covidence. Included studies were those that had a primary outcome of predicting post-mTBI prognosis or sequalae. Studies where the objective was mainly classification or analyzed outcomes after the acute mTBI presentation were excluded. The PROBAST Risk of Bias for Predictive Models assessment tool was used for assessing the risk of bias and applicability.Results:568 studies were initially screened and 35 were carried into full text screening. 11 studies met final inclusion and exclusion criteria and had their data extracted. The studies ranged in objective from predicting sports related concussion recovery, psychological comorbidity development and general post-concussion syndrome classification risk stratification. The performance of models was generally strong (AUC: 0.57-0.87). Support Vector Machine and Artificial Neural Network were the most popular modeling techniques employed. Studies in this review made limited attempts to compare their models to existing decision making tools and clinical judgment.Conclusion:Current prognostication of mTBI with ML is limited in its application. There are a number of promising models and research that are being produced. Further comparison to tools such as the KITE UHN Concussion calculator should be undertaken to solidify potential clinical use. |
Patrick | Yao | Michael G. DeGroote School of Medicine, McMaster University | |
| 0 | Bilateral femoral head osteonecrosis secondary to _Candida albicans_: A case report. | ["Osteonecrosis", "Candida albicans"] | Ryland Murphy, Amra Saric | Abstract |
Context:Here we present a complex presentation of deconditioning secondary to urosepsis, rhabdomyolysis, and takotsubo cardiomyopathy complicated by bilateral osteonecrosis of the femoral head.A 64-year-old female initially presented to the emergency department after being found on the ground hypotensive secondary to urosepsis. Upon admittance to the hospital, she was diagnosed with candidemia, rhabdomyolysis and takotsubo cardiomyopathy. After an extended stay, she was transferred to the rehabilitation center with lower extremity weakness, bowel and bladder incontinence and bilateral hip pain. During her time at rehab, she was unable to progress with her rehab goals due to her profound weakness and worsening hip pain.Initial hip x-rays before rehab admission were unremarkable. When repeated there was evidence of erosive changes. Follow-up computerized tomography (CT) and magnetic resonance imaging (MRI) showed progressive bilateral osteonecrosis of the femoral head. Rheumatological, and infectious etiologies were not identified in initial investigations including joint aspiration. Later surgical evaluation showed growth of _Candida albicans_ on a swab of the hip joint.Throughout the evaluation of her left hip pain, she progressively worsened. Involvement in therapy was limited, and simple bowel and bladder care became difficult due to pain symptoms. Weight-bearing was stopped for risk of pathological fracture or femoral head collapse. At rest, she reported significant pain which was not easily controlled by analgesics. As a result, she elected for a left hip Girdlestone procedure. Due to acute illness and surgical interventions, she had continued limitations in further rehabilitation efforts.Findings:Bilateral femoral head osteonecrosis is rare with significant effects on function and quality of life. Presentations are typically linked with systemic etiologies including infection, malignancy, pharmacologic, vascular and trauma. Here we describe an infectious etiology stemming from an initial Candida albicans urosepsis event several months prior. While Candida infections are well described as a cause of osteomyelitis particularly post-operatively, literature is limited in the description of it causing femoral head osteonecrosis.Clinical relevance:This is the second reported case of native femoral head osteonecrosis from a Candida albicans infection. Further, it highlights the substantial effect of bilateral femoral head osteonecrosis on the potential for rehabilitation. |
Amra | Saric | Department of Medicine, Dalhousie University | |
| 0 | Bilateral femoral head osteonecrosis secondary to _Candida albicans_: A case report. | ["Osteonecrosis", "Candida albicans"] | Ryland Murphy, Amra Saric | Abstract |
Context:Here we present a complex presentation of deconditioning secondary to urosepsis, rhabdomyolysis, and takotsubo cardiomyopathy complicated by bilateral osteonecrosis of the femoral head.A 64-year-old female initially presented to the emergency department after being found on the ground hypotensive secondary to urosepsis. Upon admittance to the hospital, she was diagnosed with candidemia, rhabdomyolysis and takotsubo cardiomyopathy. After an extended stay, she was transferred to the rehabilitation center with lower extremity weakness, bowel and bladder incontinence and bilateral hip pain. During her time at rehab, she was unable to progress with her rehab goals due to her profound weakness and worsening hip pain.Initial hip x-rays before rehab admission were unremarkable. When repeated there was evidence of erosive changes. Follow-up computerized tomography (CT) and magnetic resonance imaging (MRI) showed progressive bilateral osteonecrosis of the femoral head. Rheumatological, and infectious etiologies were not identified in initial investigations including joint aspiration. Later surgical evaluation showed growth of _Candida albicans_ on a swab of the hip joint.Throughout the evaluation of her left hip pain, she progressively worsened. Involvement in therapy was limited, and simple bowel and bladder care became difficult due to pain symptoms. Weight-bearing was stopped for risk of pathological fracture or femoral head collapse. At rest, she reported significant pain which was not easily controlled by analgesics. As a result, she elected for a left hip Girdlestone procedure. Due to acute illness and surgical interventions, she had continued limitations in further rehabilitation efforts.Findings:Bilateral femoral head osteonecrosis is rare with significant effects on function and quality of life. Presentations are typically linked with systemic etiologies including infection, malignancy, pharmacologic, vascular and trauma. Here we describe an infectious etiology stemming from an initial Candida albicans urosepsis event several months prior. While Candida infections are well described as a cause of osteomyelitis particularly post-operatively, literature is limited in the description of it causing femoral head osteonecrosis.Clinical relevance:This is the second reported case of native femoral head osteonecrosis from a Candida albicans infection. Further, it highlights the substantial effect of bilateral femoral head osteonecrosis on the potential for rehabilitation. |
Ryland | Murphy | Department of Medicine, Dalhousie University | |
| 0 | Bilateral femoral head osteonecrosis secondary to _Candida albicans_: A case report. | ["Osteonecrosis", "Candida albicans"] | Ryland Murphy, Amra Saric | Abstract |
Context:Here we present a complex presentation of deconditioning secondary to urosepsis, rhabdomyolysis, and takotsubo cardiomyopathy complicated by bilateral osteonecrosis of the femoral head.A 64-year-old female initially presented to the emergency department after being found on the ground hypotensive secondary to urosepsis. Upon admittance to the hospital, she was diagnosed with candidemia, rhabdomyolysis and takotsubo cardiomyopathy. After an extended stay, she was transferred to the rehabilitation center with lower extremity weakness, bowel and bladder incontinence and bilateral hip pain. Her bowel and bladder incontinence were isolated without any neurologic signs, or pathological findings on neuroimaging with MRI. During her time at rehab, she was unable to progress with her rehab goals due to her profound weakness and worsening hip pain.Initial hip x-rays before rehab admission were unremarkable. When repeated there was evidence of erosive changes. Follow-up computerized tomography (CT) and magnetic resonance imaging (MRI) showed progressive bilateral osteonecrosis of the femoral head. Rheumatological, and infectious etiologies were not identified in initial investigations including joint aspiration. Later surgical evaluation showed growth of _Candida albicans_ on a swab of the hip joint.Throughout the evaluation of her left hip pain, she progressively worsened. Involvement in therapy was limited, and simple bowel and bladder care became difficult due to pain symptoms and required full assistance. Weight-bearing was stopped for risk of pathological fracture or femoral head collapse. At rest, she reported significant pain which was not easily controlled by analgesics. As a result, she elected for a left hip Girdlestone procedure. Due to acute illness and surgical interventions, she had an extended rehabilitation process. She was later able to be discharged from rehab to home with modifications to her apartment. She utilizes a power wheelchair independently for ambulation, and transfers with a pivot disk with minimal two-person assistance. She still required full assistance with self care including bowel and bladder management at time of discharge.Findings:Bilateral femoral head osteonecrosis is rare with significant effects on function and quality of life. Presentations are typically linked with systemic etiologies including infection, malignancy, pharmacologic, vascular and trauma. Here we describe an infectious etiology stemming from an initial Candida albicans urosepsis event several months prior. While Candida infections are well described as a cause of osteomyelitis particularly post-operatively, literature is limited in the description of it causing femoral head osteonecrosis.Clinical relevance:This is the second reported case of native femoral head osteonecrosis from a Candida albicans infection. Further, it highlights the substantial effect of bilateral femoral head osteonecrosis on the potential for rehabilitation. Particularly in ambulation, and bowel and bladder care. |
Amra | Saric | Department of Medicine, Dalhousie University | |
| 0 | Bilateral femoral head osteonecrosis secondary to _Candida albicans_: A case report. | ["Osteonecrosis", "Candida albicans"] | Ryland Murphy, Amra Saric | Abstract |
Context:Here we present a complex presentation of deconditioning secondary to urosepsis, rhabdomyolysis, and takotsubo cardiomyopathy complicated by bilateral osteonecrosis of the femoral head.A 64-year-old female initially presented to the emergency department after being found on the ground hypotensive secondary to urosepsis. Upon admittance to the hospital, she was diagnosed with candidemia, rhabdomyolysis and takotsubo cardiomyopathy. After an extended stay, she was transferred to the rehabilitation center with lower extremity weakness, bowel and bladder incontinence and bilateral hip pain. Her bowel and bladder incontinence were isolated without any neurologic signs, or pathological findings on neuroimaging with MRI. During her time at rehab, she was unable to progress with her rehab goals due to her profound weakness and worsening hip pain.Initial hip x-rays before rehab admission were unremarkable. When repeated there was evidence of erosive changes. Follow-up computerized tomography (CT) and magnetic resonance imaging (MRI) showed progressive bilateral osteonecrosis of the femoral head. Rheumatological, and infectious etiologies were not identified in initial investigations including joint aspiration. Later surgical evaluation showed growth of _Candida albicans_ on a swab of the hip joint.Throughout the evaluation of her left hip pain, she progressively worsened. Involvement in therapy was limited, and simple bowel and bladder care became difficult due to pain symptoms and required full assistance. Weight-bearing was stopped for risk of pathological fracture or femoral head collapse. At rest, she reported significant pain which was not easily controlled by analgesics. As a result, she elected for a left hip Girdlestone procedure. Due to acute illness and surgical interventions, she had an extended rehabilitation process. She was later able to be discharged from rehab to home with modifications to her apartment. She utilizes a power wheelchair independently for ambulation, and transfers with a pivot disk with minimal two-person assistance. She still required full assistance with self care including bowel and bladder management at time of discharge.Findings:Bilateral femoral head osteonecrosis is rare with significant effects on function and quality of life. Presentations are typically linked with systemic etiologies including infection, malignancy, pharmacologic, vascular and trauma. Here we describe an infectious etiology stemming from an initial Candida albicans urosepsis event several months prior. While Candida infections are well described as a cause of osteomyelitis particularly post-operatively, literature is limited in the description of it causing femoral head osteonecrosis.Clinical relevance:This is the second reported case of native femoral head osteonecrosis from a Candida albicans infection. Further, it highlights the substantial effect of bilateral femoral head osteonecrosis on the potential for rehabilitation. Particularly in ambulation, and bowel and bladder care. |
Ryland | Murphy | Department of Medicine, Dalhousie University | |
| 0 | Bone Health Education in Individuals with Spinal Cord Injury: The Bare Bones Podcast Series: A QI Project | ["Bone Health", "Education", "Fracture", "Osteoporosis", "Spinal Cord Injury"] | B. Catharine Craven, Anita Kaiser, Hope Jervis-Rademeyer, Wendy Murphy, Lynn Boag, Lindsie Blencowe, Masae Miyatani | 1st place, education | Abstract |
Context:The Paralyzed Veterans of America (PVA) inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published in 2022. This CPG was developed for a clinician audience and aims to improve osteoporosis recognition, management, and fracture prevention. We now need to bridge the gap between clinician guidance and the ability of patients with lived experience (PLEX) to understand, act (implement behaviour change), and adhere to the CPG. We sought to co-develop a podcast series to ensure PLEX with SCI/D understand the CPG content and how to act to reduce their fracture risk.Methods:The “Bare Bones Series” contains 9 podcasts, 8-15 min. in length, with podcast content related to each CPG chapter. The podcasts are hosted by two PLEX with SCI/D (AK, WM). Each podcast features 1-2 CPG authors as invited podcast guests. The podcast titles and opening taglines are intended to entice listeners and were identified and refined by the project team including three PLEX (AK,WM, LB). Podcast discussion is directed by PLEX. The podcasts close with an invitation for listeners to review the next episode and specify a take home message or specific action a listener can act upon to advance their bone health. The project team met with guest speakers to orient themselves to the recording process and share the anticipated discussion prior to recording. The project leader and project team reviewed each podcast for flow, clarity, and accuracy. A project team member served as producer (HJ), providing sound editing, mixing and mastering of each podcast episode.Results:Two cohosts with SCI/D have recorded 9 distinct episodes with 11 experts. The episodes are entitled:** “Introduction to the Bare Bones of Bone Health”; “Fracture 101”; “Blood Tests a Window into You”; “I See Your Skeleton”; “Vitamin D for all, Calcium for Some & Bones, Groans and Stones”; “Get Moving and Loading”; “Pills or Poisons & Atomic Habits”; “Snap and Crack” and, “Directions for Research”.Conclusions:The Bare Bones podcast series will be shared through a social media campaign, stakeholder and community events, and conference presentations across North America. The podcasts will aid PLEX, their family caregivers, and healthcare providers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality. |
Wendy | Murphy | KITE Research Institute, University Health Network |
| 0 | Bone Health Education in Individuals with Spinal Cord Injury: The Bare Bones Podcast Series: A QI Project | ["Bone Health", "Education", "Fracture", "Osteoporosis", "Spinal Cord Injury"] | B. Catharine Craven, Anita Kaiser, Hope Jervis-Rademeyer, Wendy Murphy, Lynn Boag, Lindsie Blencowe, Masae Miyatani | 1st place, education | Abstract |
Context:The Paralyzed Veterans of America (PVA) inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published in 2022. This CPG was developed for a clinician audience and aims to improve osteoporosis recognition, management, and fracture prevention. We now need to bridge the gap between clinician guidance and the ability of patients with lived experience (PLEX) to understand, act (implement behaviour change), and adhere to the CPG. We sought to co-develop a podcast series to ensure PLEX with SCI/D understand the CPG content and how to act to reduce their fracture risk.Methods:The “Bare Bones Series” contains 9 podcasts, 8-15 min. in length, with podcast content related to each CPG chapter. The podcasts are hosted by two PLEX with SCI/D (AK, WM). Each podcast features 1-2 CPG authors as invited podcast guests. The podcast titles and opening taglines are intended to entice listeners and were identified and refined by the project team including three PLEX (AK,WM, LB). Podcast discussion is directed by PLEX. The podcasts close with an invitation for listeners to review the next episode and specify a take home message or specific action a listener can act upon to advance their bone health. The project team met with guest speakers to orient themselves to the recording process and share the anticipated discussion prior to recording. The project leader and project team reviewed each podcast for flow, clarity, and accuracy. A project team member served as producer (HJ), providing sound editing, mixing and mastering of each podcast episode.Results:Two cohosts with SCI/D have recorded 9 distinct episodes with 11 experts. The episodes are entitled:** “Introduction to the Bare Bones of Bone Health”; “Fracture 101”; “Blood Tests a Window into You”; “I See Your Skeleton”; “Vitamin D for all, Calcium for Some & Bones, Groans and Stones”; “Get Moving and Loading”; “Pills or Poisons & Atomic Habits”; “Snap and Crack” and, “Directions for Research”.Conclusions:The Bare Bones podcast series will be shared through a social media campaign, stakeholder and community events, and conference presentations across North America. The podcasts will aid PLEX, their family caregivers, and healthcare providers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality. |
Hope | Jervis-Rademeyer | Department of Medicine, University of Alberta |
| 0 | Bone Health Education in Individuals with Spinal Cord Injury: The Bare Bones Podcast Series: A QI Project | ["Bone Health", "Education", "Fracture", "Osteoporosis", "Spinal Cord Injury"] | B. Catharine Craven, Anita Kaiser, Hope Jervis-Rademeyer, Wendy Murphy, Lynn Boag, Lindsie Blencowe, Masae Miyatani | 1st place, education | Abstract |
Context:The Paralyzed Veterans of America (PVA) inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published in 2022. This CPG was developed for a clinician audience and aims to improve osteoporosis recognition, management, and fracture prevention. We now need to bridge the gap between clinician guidance and the ability of patients with lived experience (PLEX) to understand, act (implement behaviour change), and adhere to the CPG. We sought to co-develop a podcast series to ensure PLEX with SCI/D understand the CPG content and how to act to reduce their fracture risk.Methods:The “Bare Bones Series” contains 9 podcasts, 8-15 min. in length, with podcast content related to each CPG chapter. The podcasts are hosted by two PLEX with SCI/D (AK, WM). Each podcast features 1-2 CPG authors as invited podcast guests. The podcast titles and opening taglines are intended to entice listeners and were identified and refined by the project team including three PLEX (AK,WM, LB). Podcast discussion is directed by PLEX. The podcasts close with an invitation for listeners to review the next episode and specify a take home message or specific action a listener can act upon to advance their bone health. The project team met with guest speakers to orient themselves to the recording process and share the anticipated discussion prior to recording. The project leader and project team reviewed each podcast for flow, clarity, and accuracy. A project team member served as producer (HJ), providing sound editing, mixing and mastering of each podcast episode.Results:Two cohosts with SCI/D have recorded 9 distinct episodes with 11 experts. The episodes are entitled:** “Introduction to the Bare Bones of Bone Health”; “Fracture 101”; “Blood Tests a Window into You”; “I See Your Skeleton”; “Vitamin D for all, Calcium for Some & Bones, Groans and Stones”; “Get Moving and Loading”; “Pills or Poisons & Atomic Habits”; “Snap and Crack” and, “Directions for Research”.Conclusions:The Bare Bones podcast series will be shared through a social media campaign, stakeholder and community events, and conference presentations across North America. The podcasts will aid PLEX, their family caregivers, and healthcare providers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality. |
Lindsie | Blencowe | Institute of Medical Science, University of Toronto; KITE Research Institute, University Health Network |
| 0 | Bone Health Education in Individuals with Spinal Cord Injury: The Bare Bones Podcast Series: A QI Project | ["Bone Health", "Education", "Fracture", "Osteoporosis", "Spinal Cord Injury"] | B. Catharine Craven, Anita Kaiser, Hope Jervis-Rademeyer, Wendy Murphy, Lynn Boag, Lindsie Blencowe, Masae Miyatani | 1st place, education | Abstract |
Context:The Paralyzed Veterans of America (PVA) inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published in 2022. This CPG was developed for a clinician audience and aims to improve osteoporosis recognition, management, and fracture prevention. We now need to bridge the gap between clinician guidance and the ability of patients with lived experience (PLEX) to understand, act (implement behaviour change), and adhere to the CPG. We sought to co-develop a podcast series to ensure PLEX with SCI/D understand the CPG content and how to act to reduce their fracture risk.Methods:The “Bare Bones Series” contains 9 podcasts, 8-15 min. in length, with podcast content related to each CPG chapter. The podcasts are hosted by two PLEX with SCI/D (AK, WM). Each podcast features 1-2 CPG authors as invited podcast guests. The podcast titles and opening taglines are intended to entice listeners and were identified and refined by the project team including three PLEX (AK,WM, LB). Podcast discussion is directed by PLEX. The podcasts close with an invitation for listeners to review the next episode and specify a take home message or specific action a listener can act upon to advance their bone health. The project team met with guest speakers to orient themselves to the recording process and share the anticipated discussion prior to recording. The project leader and project team reviewed each podcast for flow, clarity, and accuracy. A project team member served as producer (HJ), providing sound editing, mixing and mastering of each podcast episode.Results:Two cohosts with SCI/D have recorded 9 distinct episodes with 11 experts. The episodes are entitled:** “Introduction to the Bare Bones of Bone Health”; “Fracture 101”; “Blood Tests a Window into You”; “I See Your Skeleton”; “Vitamin D for all, Calcium for Some & Bones, Groans and Stones”; “Get Moving and Loading”; “Pills or Poisons & Atomic Habits”; “Snap and Crack” and, “Directions for Research”.Conclusions:The Bare Bones podcast series will be shared through a social media campaign, stakeholder and community events, and conference presentations across North America. The podcasts will aid PLEX, their family caregivers, and healthcare providers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality. |
Masae | Miyatani | KITE Research Institute, University Health Network |
| 0 | Bone Health Education in Individuals with Spinal Cord Injury: The Bare Bones Podcast Series: A QI Project | ["Bone Health", "Education", "Fracture", "Osteoporosis", "Spinal Cord Injury"] | B. Catharine Craven, Anita Kaiser, Hope Jervis-Rademeyer, Wendy Murphy, Lynn Boag, Lindsie Blencowe, Masae Miyatani | 1st place, education | Abstract |
Context:The Paralyzed Veterans of America (PVA) inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published in 2022. This CPG was developed for a clinician audience and aims to improve osteoporosis recognition, management, and fracture prevention. We now need to bridge the gap between clinician guidance and the ability of patients with lived experience (PLEX) to understand, act (implement behaviour change), and adhere to the CPG. We sought to co-develop a podcast series to ensure PLEX with SCI/D understand the CPG content and how to act to reduce their fracture risk.Methods:The “Bare Bones Series” contains 9 podcasts, 8-15 min. in length, with podcast content related to each CPG chapter. The podcasts are hosted by two PLEX with SCI/D (AK, WM). Each podcast features 1-2 CPG authors as invited podcast guests. The podcast titles and opening taglines are intended to entice listeners and were identified and refined by the project team including three PLEX (AK,WM, LB). Podcast discussion is directed by PLEX. The podcasts close with an invitation for listeners to review the next episode and specify a take home message or specific action a listener can act upon to advance their bone health. The project team met with guest speakers to orient themselves to the recording process and share the anticipated discussion prior to recording. The project leader and project team reviewed each podcast for flow, clarity, and accuracy. A project team member served as producer (HJ), providing sound editing, mixing and mastering of each podcast episode.Results:Two cohosts with SCI/D have recorded 9 distinct episodes with 11 experts. The episodes are entitled:** “Introduction to the Bare Bones of Bone Health”; “Fracture 101”; “Blood Tests a Window into You”; “I See Your Skeleton”; “Vitamin D for all, Calcium for Some & Bones, Groans and Stones”; “Get Moving and Loading”; “Pills or Poisons & Atomic Habits”; “Snap and Crack” and, “Directions for Research”.Conclusions:The Bare Bones podcast series will be shared through a social media campaign, stakeholder and community events, and conference presentations across North America. The podcasts will aid PLEX, their family caregivers, and healthcare providers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality. |
Lynn | Boag | KITE Research Institute, University Health Network |
| 0 | Bone Health Education in Individuals with Spinal Cord Injury: The Bare Bones Podcast Series: A QI Project | ["Bone Health", "Education", "Fracture", "Osteoporosis", "Spinal Cord Injury"] | B. Catharine Craven, Anita Kaiser, Hope Jervis-Rademeyer, Wendy Murphy, Lynn Boag, Lindsie Blencowe, Masae Miyatani | 1st place, education | Abstract |
Context:The Paralyzed Veterans of America (PVA) inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published in 2022. This CPG was developed for a clinician audience and aims to improve osteoporosis recognition, management, and fracture prevention. We now need to bridge the gap between clinician guidance and the ability of patients with lived experience (PLEX) to understand, act (implement behaviour change), and adhere to the CPG. We sought to co-develop a podcast series to ensure PLEX with SCI/D understand the CPG content and how to act to reduce their fracture risk.Methods:The “Bare Bones Series” contains 9 podcasts, 8-15 min. in length, with podcast content related to each CPG chapter. The podcasts are hosted by two PLEX with SCI/D (AK, WM). Each podcast features 1-2 CPG authors as invited podcast guests. The podcast titles and opening taglines are intended to entice listeners and were identified and refined by the project team including three PLEX (AK,WM, LB). Podcast discussion is directed by PLEX. The podcasts close with an invitation for listeners to review the next episode and specify a take home message or specific action a listener can act upon to advance their bone health. The project team met with guest speakers to orient themselves to the recording process and share the anticipated discussion prior to recording. The project leader and project team reviewed each podcast for flow, clarity, and accuracy. A project team member served as producer (HJ), providing sound editing, mixing and mastering of each podcast episode.Results:Two cohosts with SCI/D have recorded 9 distinct episodes with 11 experts. The episodes are entitled:** “Introduction to the Bare Bones of Bone Health”; “Fracture 101”; “Blood Tests a Window into You”; “I See Your Skeleton”; “Vitamin D for all, Calcium for Some & Bones, Groans and Stones”; “Get Moving and Loading”; “Pills or Poisons & Atomic Habits”; “Snap and Crack” and, “Directions for Research”.Conclusions:The Bare Bones podcast series will be shared through a social media campaign, stakeholder and community events, and conference presentations across North America. The podcasts will aid PLEX, their family caregivers, and healthcare providers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality. |
Anita | Kaiser | Canadian Spinal Research Organization; KITE Research Institute, University Health Network; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto |
| 0 | Bone Health Education in Individuals with Spinal Cord Injury: The Bare Bones Podcast Series: A QI Project | ["Bone Health", "Education", "Fracture", "Osteoporosis", "Spinal Cord Injury"] | B. Catharine Craven, Anita Kaiser, Hope Jervis-Rademeyer, Wendy Murphy, Lynn Boag, Lindsie Blencowe, Masae Miyatani | 1st place, education | Abstract |
Context:The Paralyzed Veterans of America (PVA) inaugural Clinical Practice Guideline (CPG) for Bone Health and Osteoporosis Management for individuals with spinal cord injury or disease (SCI/D) was published in 2022. This CPG was developed for a clinician audience and aims to improve osteoporosis recognition, management, and fracture prevention. We now need to bridge the gap between clinician guidance and the ability of patients with lived experience (PLEX) to understand, act (implement behaviour change), and adhere to the CPG. We sought to co-develop a podcast series to ensure PLEX with SCI/D understand the CPG content and how to act to reduce their fracture risk.Methods:The “Bare Bones Series” contains 9 podcasts, 8-15 min. in length, with podcast content related to each CPG chapter. The podcasts are hosted by two PLEX with SCI/D (AK, WM). Each podcast features 1-2 CPG authors as invited podcast guests. The podcast titles and opening taglines are intended to entice listeners and were identified and refined by the project team including three PLEX (AK,WM, LB). Podcast discussion is directed by PLEX. The podcasts close with an invitation for listeners to review the next episode and specify a take home message or specific action a listener can act upon to advance their bone health. The project team met with guest speakers to orient themselves to the recording process and share the anticipated discussion prior to recording. The project leader and project team reviewed each podcast for flow, clarity, and accuracy. A project team member served as producer (HJ), providing sound editing, mixing and mastering of each podcast episode.Results:Two cohosts with SCI/D have recorded 9 distinct episodes with 11 experts. The episodes are entitled:** “Introduction to the Bare Bones of Bone Health”; “Fracture 101”; “Blood Tests a Window into You”; “I See Your Skeleton”; “Vitamin D for all, Calcium for Some & Bones, Groans and Stones”; “Get Moving and Loading”; “Pills or Poisons & Atomic Habits”; “Snap and Crack” and, “Directions for Research”.Conclusions:The Bare Bones podcast series will be shared through a social media campaign, stakeholder and community events, and conference presentations across North America. The podcasts will aid PLEX, their family caregivers, and healthcare providers to advocate for ongoing bone health assessments and to promote an ongoing dialogue with care team members regarding how to prevent fractures and fracture-related morbidity and mortality. |
B. Catharine | Craven | Brain and Spinal Cord Rehabilitation Program, Toronto Rehabilitation Institute , University Health Network; Division of Physical Medicine and Rehabilitation, Temerty Faculty of Medicine, University of Toronto; Rehabilitation Sciences Institute, Temerty Faculty of Medicine, University of Toronto; KITE Research Institute, University Health Network |
| 0 | Burnout in family-caregivers of Mauritians with neurological disabilities during COVID-19 lockdown: a phenomenological analysis | ["caregiver burden", "COVID-19", "developing countries", "disabled persons", "rehabilitation research"] | Britney Soll, Vincent Oxenham, Farris Kassam, Rajiv Reebye | 2nd place, original research | Abstract | **Background and objectives** Mauritius lacks adequate neurorehabilitation facilities, preventing patients from regaining independence and increasing failed reintegration into the community. While patients are isolated, family members must fulfil many carer roles leading to burnout. In 2022, the NEURAM Foundation collaborated with the Mauritian Ministry of Health to survey the impact of COVID-19 lockdowns on the functioning of Mauritians with neurological disabilities. Initial thematic analysis revealed the most prevalent theme was “caregiver burnout”. As a result, we conducted a sub-analysis of this theme and aim to illustrate phenomenological perspectives of these family caregivers. Design/methods:We conducted a thematic analysis of 34 semi-structured interviews of patients with either Traumatic Brain Injuries (TBI), Spinal Cord Injuries (SCI), Cerebro-Vascular Accidents (CVA) and/or their family-caregivers. We excluded patients and caregivers of patients without physical or cognitive disabilities. Participants:Interviewed participants included 22 patients and 18 family-caregivers. Of the 34 cases, patient aetiology included 65% CVA, 32% SCI, 3% TBI. Results:100% of patients lived at home and 70% depended on at least one person to assist in their activities of daily living. Qualitative analysis assessing “caregiver burnout” revealed that the word “everything” was cited 170 times, emphasising that family-caregivers feel obligated to endorse and be “everything” to patients who can do “nothing”. Further analysis revealed many roles comprise the caregiver’s identity:family member, therapist, nurse, and provider. Analysis also revealed that lack of specialised neurorehabilitation services, social support, and geographical barriers create financial burden for caregivers. Reported benefits of COVID-19 lockdown include strengthened familial bonds and improved patient mood, cognition, and speech due to increased contact with caregivers permanently at home. In contrast, caregiver burnout increased as lockdown limited available support to assist in patient care, medication shortages, and increased financial burden.Conclusions:Patient isolation and caregiver burnout were present before and during COVID-19 lockdowns. We recommend that the development of structured neuro-rehabilitation services providing community-level multi-disciplinary support should not only focus on optimizing patient care but also developing strategies to reduce caregiver burnout. |
Rajiv | Reebye | Division of Physical Medicine and Rehabilitation, Department of Medicine, University of British Columbia |
| 0 | Burnout in family-caregivers of Mauritians with neurological disabilities during COVID-19 lockdown: a phenomenological analysis | ["caregiver burden", "COVID-19", "developing countries", "disabled persons", "rehabilitation research"] | Britney Soll, Vincent Oxenham, Farris Kassam, Rajiv Reebye | 2nd place, original research | Abstract | **Background and objectives** Mauritius lacks adequate neurorehabilitation facilities, preventing patients from regaining independence and increasing failed reintegration into the community. While patients are isolated, family members must fulfil many carer roles leading to burnout. In 2022, the NEURAM Foundation collaborated with the Mauritian Ministry of Health to survey the impact of COVID-19 lockdowns on the functioning of Mauritians with neurological disabilities. Initial thematic analysis revealed the most prevalent theme was “caregiver burnout”. As a result, we conducted a sub-analysis of this theme and aim to illustrate phenomenological perspectives of these family caregivers. Design/methods:We conducted a thematic analysis of 34 semi-structured interviews of patients with either Traumatic Brain Injuries (TBI), Spinal Cord Injuries (SCI), Cerebro-Vascular Accidents (CVA) and/or their family-caregivers. We excluded patients and caregivers of patients without physical or cognitive disabilities. Participants:Interviewed participants included 22 patients and 18 family-caregivers. Of the 34 cases, patient aetiology included 65% CVA, 32% SCI, 3% TBI. Results:100% of patients lived at home and 70% depended on at least one person to assist in their activities of daily living. Qualitative analysis assessing “caregiver burnout” revealed that the word “everything” was cited 170 times, emphasising that family-caregivers feel obligated to endorse and be “everything” to patients who can do “nothing”. Further analysis revealed many roles comprise the caregiver’s identity:family member, therapist, nurse, and provider. Analysis also revealed that lack of specialised neurorehabilitation services, social support, and geographical barriers create financial burden for caregivers. Reported benefits of COVID-19 lockdown include strengthened familial bonds and improved patient mood, cognition, and speech due to increased contact with caregivers permanently at home. In contrast, caregiver burnout increased as lockdown limited available support to assist in patient care, medication shortages, and increased financial burden.Conclusions:Patient isolation and caregiver burnout were present before and during COVID-19 lockdowns. We recommend that the development of structured neuro-rehabilitation services providing community-level multi-disciplinary support should not only focus on optimizing patient care but also developing strategies to reduce caregiver burnout. |
Vincent | Oxenham | School of Psychological Sciences, Macquari University |
| 0 | Burnout in family-caregivers of Mauritians with neurological disabilities during COVID-19 lockdown: a phenomenological analysis | ["caregiver burden", "COVID-19", "developing countries", "disabled persons", "rehabilitation research"] | Britney Soll, Vincent Oxenham, Farris Kassam, Rajiv Reebye | 2nd place, original research | Abstract | **Background and objectives** Mauritius lacks adequate neurorehabilitation facilities, preventing patients from regaining independence and increasing failed reintegration into the community. While patients are isolated, family members must fulfil many carer roles leading to burnout. In 2022, the NEURAM Foundation collaborated with the Mauritian Ministry of Health to survey the impact of COVID-19 lockdowns on the functioning of Mauritians with neurological disabilities. Initial thematic analysis revealed the most prevalent theme was “caregiver burnout”. As a result, we conducted a sub-analysis of this theme and aim to illustrate phenomenological perspectives of these family caregivers. Design/methods:We conducted a thematic analysis of 34 semi-structured interviews of patients with either Traumatic Brain Injuries (TBI), Spinal Cord Injuries (SCI), Cerebro-Vascular Accidents (CVA) and/or their family-caregivers. We excluded patients and caregivers of patients without physical or cognitive disabilities. Participants:Interviewed participants included 22 patients and 18 family-caregivers. Of the 34 cases, patient aetiology included 65% CVA, 32% SCI, 3% TBI. Results:100% of patients lived at home and 70% depended on at least one person to assist in their activities of daily living. Qualitative analysis assessing “caregiver burnout” revealed that the word “everything” was cited 170 times, emphasising that family-caregivers feel obligated to endorse and be “everything” to patients who can do “nothing”. Further analysis revealed many roles comprise the caregiver’s identity:family member, therapist, nurse, and provider. Analysis also revealed that lack of specialised neurorehabilitation services, social support, and geographical barriers create financial burden for caregivers. Reported benefits of COVID-19 lockdown include strengthened familial bonds and improved patient mood, cognition, and speech due to increased contact with caregivers permanently at home. In contrast, caregiver burnout increased as lockdown limited available support to assist in patient care, medication shortages, and increased financial burden.Conclusions:Patient isolation and caregiver burnout were present before and during COVID-19 lockdowns. We recommend that the development of structured neuro-rehabilitation services providing community-level multi-disciplinary support should not only focus on optimizing patient care but also developing strategies to reduce caregiver burnout. |
Britney | Soll | Department of Psychology, University of Derby |
| 0 | Burnout in family-caregivers of Mauritians with neurological disabilities during COVID-19 lockdown: a phenomenological analysis | ["caregiver burden", "COVID-19", "developing countries", "disabled persons", "rehabilitation research"] | Britney Soll, Vincent Oxenham, Farris Kassam, Rajiv Reebye | 2nd place, original research | Abstract | **Background and objectives** Mauritius lacks adequate neurorehabilitation facilities, preventing patients from regaining independence and increasing failed reintegration into the community. While patients are isolated, family members must fulfil many carer roles leading to burnout. In 2022, the NEURAM Foundation collaborated with the Mauritian Ministry of Health to survey the impact of COVID-19 lockdowns on the functioning of Mauritians with neurological disabilities. Initial thematic analysis revealed the most prevalent theme was “caregiver burnout”. As a result, we conducted a sub-analysis of this theme and aim to illustrate phenomenological perspectives of these family caregivers. Design/methods:We conducted a thematic analysis of 34 semi-structured interviews of patients with either Traumatic Brain Injuries (TBI), Spinal Cord Injuries (SCI), Cerebro-Vascular Accidents (CVA) and/or their family-caregivers. We excluded patients and caregivers of patients without physical or cognitive disabilities. Participants:Interviewed participants included 22 patients and 18 family-caregivers. Of the 34 cases, patient aetiology included 65% CVA, 32% SCI, 3% TBI. Results:100% of patients lived at home and 70% depended on at least one person to assist in their activities of daily living. Qualitative analysis assessing “caregiver burnout” revealed that the word “everything” was cited 170 times, emphasising that family-caregivers feel obligated to endorse and be “everything” to patients who can do “nothing”. Further analysis revealed many roles comprise the caregiver’s identity:family member, therapist, nurse, and provider. Analysis also revealed that lack of specialised neurorehabilitation services, social support, and geographical barriers create financial burden for caregivers. Reported benefits of COVID-19 lockdown include strengthened familial bonds and improved patient mood, cognition, and speech due to increased contact with caregivers permanently at home. In contrast, caregiver burnout increased as lockdown limited available support to assist in patient care, medication shortages, and increased financial burden.Conclusions:Patient isolation and caregiver burnout were present before and during COVID-19 lockdowns. We recommend that the development of structured neuro-rehabilitation services providing community-level multi-disciplinary support should not only focus on optimizing patient care but also developing strategies to reduce caregiver burnout. |
Farris | Kassam | Canadian Advances in Neuro-Orthopedics for Spasticity Congress |
| 0 | Cervical myelopathy in Weaver Syndrome: a case report reflecting ableism in medicine | ["Bias", "Muscle Spasticity", "Social Discrimination", "Spinal Cord Diseases", "Weaver Syndrome"] | Yvette Y. Yao, Ranita H. K. Manocha | Abstract |
Context:A 39-year-old female living in the community with Weaver syndrome gradually lost ambulatory ability over 6 months. The patient was hospitalized for 3 months during which reportedly no cause for loss of mobility was found, and the patient was discharged to a long-term care facility. Four months later, an occupational therapist at the facility referred the patient to a physiatrist to address significant bilateral lower limb spasticity.Findings:There was left proximal upper limb and diffuse bilateral lower limb spasticity (Table 1, Figure 1). There was bilateral hand hypotonia with profound symmetric atrophy of the interossei and hypothenar and thenar eminences. Although spasticity can rarely be seen in Weaver syndrome, this condition does not cause polyneuropathy or muscle atrophy. As such, upper limb nerve conduction studies were performed, which were normal. Electromyography was poorly tolerated so only the first dorsal interosseous of the hand was needled, and this showed reduced activation at full effort, consistent with central nervous system dysfunction. Non-contrast magnetic resonance imaging (MRI) of the cervical spine (Figure 2) showed severe spinal cord compression at C3-4, C4-5, and C5-6 due to degenerative changes.Clinical relevance:Weaver syndrome is a rare genetic disorder reported to affect 54 people worldwide that is associated with rapid bony overgrowth and intellectual impairment. This can lead to early osteoarthritis, macrocephaly, spasticity, and dysphonia. Only two pediatric cases of cervical myelopathy in Weaver syndrome have been reported. Cervical kyphosis, early cervical osteoarthritis, and a lack of development of the mid-cervical vertebral bodies have also been reported in Weaver syndrome. This is the first report of cervical spondylotic myelopathy in an adult with Weaver syndrome. Although cervical myelopathy is a common cause for losing ambulatory ability, the patient did not have a cervical MRI during a 3-month hospitalization for work-up, potentially secondary to cognitive biases in clinical decision-making and ableist ideas about patients living with a genetic condition and intellectual impairment. It is important for physiatrists to consider cervical myelopathy in patients with Weaver syndrome to improve early detection. The recognition of how cognitive biases towards people who use wheelchairs, have intellectual impairment, and/or have genetic conditions is also important for physicians to recognize as this can negatively impact decisions around appropriate clinical work-up and treatment. |
Yvette Y. | Yao | ||
| 0 | Cervical myelopathy in Weaver Syndrome: a case report reflecting ableism in medicine | ["Bias", "Muscle Spasticity", "Social Discrimination", "Spinal Cord Diseases", "Weaver Syndrome"] | Yvette Y. Yao, Ranita H. K. Manocha | Abstract |
Context:A 39-year-old female living in the community with Weaver syndrome gradually lost ambulatory ability over 6 months. The patient was hospitalized for 3 months during which reportedly no cause for loss of mobility was found, and the patient was discharged to a long-term care facility. Four months later, an occupational therapist at the facility referred the patient to a physiatrist to address significant bilateral lower limb spasticity.Findings:There was left proximal upper limb and diffuse bilateral lower limb spasticity (Table 1, Figure 1). There was bilateral hand hypotonia with profound symmetric atrophy of the interossei and hypothenar and thenar eminences. Although spasticity can rarely be seen in Weaver syndrome, this condition does not cause polyneuropathy or muscle atrophy. As such, upper limb nerve conduction studies were performed, which were normal. Electromyography was poorly tolerated so only the first dorsal interosseous of the hand was needled, and this showed reduced activation at full effort, consistent with central nervous system dysfunction. Non-contrast magnetic resonance imaging (MRI) of the cervical spine (Figure 2) showed severe spinal cord compression at C3-4, C4-5, and C5-6 due to degenerative changes.Clinical relevance:Weaver syndrome is a rare genetic disorder reported to affect 54 people worldwide that is associated with rapid bony overgrowth and intellectual impairment. This can lead to early osteoarthritis, macrocephaly, spasticity, and dysphonia. Only two pediatric cases of cervical myelopathy in Weaver syndrome have been reported. Cervical kyphosis, early cervical osteoarthritis, and a lack of development of the mid-cervical vertebral bodies have also been reported in Weaver syndrome. This is the first report of cervical spondylotic myelopathy in an adult with Weaver syndrome. Although cervical myelopathy is a common cause for losing ambulatory ability, the patient did not have a cervical MRI during a 3-month hospitalization for work-up, potentially secondary to cognitive biases in clinical decision-making and ableist ideas about patients living with a genetic condition and intellectual impairment. It is important for physiatrists to consider cervical myelopathy in patients with Weaver syndrome to improve early detection. The recognition of how cognitive biases towards people who use wheelchairs, have intellectual impairment, and/or have genetic conditions is also important for physicians to recognize as this can negatively impact decisions around appropriate clinical work-up and treatment. |
Ranita H. K. | Manocha | ||
| 0 | Challenges Associated with Studying Quality of Life in the Inpatient Rehabilitation Setting | ["Patient Reported Outcome Measures", "Qualitative Research", "Quality of Life", "Stroke Rehabilitation"] | Courtney Grotski, Sepideh Pooyania | Abstract |
Objectives:Describe common inconsistencies seen in research when defining quality of life. Discuss advantages and disadvantages for frequently used quality of life outcome measures in research settings. Propose an alternative method for quality of life research in an inpatient stroke rehabilitation setting.Background:Quality of life (QOL) can be poorly defined in research, with arbitrary vocabulary and outcome measures often used. Many terms such as “Quality of Life,” “Health-related QOL,” “Health,” “Wellness,” “Happiness,” are seen used interchangeably. And while certain popular instruments such as the Short-Form Health Survey (SF-36) and the EuroQol 5-dimensions (EQ-5D) are validated for QOL research, there are limitations to their application in a subacute inpatient setting. Sub-sections of these instruments ask patients to reflect on their activities of social functioning such as work, leisure and sexuality, which likely have not yet been experienced by a patient who has been transferred directly from acute care to rehabilitation. Additionally, the EQ-5D is not a free tool, making it less easily accessible for researchers.Methods:To study the effect of gender on QOL in an inpatient stroke rehabilitation setting, a review of multiple databases was undergone to see if there existed any appropriate quantitative measures for this population. This included a review of Stroke Engine Assessments, Shirley Ryan Ability Lab Rehabilitation Measures, and a literature review for validated and reliable methods to measure QOL in this population.Results:A visual analogue scale was the only applicable outcome measure identified. No other defined and validated quantitative QOL tools specific for an inpatient stroke rehab population were recognized.Discussion:QOL is commonly studied through patient-reported outcomes (PROs). While tools like the E5-5D and the SF-36 collect PROs by quantitative means; these outcomes can be collected using qualitative methods as well. Qualitative research collects data from interviews, focus groups, observations, or written materials. However, clinicians in the medical field are often less trained and experienced in this type of research, including how to critically appraise and establish trustworthiness of qualitative data, as well as conducting and interpreting qualitative data analysis.Conclusion:Consideration of QOL research is important for person-centered care. There exists a need for increased training in qualitative research and for validated quantitative QOL instruments for an inpatient rehabilitation population. |
Sepideh | Pooyania | Stroke Rehabilitation , Riverview Health Centre | |
| 0 | Challenges Associated with Studying Quality of Life in the Inpatient Rehabilitation Setting | ["Patient Reported Outcome Measures", "Qualitative Research", "Quality of Life", "Stroke Rehabilitation"] | Courtney Grotski, Sepideh Pooyania | Abstract |
Objectives:Describe common inconsistencies seen in research when defining quality of life. Discuss advantages and disadvantages for frequently used quality of life outcome measures in research settings. Propose an alternative method for quality of life research in an inpatient stroke rehabilitation setting.Background:Quality of life (QOL) can be poorly defined in research, with arbitrary vocabulary and outcome measures often used. Many terms such as “Quality of Life,” “Health-related QOL,” “Health,” “Wellness,” “Happiness,” are seen used interchangeably. And while certain popular instruments such as the Short-Form Health Survey (SF-36) and the EuroQol 5-dimensions (EQ-5D) are validated for QOL research, there are limitations to their application in a subacute inpatient setting. Sub-sections of these instruments ask patients to reflect on their activities of social functioning such as work, leisure and sexuality, which likely have not yet been experienced by a patient who has been transferred directly from acute care to rehabilitation. Additionally, the EQ-5D is not a free tool, making it less easily accessible for researchers.Methods:To study the effect of gender on QOL in an inpatient stroke rehabilitation setting, a review of multiple databases was undergone to see if there existed any appropriate quantitative measures for this population. This included a review of Stroke Engine Assessments, Shirley Ryan Ability Lab Rehabilitation Measures, and a literature review for validated and reliable methods to measure QOL in this population.Results:A visual analogue scale was the only applicable outcome measure identified. No other defined and validated quantitative QOL tools specific for an inpatient stroke rehab population were recognized.Discussion:QOL is commonly studied through patient-reported outcomes (PROs). While tools like the E5-5D and the SF-36 collect PROs by quantitative means; these outcomes can be collected using qualitative methods as well. Qualitative research collects data from interviews, focus groups, observations, or written materials. However, clinicians in the medical field are often less trained and experienced in this type of research, including how to critically appraise and establish trustworthiness of qualitative data, as well as conducting and interpreting qualitative data analysis.Conclusion:Consideration of QOL research is important for person-centered care. There exists a need for increased training in qualitative research and for validated quantitative QOL instruments for an inpatient rehabilitation population. |
Courtney | Grotski | Physical Medicine and Rehabilitation , University of Manitoba | |
| 0 | Discontinuing Prolonged Venous Thromboembolism Prophylaxis in Inpatients with a Newly Diagnosed Spinal Cord Injury: A Quality Improvement Initiative | ["Medication Overutilization", "Neurological Rehabilitation", "Quality Improvement", "Spinal Cord Injury", "Venous Thromboembolism"] | Lauren Cormier, E. Ali Bateman, Heather M. MacKenzie | 1st place, quality improvement | Abstract |
Problem:Persons with spinal cord injury (SCI) are at high risk of venous thromboembolism (VTE); guidelines recommend VTE prophylaxis (VTEp) for 8-12 weeks or until discharge, whichever is shorter. Because persons with SCI may have prolonged hospital stays, the need for ongoing VTEp may warrant reassessment as VTEp has risks including hemorrhage, thrombocytopenia, and osteoporosis. From local baseline data from June-August 2022 inclusive, 45.5% of SCI rehabilitation inpatients received VTEp in excess of guideline recommendations by 58 days on average. Thus, this initiative aimed to decrease the proportion of patients with a new SCI admitted for rehabilitation to Parkwood Institute who receive VTEp beyond their individualized recommended treatment duration from 45.5% to 30%.Root cause analysis:Fishbone framework, process map, and stakeholder interviews identified 7 key providers (4 physiatrists, 3 hospitalists, 1 pharmacist) and 3 priority root causes:** unclear duration of VTEp; knowledge gap for VTEp recommendations; and no mechanism to prompt providers to reassess VTEp duration.Interventions:A series of interventions were introduced. 7 key providers were engaged in consensus-building for criteria for 8- or 12-week VTEp duration. Key providers and other stakeholders, including leaders, nurses, trainees, and allied health team members, received education outlining the above care gap, rationale for the intervention, and the indications for 8 or 12-week duration of VTEp. Stakeholder feedback guided the development of a standardized process for recording the VTEp start date, deciding on the duration of VTEp, and setting a VTEp end date during weekly interdisciplinary team rounds for newly admitted patients.Measurement of improvement:Data was analyzed using interrupted time-series for consecutive patients admitted with a new SCI from June 2022 to January 2023 inclusive. The outcome measure was the proportion of patients with VTEp prescribed >7 days beyond the recommended duration. Balancing measures included the rate of VTE.Effects of intervention:Monthly run chart data demonstrated a downward shift in the outcome measure after the education sessions and initiation of the standardized VTEp review process. The median proportion of patients receiving prolonged VTEp decreased from 45.5% to 22.7%. No inpatients developed VTE post-intervention.Conclusions:This initiative established provider buy-in and engaged stakeholders to reduce the proportion of persons receiving prolonged VTEp. Sustainability will be the focus of future efforts.Funding:none |
Lauren | Cormier | Physical Medicine and Rehabilitation, Western University |
| 0 | Discontinuing Prolonged Venous Thromboembolism Prophylaxis in Inpatients with a Newly Diagnosed Spinal Cord Injury: A Quality Improvement Initiative | ["Medication Overutilization", "Neurological Rehabilitation", "Quality Improvement", "Spinal Cord Injury", "Venous Thromboembolism"] | Lauren Cormier, E. Ali Bateman, Heather M. MacKenzie | 1st place, quality improvement | Abstract |
Problem:Persons with spinal cord injury (SCI) are at high risk of venous thromboembolism (VTE); guidelines recommend VTE prophylaxis (VTEp) for 8-12 weeks or until discharge, whichever is shorter. Because persons with SCI may have prolonged hospital stays, the need for ongoing VTEp may warrant reassessment as VTEp has risks including hemorrhage, thrombocytopenia, and osteoporosis. From local baseline data from June-August 2022 inclusive, 45.5% of SCI rehabilitation inpatients received VTEp in excess of guideline recommendations by 58 days on average. Thus, this initiative aimed to decrease the proportion of patients with a new SCI admitted for rehabilitation to Parkwood Institute who receive VTEp beyond their individualized recommended treatment duration from 45.5% to 30%.Root cause analysis:Fishbone framework, process map, and stakeholder interviews identified 7 key providers (4 physiatrists, 3 hospitalists, 1 pharmacist) and 3 priority root causes:** unclear duration of VTEp; knowledge gap for VTEp recommendations; and no mechanism to prompt providers to reassess VTEp duration.Interventions:A series of interventions were introduced. 7 key providers were engaged in consensus-building for criteria for 8- or 12-week VTEp duration. Key providers and other stakeholders, including leaders, nurses, trainees, and allied health team members, received education outlining the above care gap, rationale for the intervention, and the indications for 8 or 12-week duration of VTEp. Stakeholder feedback guided the development of a standardized process for recording the VTEp start date, deciding on the duration of VTEp, and setting a VTEp end date during weekly interdisciplinary team rounds for newly admitted patients.Measurement of improvement:Data was analyzed using interrupted time-series for consecutive patients admitted with a new SCI from June 2022 to January 2023 inclusive. The outcome measure was the proportion of patients with VTEp prescribed >7 days beyond the recommended duration. Balancing measures included the rate of VTE.Effects of intervention:Monthly run chart data demonstrated a downward shift in the outcome measure after the education sessions and initiation of the standardized VTEp review process. The median proportion of patients receiving prolonged VTEp decreased from 45.5% to 22.7%. No inpatients developed VTE post-intervention.Conclusions:This initiative established provider buy-in and engaged stakeholders to reduce the proportion of persons receiving prolonged VTEp. Sustainability will be the focus of future efforts.Funding:none |
Heather M. | MacKenzie | Physical Medicine and Rehabilitation , Western University |
| 0 | Discontinuing Prolonged Venous Thromboembolism Prophylaxis in Inpatients with a Newly Diagnosed Spinal Cord Injury: A Quality Improvement Initiative | ["Medication Overutilization", "Neurological Rehabilitation", "Quality Improvement", "Spinal Cord Injury", "Venous Thromboembolism"] | Lauren Cormier, E. Ali Bateman, Heather M. MacKenzie | 1st place, quality improvement | Abstract |
Problem:Persons with spinal cord injury (SCI) are at high risk of venous thromboembolism (VTE); guidelines recommend VTE prophylaxis (VTEp) for 8-12 weeks or until discharge, whichever is shorter. Because persons with SCI may have prolonged hospital stays, the need for ongoing VTEp may warrant reassessment as VTEp has risks including hemorrhage, thrombocytopenia, and osteoporosis. From local baseline data from June-August 2022 inclusive, 45.5% of SCI rehabilitation inpatients received VTEp in excess of guideline recommendations by 58 days on average. Thus, this initiative aimed to decrease the proportion of patients with a new SCI admitted for rehabilitation to Parkwood Institute who receive VTEp beyond their individualized recommended treatment duration from 45.5% to 30%.Root cause analysis:Fishbone framework, process map, and stakeholder interviews identified 7 key providers (4 physiatrists, 3 hospitalists, 1 pharmacist) and 3 priority root causes:** unclear duration of VTEp; knowledge gap for VTEp recommendations; and no mechanism to prompt providers to reassess VTEp duration.Interventions:A series of interventions were introduced. 7 key providers were engaged in consensus-building for criteria for 8- or 12-week VTEp duration. Key providers and other stakeholders, including leaders, nurses, trainees, and allied health team members, received education outlining the above care gap, rationale for the intervention, and the indications for 8 or 12-week duration of VTEp. Stakeholder feedback guided the development of a standardized process for recording the VTEp start date, deciding on the duration of VTEp, and setting a VTEp end date during weekly interdisciplinary team rounds for newly admitted patients.Measurement of improvement:Data was analyzed using interrupted time-series for consecutive patients admitted with a new SCI from June 2022 to January 2023 inclusive. The outcome measure was the proportion of patients with VTEp prescribed >7 days beyond the recommended duration. Balancing measures included the rate of VTE.Effects of intervention:Monthly run chart data demonstrated a downward shift in the outcome measure after the education sessions and initiation of the standardized VTEp review process. The median proportion of patients receiving prolonged VTEp decreased from 45.5% to 22.7%. No inpatients developed VTE post-intervention.Conclusions:This initiative established provider buy-in and engaged stakeholders to reduce the proportion of persons receiving prolonged VTEp. Sustainability will be the focus of future efforts.Funding:none |
E. Ali | Bateman | Physical Medicine and Rehabilitation , Western University |
| 0 | Evaluation of a Spiral Integrated Curriculum Design on Family Medicine Residents’ Competency Acquisition in Concussion Care | ["Curriculum\nEducation", "Medical Education", "Brain Concussion"] | Alice Kam, Tobi Lam, Nicolas Fernandez, Denyse Richardson | Abstract |
Context:To address knowledge gaps in concussion care within a family medicine residency program, a novel curriculum was designed using a Spiral Integrated model of education delivery. The Spiral Integrated Concussion Curriculum (SICC) applied active learning teaching techniques mixed with longitudinal deepening learning opportunities. SICC entailed interactive case-based academic half-days (AHD), clinical rotations in a specialized clinic, reflective activities and feedback during rotations. A previous pilot study concluded that SICC is a promising solution to improving concussion education in family medicine residency programs. To investigate the impact of the SICC on concussion competency development, we aimed to describe how the educational design is experienced by residents. Methods:This study is employing a mixed methods research methodology using subjective and objective methods for describing curriculum effectiveness. Semi-structured interviews are being conducted with residents six months after completion of the SICC elective. The interviews include constructivist content analysis to explore the perceived effectiveness of SICC on competency development and a concussion case scenario for evaluation of competency. Pre- and post-intervention knowledge surveys conducted during AHDs are being analyzed quantitatively using descriptive statistics. Based on previously developed Concussion Entrustable Professional Activities (EPAs) as a deductive framework for data analysis, we are exploring how CanMEDS competencies develop longitudinally within a SICC. Our secondary aim is to identify enablers and barriers of competency development using SICC in order to improve on curricular design. Results:The learner-centered approach to describing SICC effectiveness identifies how residents integrate knowledge into clinical practice and adapt to case-specific contexts that demonstrate horizontal and vertical learning. Our preliminary results suggest that opportunities for tailored learning experiences (patient contexts, sociodemographics, complexity) enable the deepening of knowledge across competencies. However, this approach is limited by time-consuming iterative cycles and the intensive needs of human resources. Some competencies are developing, which may be more challenging to integrate them. Conclusion:This study illustrated an integrated approach to curriculum design and evaluation to unify competence development as a unit with patient care-driven outcomes. |
Tobi | Lam | Wilson Centre, University Health Network; Translational Research Program , University of Toronto | |
| 0 | Evaluation of a Spiral Integrated Curriculum Design on Family Medicine Residents’ Competency Acquisition in Concussion Care | ["Curriculum\nEducation", "Medical Education", "Brain Concussion"] | Alice Kam, Tobi Lam, Nicolas Fernandez, Denyse Richardson | Abstract |
Context:To address knowledge gaps in concussion care within a family medicine residency program, a novel curriculum was designed using a Spiral Integrated model of education delivery. The Spiral Integrated Concussion Curriculum (SICC) applied active learning teaching techniques mixed with longitudinal deepening learning opportunities. SICC entailed interactive case-based academic half-days (AHD), clinical rotations in a specialized clinic, reflective activities and feedback during rotations. A previous pilot study concluded that SICC is a promising solution to improving concussion education in family medicine residency programs. To investigate the impact of the SICC on concussion competency development, we aimed to describe how the educational design is experienced by residents. Methods:This study is employing a mixed methods research methodology using subjective and objective methods for describing curriculum effectiveness. Semi-structured interviews are being conducted with residents six months after completion of the SICC elective. The interviews include constructivist content analysis to explore the perceived effectiveness of SICC on competency development and a concussion case scenario for evaluation of competency. Pre- and post-intervention knowledge surveys conducted during AHDs are being analyzed quantitatively using descriptive statistics. Based on previously developed Concussion Entrustable Professional Activities (EPAs) as a deductive framework for data analysis, we are exploring how CanMEDS competencies develop longitudinally within a SICC. Our secondary aim is to identify enablers and barriers of competency development using SICC in order to improve on curricular design. Results:The learner-centered approach to describing SICC effectiveness identifies how residents integrate knowledge into clinical practice and adapt to case-specific contexts that demonstrate horizontal and vertical learning. Our preliminary results suggest that opportunities for tailored learning experiences (patient contexts, sociodemographics, complexity) enable the deepening of knowledge across competencies. However, this approach is limited by time-consuming iterative cycles and the intensive needs of human resources. Some competencies are developing, which may be more challenging to integrate them. Conclusion:This study illustrated an integrated approach to curriculum design and evaluation to unify competence development as a unit with patient care-driven outcomes. |
Alice | Kam | Toronto Western Hospital, University Health Network, Toronto, Ontario, Canada;; North York General Hospital, Toronto, Ontario, Canada; ; Toronto Rehabilitation Institute, University Health Network, Toronto, Ontario, Canada; Division of Physical Medicine and Rehabilitation, Department of Medicine, University of Toronto, Toronto, Ontario, Canada; , University of Toronto | |
| 0 | Evaluation of a Spiral Integrated Curriculum Design on Family Medicine Residents’ Competency Acquisition in Concussion Care | ["Curriculum\nEducation", "Medical Education", "Brain Concussion"] | Alice Kam, Tobi Lam, Nicolas Fernandez, Denyse Richardson | Abstract |
Context:To address knowledge gaps in concussion care within a family medicine residency program, a novel curriculum was designed using a Spiral Integrated model of education delivery. The Spiral Integrated Concussion Curriculum (SICC) applied active learning teaching techniques mixed with longitudinal deepening learning opportunities. SICC entailed interactive case-based academic half-days (AHD), clinical rotations in a specialized clinic, reflective activities and feedback during rotations. A previous pilot study concluded that SICC is a promising solution to improving concussion education in family medicine residency programs. To investigate the impact of the SICC on concussion competency development, we aimed to describe how the educational design is experienced by residents. Methods:This study is employing a mixed methods research methodology using subjective and objective methods for describing curriculum effectiveness. Semi-structured interviews are being conducted with residents six months after completion of the SICC elective. The interviews include constructivist content analysis to explore the perceived effectiveness of SICC on competency development and a concussion case scenario for evaluation of competency. Pre- and post-intervention knowledge surveys conducted during AHDs are being analyzed quantitatively using descriptive statistics. Based on previously developed Concussion Entrustable Professional Activities (EPAs) as a deductive framework for data analysis, we are exploring how CanMEDS competencies develop longitudinally within a SICC. Our secondary aim is to identify enablers and barriers of competency development using SICC in order to improve on curricular design. Results:The learner-centered approach to describing SICC effectiveness identifies how residents integrate knowledge into clinical practice and adapt to case-specific contexts that demonstrate horizontal and vertical learning. Our preliminary results suggest that opportunities for tailored learning experiences (patient contexts, sociodemographics, complexity) enable the deepening of knowledge across competencies. However, this approach is limited by time-consuming iterative cycles and the intensive needs of human resources. Some competencies are developing, which may be more challenging to integrate them. Conclusion:This study illustrated an integrated approach to curriculum design and evaluation to unify competence development as a unit with patient care-driven outcomes. |
Denyse | Richardson | Department of Physical Medicine and Rehabilitation, Queen’s University, Kingston, Ontario, Canada; Providence Care Hospital, Kingston, Ontario, Canada | |
| 0 | Evaluation of a Spiral Integrated Curriculum Design on Family Medicine Residents’ Competency Acquisition in Concussion Care | ["Curriculum\nEducation", "Medical Education", "Brain Concussion"] | Alice Kam, Tobi Lam, Nicolas Fernandez, Denyse Richardson | Abstract |
Context:To address knowledge gaps in concussion care within a family medicine residency program, a novel curriculum was designed using a Spiral Integrated model of education delivery. The Spiral Integrated Concussion Curriculum (SICC) applied active learning teaching techniques mixed with longitudinal deepening learning opportunities. SICC entailed interactive case-based academic half-days (AHD), clinical rotations in a specialized clinic, reflective activities and feedback during rotations. A previous pilot study concluded that SICC is a promising solution to improving concussion education in family medicine residency programs. To investigate the impact of the SICC on concussion competency development, we aimed to describe how the educational design is experienced by residents. Methods:This study is employing a mixed methods research methodology using subjective and objective methods for describing curriculum effectiveness. Semi-structured interviews are being conducted with residents six months after completion of the SICC elective. The interviews include constructivist content analysis to explore the perceived effectiveness of SICC on competency development and a concussion case scenario for evaluation of competency. Pre- and post-intervention knowledge surveys conducted during AHDs are being analyzed quantitatively using descriptive statistics. Based on previously developed Concussion Entrustable Professional Activities (EPAs) as a deductive framework for data analysis, we are exploring how CanMEDS competencies develop longitudinally within a SICC. Our secondary aim is to identify enablers and barriers of competency development using SICC in order to improve on curricular design. Results:The learner-centered approach to describing SICC effectiveness identifies how residents integrate knowledge into clinical practice and adapt to case-specific contexts that demonstrate horizontal and vertical learning. Our preliminary results suggest that opportunities for tailored learning experiences (patient contexts, sociodemographics, complexity) enable the deepening of knowledge across competencies. However, this approach is limited by time-consuming iterative cycles and the intensive needs of human resources. Some competencies are developing, which may be more challenging to integrate them. Conclusion:This study illustrated an integrated approach to curriculum design and evaluation to unify competence development as a unit with patient care-driven outcomes. |
Nicolas | Fernandez | Department of Family and Emergency, Université de Montréal, Montreal, Quebec, Canada; | |
| 0 | Implications of altered leg length following total hip arthroplasty in patient with compensated gait following childhood polio: A case report. | ["polio", "hip replacement", "arthroplasty", "rehabilitation", "leg length"] | Steven Macaluso, Tyrus Gibson | Abstract | Context Total hip arthroplasty (THA) can provide pain relief and functional improvements. However, following the procedure patients often experience a relative change in leg length compared to baseline. While this may not impact function in the general population the rehabilitation consequences in patients who have learned compensatory gait techniques for baseline weakness can be considerable.Findings A 57 year old female patient who contracted poliomyelitis at a young age resulting in asymmetric lower limb weakness was seen in an academic physiatry clinic for left hip and groin pain. Upon examination the patient demonstrated considerable weakness in the right lower extremity (3/5 hip flexion, knee extension, knee flexion and 1/5 dorsiflexion, plantarflexion) and gait demonstrating compensatory hip hike, circumduction, contralateral toe walking, and a 3cm leg length discrepancy (Left > Right). X-Ray imaging revealed superior and lateral migration of the femoral head, alterations of the hemi-pelvis and severe joint space narrowing of the left femoroacetabular joint. Referral to Orthopedic surgery was made and a Left THA was provided. Following surgery both inpatient and outpatient rehabilitation was provided with note of the patient having difficulties with adaptation of gait mechanics required due to altered leg length. Evidence informed strategies employed to assist the patient included additional physiotherapy focussed on gait retraining, emotional and psychological support, and pedorthist assessment with provision of a shoe lift.Conclusion/Clinical Relevance Considerable thought and planning should accompany referral of patients with baseline compensated gait patterns for arthroplasty. Discussion of implications of alteration of leg length should ideally be discussed by physiatrist, orthopedic surgeon, therapists, and patient prior to surgery. |
Tyrus | Gibson | Western University | |
| 0 | Implications of altered leg length following total hip arthroplasty in patient with compensated gait following childhood polio: A case report. | ["polio", "hip replacement", "arthroplasty", "rehabilitation", "leg length"] | Steven Macaluso, Tyrus Gibson | Abstract | Context Total hip arthroplasty (THA) can provide pain relief and functional improvements. However, following the procedure patients often experience a relative change in leg length compared to baseline. While this may not impact function in the general population the rehabilitation consequences in patients who have learned compensatory gait techniques for baseline weakness can be considerable.Findings A 57 year old female patient who contracted poliomyelitis at a young age resulting in asymmetric lower limb weakness was seen in an academic physiatry clinic for left hip and groin pain. Upon examination the patient demonstrated considerable weakness in the right lower extremity (3/5 hip flexion, knee extension, knee flexion and 1/5 dorsiflexion, plantarflexion) and gait demonstrating compensatory hip hike, circumduction, contralateral toe walking, and a 3cm leg length discrepancy (Left > Right). X-Ray imaging revealed superior and lateral migration of the femoral head, alterations of the hemi-pelvis and severe joint space narrowing of the left femoroacetabular joint. Referral to Orthopedic surgery was made and a Left THA was provided. Following surgery both inpatient and outpatient rehabilitation was provided with note of the patient having difficulties with adaptation of gait mechanics required due to altered leg length. Evidence informed strategies employed to assist the patient included additional physiotherapy focussed on gait retraining, emotional and psychological support, and pedorthist assessment with provision of a shoe lift.Conclusion/Clinical Relevance Considerable thought and planning should accompany referral of patients with baseline compensated gait patterns for arthroplasty. Discussion of implications of alteration of leg length should ideally be discussed by physiatrist, orthopedic surgeon, therapists, and patient prior to surgery. |
Steven | Macaluso | Physical Medicine and Rehabilitation, Western University; St. Joseph's Health Care London, Ontario | |
| 0 | Post-Stroke Osteoporosis: A Scoping Review | ["Mass Screening", "Osteoporosis", "Rehabilitation", "Physical and Rehabilitative Medicine", "Stroke"] | Sydney Knight | Abstract |
Context:Post-stroke patients are infrequently screened and treated for osteoporosis, yet growing evidence demonstrates that stroke is associated with an increased risk of low-trauma fractures and osteoporosis. There are no specific osteoporosis screening, prevention, or treatment recommendations for post-stroke patients, including none in the Canadian Best Stroke Practice Guidelines.Objective:To explore the extent and type of evidence available in relation to osteoporosis and bone health in the post-stroke population, with the aim to further investigate and map the current literature on post-stroke osteoporosis screening.Methods:Studies were included if they involved post-stroke patients and discuss osteoporosis. They were further assessed in the context of post-stroke osteoporosis screening. A full search strategy for Medline and Embase was developed. Data extracted included the concept, context, study methods, and key findings. Analysis of the studies is descriptive and narrative.Results:Following study selection, one hundred and thirty-nine papers were included in the scoping review to map study distribution by year, country, research methods, aims, and setting. Once further selected by the context of post-stroke osteoporosis screening, twelve papers were included for further discussion in the scoping review. The largest proportion of studies specific to screening for post-stroke osteoporosis were published in 2021 (n=3, 25%). Many of the included texts were conference abstracts (n=33, 24%). Of the two randomized control trials included, one investigated the pharmacologic management of post-stroke osteoporosis, and one explored non-pharmacologic post-stroke osteoporosis management. Many of the included articles focused on the etiology of post-stroke osteoporosis (n= 61, 44%). All twelve included studies on the screening of post-stroke osteoporosis comment on or indicate the need for screening, prevention, and management guidelines for bone health and osteoporosis post-stroke.Conclusions:This scoping review demonstrates a continued international interest in the screening, diagnosis, prevention, and management of post-stroke osteoporosis. It highlights current gaps in the post-stroke osteoporosis literature and emphasizes the need for screening, prevention, and management guidelines as well as risk assessment tools specific for the post-stroke population. |
Sydney | Knight | Schulich School of Medicine & Dentistry, Western University | |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick Yao, Yi Diao, Eric McMullen, Marlin Manka, Jessica Murphy, Celina Lin | 1st place, systematic review | Abstract | **Context**: Amputation is an irreversible, last-line treatment for several medical issues including trauma, gangrene, cancer, and diabetes. Delaying amputation may lead to increased risks of morbidity and mortality whereas amputation itself can lead to physiological and psychological complications that can have a profound impact on quality of life. Early accurate identification of patients who may require amputation can lead to fewer postoperative complications, less cost to the system and better rehabilitation outcomes. Therefore, determining the likelihood of amputation can help patients understand the potential benefits of education and intervention as well as the risks and benefits associated with a decision to amputate. **Objective**: This systematic review (SR) aims to synthesize the literature which described the effectiveness of machine learning (ML) models in predicting amputation of varying etiologies.**Methods**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. ML performance variables such as area under the receiver operator curve (AUC) were recorded and PROBAST scores were used to assess for risk of bias. Two reviewers (P.Y., Y.D.) completed the title and abstract screening, full-text review, and data extraction independently and in duplicate. A full-text review was subsequently conducted for eligible papers.**Results**: 3572 articles were identified; 30 underwent full-text review, and 15 articles were included. Random Forest Models and Gradient Boosted machine were the most used ML modeling techniques. For the diabetic population, models ranged in performance from sup-optimal to excellent (AUC: 0.60-0.94). In trauma patients, a total of three studies displayed ML models with strong to excellent performance (AUC: 0.88-0.95). In amputation secondary to other etiologies (burns and peripheral vascular disease), ML models had strong performance (AUC: 0.81-1.00). Many of the studies had a high PROBAST risk of bias owing to small sample size.**Conclusion**: Multiple ML models with various target populations have been developed with respect to predicting amputation. These models contain the potential of superiority to traditional modeling techniques and prospective clinical judgment. This could benefit care teams in helping make treatment decisions and plans that mitigate complications and better support patients. Further research is needed to overcome the limitations of the ML models themselves, and the developing literature to bring applicability to the clinical setting. | Jessica | Murphy | Division of Physical Medicine and Rehabilitation, McMaster University |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick Yao, Yi Diao, Eric McMullen, Marlin Manka, Jessica Murphy, Celina Lin | 1st place, systematic review | Abstract | **Context**: Amputation is an irreversible, last-line treatment for several medical issues including trauma, gangrene, cancer, and diabetes. Delaying amputation may lead to increased risks of morbidity and mortality whereas amputation itself can lead to physiological and psychological complications that can have a profound impact on quality of life. Early accurate identification of patients who may require amputation can lead to fewer postoperative complications, less cost to the system and better rehabilitation outcomes. Therefore, determining the likelihood of amputation can help patients understand the potential benefits of education and intervention as well as the risks and benefits associated with a decision to amputate. **Objective**: This systematic review (SR) aims to synthesize the literature which described the effectiveness of machine learning (ML) models in predicting amputation of varying etiologies.**Methods**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. ML performance variables such as area under the receiver operator curve (AUC) were recorded and PROBAST scores were used to assess for risk of bias. Two reviewers (P.Y., Y.D.) completed the title and abstract screening, full-text review, and data extraction independently and in duplicate. A full-text review was subsequently conducted for eligible papers.**Results**: 3572 articles were identified; 30 underwent full-text review, and 15 articles were included. Random Forest Models and Gradient Boosted machine were the most used ML modeling techniques. For the diabetic population, models ranged in performance from sup-optimal to excellent (AUC: 0.60-0.94). In trauma patients, a total of three studies displayed ML models with strong to excellent performance (AUC: 0.88-0.95). In amputation secondary to other etiologies (burns and peripheral vascular disease), ML models had strong performance (AUC: 0.81-1.00). Many of the studies had a high PROBAST risk of bias owing to small sample size.**Conclusion**: Multiple ML models with various target populations have been developed with respect to predicting amputation. These models contain the potential of superiority to traditional modeling techniques and prospective clinical judgment. This could benefit care teams in helping make treatment decisions and plans that mitigate complications and better support patients. Further research is needed to overcome the limitations of the ML models themselves, and the developing literature to bring applicability to the clinical setting. | Marlin | Manka | Department of Computer Science, Western University |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick Yao, Yi Diao, Eric McMullen, Marlin Manka, Jessica Murphy, Celina Lin | 1st place, systematic review | Abstract | **Context**: Amputation is an irreversible, last-line treatment for several medical issues including trauma, gangrene, cancer, and diabetes. Delaying amputation may lead to increased risks of morbidity and mortality whereas amputation itself can lead to physiological and psychological complications that can have a profound impact on quality of life. Early accurate identification of patients who may require amputation can lead to fewer postoperative complications, less cost to the system and better rehabilitation outcomes. Therefore, determining the likelihood of amputation can help patients understand the potential benefits of education and intervention as well as the risks and benefits associated with a decision to amputate. **Objective**: This systematic review (SR) aims to synthesize the literature which described the effectiveness of machine learning (ML) models in predicting amputation of varying etiologies.**Methods**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. ML performance variables such as area under the receiver operator curve (AUC) were recorded and PROBAST scores were used to assess for risk of bias. Two reviewers (P.Y., Y.D.) completed the title and abstract screening, full-text review, and data extraction independently and in duplicate. A full-text review was subsequently conducted for eligible papers.**Results**: 3572 articles were identified; 30 underwent full-text review, and 15 articles were included. Random Forest Models and Gradient Boosted machine were the most used ML modeling techniques. For the diabetic population, models ranged in performance from sup-optimal to excellent (AUC: 0.60-0.94). In trauma patients, a total of three studies displayed ML models with strong to excellent performance (AUC: 0.88-0.95). In amputation secondary to other etiologies (burns and peripheral vascular disease), ML models had strong performance (AUC: 0.81-1.00). Many of the studies had a high PROBAST risk of bias owing to small sample size.**Conclusion**: Multiple ML models with various target populations have been developed with respect to predicting amputation. These models contain the potential of superiority to traditional modeling techniques and prospective clinical judgment. This could benefit care teams in helping make treatment decisions and plans that mitigate complications and better support patients. Further research is needed to overcome the limitations of the ML models themselves, and the developing literature to bring applicability to the clinical setting. | Celina | Lin | Division of Physical Medicine and Rehabilitation, Hamilton Health Sciences; Division of Physical Medicine and Rehabilitation, McMaster University |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick Yao, Yi Diao, Eric McMullen, Marlin Manka, Jessica Murphy, Celina Lin | 1st place, systematic review | Abstract | **Context**: Amputation is an irreversible, last-line treatment for several medical issues including trauma, gangrene, cancer, and diabetes. Delaying amputation may lead to increased risks of morbidity and mortality whereas amputation itself can lead to physiological and psychological complications that can have a profound impact on quality of life. Early accurate identification of patients who may require amputation can lead to fewer postoperative complications, less cost to the system and better rehabilitation outcomes. Therefore, determining the likelihood of amputation can help patients understand the potential benefits of education and intervention as well as the risks and benefits associated with a decision to amputate. **Objective**: This systematic review (SR) aims to synthesize the literature which described the effectiveness of machine learning (ML) models in predicting amputation of varying etiologies.**Methods**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. ML performance variables such as area under the receiver operator curve (AUC) were recorded and PROBAST scores were used to assess for risk of bias. Two reviewers (P.Y., Y.D.) completed the title and abstract screening, full-text review, and data extraction independently and in duplicate. A full-text review was subsequently conducted for eligible papers.**Results**: 3572 articles were identified; 30 underwent full-text review, and 15 articles were included. Random Forest Models and Gradient Boosted machine were the most used ML modeling techniques. For the diabetic population, models ranged in performance from sup-optimal to excellent (AUC: 0.60-0.94). In trauma patients, a total of three studies displayed ML models with strong to excellent performance (AUC: 0.88-0.95). In amputation secondary to other etiologies (burns and peripheral vascular disease), ML models had strong performance (AUC: 0.81-1.00). Many of the studies had a high PROBAST risk of bias owing to small sample size.**Conclusion**: Multiple ML models with various target populations have been developed with respect to predicting amputation. These models contain the potential of superiority to traditional modeling techniques and prospective clinical judgment. This could benefit care teams in helping make treatment decisions and plans that mitigate complications and better support patients. Further research is needed to overcome the limitations of the ML models themselves, and the developing literature to bring applicability to the clinical setting. | Patrick | Yao | Michael G. DeGroote School of Medicine, McMaster University |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick Yao, Yi Diao, Eric McMullen, Marlin Manka, Jessica Murphy, Celina Lin | 1st place, systematic review | Abstract | **Context**: Amputation is an irreversible, last-line treatment for several medical issues including trauma, gangrene, cancer, and diabetes. Delaying amputation may lead to increased risks of morbidity and mortality whereas amputation itself can lead to physiological and psychological complications that can have a profound impact on quality of life. Early accurate identification of patients who may require amputation can lead to fewer postoperative complications, less cost to the system and better rehabilitation outcomes. Therefore, determining the likelihood of amputation can help patients understand the potential benefits of education and intervention as well as the risks and benefits associated with a decision to amputate. **Objective**: This systematic review (SR) aims to synthesize the literature which described the effectiveness of machine learning (ML) models in predicting amputation of varying etiologies.**Methods**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. ML performance variables such as area under the receiver operator curve (AUC) were recorded and PROBAST scores were used to assess for risk of bias. Two reviewers (P.Y., Y.D.) completed the title and abstract screening, full-text review, and data extraction independently and in duplicate. A full-text review was subsequently conducted for eligible papers.**Results**: 3572 articles were identified; 30 underwent full-text review, and 15 articles were included. Random Forest Models and Gradient Boosted machine were the most used ML modeling techniques. For the diabetic population, models ranged in performance from sup-optimal to excellent (AUC: 0.60-0.94). In trauma patients, a total of three studies displayed ML models with strong to excellent performance (AUC: 0.88-0.95). In amputation secondary to other etiologies (burns and peripheral vascular disease), ML models had strong performance (AUC: 0.81-1.00). Many of the studies had a high PROBAST risk of bias owing to small sample size.**Conclusion**: Multiple ML models with various target populations have been developed with respect to predicting amputation. These models contain the potential of superiority to traditional modeling techniques and prospective clinical judgment. This could benefit care teams in helping make treatment decisions and plans that mitigate complications and better support patients. Further research is needed to overcome the limitations of the ML models themselves, and the developing literature to bring applicability to the clinical setting. | Eric | McMullen | Michael G. DeGroote School of Medicine, McMaster University |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick Yao, Yi Diao, Eric McMullen, Marlin Manka, Jessica Murphy, Celina Lin | 1st place, systematic review | Abstract | **Context**: Amputation is an irreversible, last-line treatment for several medical issues including trauma, gangrene, cancer, and diabetes. Delaying amputation may lead to increased risks of morbidity and mortality whereas amputation itself can lead to physiological and psychological complications that can have a profound impact on quality of life. Early accurate identification of patients who may require amputation can lead to fewer postoperative complications, less cost to the system and better rehabilitation outcomes. Therefore, determining the likelihood of amputation can help patients understand the potential benefits of education and intervention as well as the risks and benefits associated with a decision to amputate. **Objective**: This systematic review (SR) aims to synthesize the literature which described the effectiveness of machine learning (ML) models in predicting amputation of varying etiologies.**Methods**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. ML performance variables such as area under the receiver operator curve (AUC) were recorded and PROBAST scores were used to assess for risk of bias. Two reviewers (P.Y., Y.D.) completed the title and abstract screening, full-text review, and data extraction independently and in duplicate. A full-text review was subsequently conducted for eligible papers.**Results**: 3572 articles were identified; 30 underwent full-text review, and 15 articles were included. Random Forest Models and Gradient Boosted machine were the most used ML modeling techniques. For the diabetic population, models ranged in performance from sup-optimal to excellent (AUC: 0.60-0.94). In trauma patients, a total of three studies displayed ML models with strong to excellent performance (AUC: 0.88-0.95). In amputation secondary to other etiologies (burns and peripheral vascular disease), ML models had strong performance (AUC: 0.81-1.00). Many of the studies had a high PROBAST risk of bias owing to small sample size.**Conclusion**: Multiple ML models with various target populations have been developed with respect to predicting amputation. These models contain the potential of superiority to traditional modeling techniques and prospective clinical judgment. This could benefit care teams in helping make treatment decisions and plans that mitigate complications and better support patients. Further research is needed to overcome the limitations of the ML models themselves, and the developing literature to bring applicability to the clinical setting. | Yi | Diao | Michael G. DeGroote School of Medicine, McMaster University |
| 0 | The Effectiveness of Cervical Facet Joint Radiofrequency Neurotomy Using a Tripolar (Trident) Cannula and Perpendicular Approach – in progress | ["interventions", "physiatry", "pain"] | shyane wiegers, Robert Burnham | Abstract | Background There are potential procedural and safety advantages to performing cervical facet radiofrequency neurotomy (CRFN) using a perpendicular approach to the medial branch nerves. The tripolar Trident cannula design and thermal configuration are well suited for this application. However, the effectiveness and procedural characteristics of Trident cervical facet radiofrequency neurotomy (TCRFN) have not been described or compared to conventional approaches.Objective To determine the effectiveness and procedural characteristics of fluoroscopic guided CRFN using a Trident cannula with perpendicular to the medial branch nerve approach in comparison to the traditional monopolar cannula parallel to the medial branch nerve approach for cervical facetogenic pain relief.Methods Design:With-in subject retrospective cohort study of TCRFN performed at an Alberta community multidisciplinary chronic musculoskeletal pain clinic between 2016 and 2021.Selection criteria:facetogenic neck pain confirmed by ≥50% pain relief following dual (90%) or single (8%) local anesthetic facet joint blocks; CRFN of the same facet joint(s) on two occasions, using different cannulae (conventional monopolar versus Trident).Interventions:Fluoroscopically guided CRFN on two occasions targeting the same facet joint(s)– once using a conventional monopolar cannula and parallel to the nerve approach and, when the neck pain recurred, once using the Trident cannula and perpendicular to the nerve approach. Lesion temperature was 80°C and duration was two minutes. All procedures were performed by the same interventional physiatrist.Outcome MeasuresEffectiveness of crfn:Pre-and three-month post-CRFN numerical rating scale of pain intensity and Pain Disability Quality-Of-Life Questionnaire-Spine score.Procedural characteristics:total procedure and fluoroscopy times.Results (pending)Conclusions (pending)Upon completion of the project, results will help determine the effectiveness and procedural characteristics of TCRFN and whether TCRFN is a reasonable interventional approach to consider for cervical facetogenic pain. |
shyane | wiegers | physical medicine and rehabilitation, University of Calgary | |
| 0 | The Effectiveness of Cervical Facet Joint Radiofrequency Neurotomy Using a Tripolar (Trident) Cannula and Perpendicular Approach – in progress | ["interventions", "physiatry", "pain"] | shyane wiegers, Robert Burnham | Abstract | Background There are potential procedural and safety advantages to performing cervical facet radiofrequency neurotomy (CRFN) using a perpendicular approach to the medial branch nerves. The tripolar Trident cannula design and thermal configuration are well suited for this application. However, the effectiveness and procedural characteristics of Trident cervical facet radiofrequency neurotomy (TCRFN) have not been described or compared to conventional approaches.Objective To determine the effectiveness and procedural characteristics of fluoroscopic guided CRFN using a Trident cannula with perpendicular to the medial branch nerve approach in comparison to the traditional monopolar cannula parallel to the medial branch nerve approach for cervical facetogenic pain relief.Methods Design:With-in subject retrospective cohort study of TCRFN performed at an Alberta community multidisciplinary chronic musculoskeletal pain clinic between 2016 and 2021.Selection criteria:facetogenic neck pain confirmed by ≥50% pain relief following dual (90%) or single (8%) local anesthetic facet joint blocks; CRFN of the same facet joint(s) on two occasions, using different cannulae (conventional monopolar versus Trident).Interventions:Fluoroscopically guided CRFN on two occasions targeting the same facet joint(s)– once using a conventional monopolar cannula and parallel to the nerve approach and, when the neck pain recurred, once using the Trident cannula and perpendicular to the nerve approach. Lesion temperature was 80°C and duration was two minutes. All procedures were performed by the same interventional physiatrist.Outcome MeasuresEffectiveness of crfn:Pre-and three-month post-CRFN numerical rating scale of pain intensity and Pain Disability Quality-Of-Life Questionnaire-Spine score.Procedural characteristics:total procedure and fluoroscopy times.Results (pending)Conclusions (pending)Upon completion of the project, results will help determine the effectiveness and procedural characteristics of TCRFN and whether TCRFN is a reasonable interventional approach to consider for cervical facetogenic pain. |
Robert | Burnham | Physical Medicine and Rehabilitation, University of Alberta | |
| 0 | Transcutaneous Electrical Nerve Stimulation for Spasticity Management; A Guide for Patients | ["Transcutaneous electrical nerve stimulation", "spasticity"] | Taha Qaiser, Rajiv Reebye | Abstract |
Background:Spasticity is characterized by intermittent or sustained involuntary activation of muscles. There is evidence that transcutaneous electrical nerve stimulation (TENS) can be helpful as part of a multi-modal treatment approach for spasticity management. This treatment modality is of great interest for physicians and patients as it is affordable and can be self-administered. Even with various literature demonstrating positive outcomes, there is little consensus on TENS operating parameters. With contradicting parameters, it can be difficult for patients to find clarity on how to use TENS to manage their spasticity.Methods:A narrative review of studies (N=12) involving the use of TENS for spasticity management was conducted. Key parameters for TENS machine settings from the reviewed studies were extracted to help in designing the patient oriented resource/brochure.Results:We reviewed randomized-control trials (N=7), systematic reviews (N=2), case control studies (N=2), and meta-analysis (N=1). TENS parameters such as electrode placement, intensity, pulse, frequency, and duration of treatment were compiled. The narrative review demonstrated a variability in electrode positioning and key settings with TENS utilization. An easy-to-understand patient oriented resource/brochure was then created based on the common themes (including the mechanism of action, pathophysiology and TENS parameters).Conclusion:This is the first narrative review involving the use of TENS for spasticity to help design an education brochure/resource that can help patients incorporate TENS as part of their multi-modal spasticity treatment. This resource could help busy clinicians reinforce patient education regarding proper electrode placement and TENS parameters in order to manage spasticity. Future research can be used to validate our parameters through patient satisfaction projects. |
Rajiv | Reebye | Medicine, University of British Columbia | |
| 0 | Transcutaneous Electrical Nerve Stimulation for Spasticity Management; A Guide for Patients | ["Transcutaneous electrical nerve stimulation", "spasticity"] | Taha Qaiser, Rajiv Reebye | Abstract |
Background:Spasticity is characterized by intermittent or sustained involuntary activation of muscles. There is evidence that transcutaneous electrical nerve stimulation (TENS) can be helpful as part of a multi-modal treatment approach for spasticity management. This treatment modality is of great interest for physicians and patients as it is affordable and can be self-administered. Even with various literature demonstrating positive outcomes, there is little consensus on TENS operating parameters. With contradicting parameters, it can be difficult for patients to find clarity on how to use TENS to manage their spasticity.Methods:A narrative review of studies (N=12) involving the use of TENS for spasticity management was conducted. Key parameters for TENS machine settings from the reviewed studies were extracted to help in designing the patient oriented resource/brochure.Results:We reviewed randomized-control trials (N=7), systematic reviews (N=2), case control studies (N=2), and meta-analysis (N=1). TENS parameters such as electrode placement, intensity, pulse, frequency, and duration of treatment were compiled. The narrative review demonstrated a variability in electrode positioning and key settings with TENS utilization. An easy-to-understand patient oriented resource/brochure was then created based on the common themes (including the mechanism of action, pathophysiology and TENS parameters).Conclusion:This is the first narrative review involving the use of TENS for spasticity to help design an education brochure/resource that can help patients incorporate TENS as part of their multi-modal spasticity treatment. This resource could help busy clinicians reinforce patient education regarding proper electrode placement and TENS parameters in order to manage spasticity. Future research can be used to validate our parameters through patient satisfaction projects. |
Taha | Qaiser | Medicine, University of British Columbia | |
| 0 | Use of Corticosteroids for Complex Regional Pain Syndrome: A Cross-Sectional Survey of Physician Practice Patterns | ["complex regional pain syndrome", "corticosteroids", "glucocorticoids", "prednisone"] | Saroop Dhatt, Farris Kassam, Paul Winston | Abstract |
Objective:Corticosteroids are one of the pharmacological management options that have been studied for complex regional pain syndrome (CRPS), however, there remains no clear consensus in the literature regarding its use. With no validated treatment algorithms, the use of corticosteroids, among other treatment regimens, are left to individual practitioners. The purpose of this study was to investigate the practice patterns of physicians who use corticosteroids to treat CRPS.Methods:A cross-sectional survey composed of an invitation email and a 48-item questionnaire was distributed to all members of the Canadian Association of Physical Medicine & Rehabilitation, the national organization for Physical Medicine and Rehabilitation (PM&R) specialists.Results:49% of participants completed the survey. Majority of the respondents were PM&R specialists, and all practiced in Canada. The most common setting for assessment and management of CRPS was outpatient clinics, while the most common cause was following stroke. 90% of respondents used corticosteroids to treat CRPS, most commonly in the acute phase (<1 month from initial presentation) and with prednisone. The typical dosing regimen included a starting dose between 30-60 mg and maximum dose of 40-60 mg. A modified dosing regimen was commonly used for patients with diabetes, elderly patients, or pediatric patients. Majority reported an estimated efficacy between 25-75%, with the greatest effect on pain. Common adverse effects encountered included hyperglycemia and insomnia.Conclusion:Corticosteroids are commonly used amongst physicians in Canada for the treatment of CRPS. Understanding how physicians treat CRPS can lead to the creation of treatment algorithms and guidelines, and ultimately improve patient outcomes. |
Saroop | Dhatt | Physical Medicine and Rehabilitation, University of British Columbia | |
| 0 | Use of Corticosteroids for Complex Regional Pain Syndrome: A Cross-Sectional Survey of Physician Practice Patterns | ["complex regional pain syndrome", "corticosteroids", "glucocorticoids", "prednisone"] | Saroop Dhatt, Farris Kassam, Paul Winston | Abstract |
Objective:Corticosteroids are one of the pharmacological management options that have been studied for complex regional pain syndrome (CRPS), however, there remains no clear consensus in the literature regarding its use. With no validated treatment algorithms, the use of corticosteroids, among other treatment regimens, are left to individual practitioners. The purpose of this study was to investigate the practice patterns of physicians who use corticosteroids to treat CRPS.Methods:A cross-sectional survey composed of an invitation email and a 48-item questionnaire was distributed to all members of the Canadian Association of Physical Medicine & Rehabilitation, the national organization for Physical Medicine and Rehabilitation (PM&R) specialists.Results:49% of participants completed the survey. Majority of the respondents were PM&R specialists, and all practiced in Canada. The most common setting for assessment and management of CRPS was outpatient clinics, while the most common cause was following stroke. 90% of respondents used corticosteroids to treat CRPS, most commonly in the acute phase (<1 month from initial presentation) and with prednisone. The typical dosing regimen included a starting dose between 30-60 mg and maximum dose of 40-60 mg. A modified dosing regimen was commonly used for patients with diabetes, elderly patients, or pediatric patients. Majority reported an estimated efficacy between 25-75%, with the greatest effect on pain. Common adverse effects encountered included hyperglycemia and insomnia.Conclusion:Corticosteroids are commonly used amongst physicians in Canada for the treatment of CRPS. Understanding how physicians treat CRPS can lead to the creation of treatment algorithms and guidelines, and ultimately improve patient outcomes. |
Farris | Kassam | ||
| 0 | Use of Corticosteroids for Complex Regional Pain Syndrome: A Cross-Sectional Survey of Physician Practice Patterns | ["complex regional pain syndrome", "corticosteroids", "glucocorticoids", "prednisone"] | Saroop Dhatt, Farris Kassam, Paul Winston | Abstract |
Objective:Corticosteroids are one of the pharmacological management options that have been studied for complex regional pain syndrome (CRPS), however, there remains no clear consensus in the literature regarding its use. With no validated treatment algorithms, the use of corticosteroids, among other treatment regimens, are left to individual practitioners. The purpose of this study was to investigate the practice patterns of physicians who use corticosteroids to treat CRPS.Methods:A cross-sectional survey composed of an invitation email and a 48-item questionnaire was distributed to all members of the Canadian Association of Physical Medicine & Rehabilitation, the national organization for Physical Medicine and Rehabilitation (PM&R) specialists.Results:49% of participants completed the survey. Majority of the respondents were PM&R specialists, and all practiced in Canada. The most common setting for assessment and management of CRPS was outpatient clinics, while the most common cause was following stroke. 90% of respondents used corticosteroids to treat CRPS, most commonly in the acute phase (<1 month from initial presentation) and with prednisone. The typical dosing regimen included a starting dose between 30-60 mg and maximum dose of 40-60 mg. A modified dosing regimen was commonly used for patients with diabetes, elderly patients, or pediatric patients. Majority reported an estimated efficacy between 25-75%, with the greatest effect on pain. Common adverse effects encountered included hyperglycemia and insomnia.Conclusion:Corticosteroids are commonly used amongst physicians in Canada for the treatment of CRPS. Understanding how physicians treat CRPS can lead to the creation of treatment algorithms and guidelines, and ultimately improve patient outcomes. |
Paul | Winston | ||
| 0 | _Nehiyô miyomahcihowin ekwa kiskinwahamakosiwin_ (“Cree Health and Learning”): Land-based Learning Experience - a novel approach to Indigenous Health learning for residency programs | ["Medical education", "Indigenous health", "decolonization", "experiential learning"] | Jaime C. Yu, Jaspreet K. Khangura, Carol S. Hodgson, James Makokis, Wayne Clark | 2nd place, education | Abstract | ##Context Major gaps in health outcomes exist for Indigenous populations in Canada. The 2015 Truth and Reconciliation calls to action included improving acceptance of Indigenous healing practices, providing cultural competency training and developing skills in anti-racism. The Royal College of Physicians and Surgeons of Canada (RCPSC) has identified a critical need for healthcare providers to develop the knowledge, skills and tools to address Indigenous health issues and foster culturally safe environments. Most Canadian residency programs lack formal educational programming and connections to Indigenous communities. This project involved collaboration amongst specialty residency programs and a local Indigenous physician, where a novel land-based Indigenous health curriculum was piloted and evaluated, with the aim to decolonize the medical curriculum and empower Indigenous communities.##Methods Residents and selected faculty from 3 residency programs (Physical Medicine and Rehabilitation, Emergency Medicine and Psychiatry) participated in half-day learning sessions held in an Indigenous ceremonial space. The sessions were hosted by an Indigenous physician outside the university setting and all teachings were led by Indigenous Elders and Knowledge Keepers from local communities, in a targeted effort to decolonize the learning environment and situate Indigenous teaching appropriately on the land. The curriculum was designed and delivered by Indigenous physicians, scholars, and Elders. Participants completed pre- and post-session anonymous surveys regarding knowledge, attitude and skills related to Indigenous health in the context of their current educational experiences.##Results A total of 52 residents and faculty attended 1 of 4 half-day sessions offered. Pre-session survey response rate was 83% and post-session 77%. Regarding general experiences, 95% of respondents rated the session as very good or excellent for overall quality, 95% indicated the session provided a safe space for questions and discussions, and 98% indicated the land-based session was better than typical classroom teaching. In addition, 98% indicated they felt it was important for them to learn more about Indigenous ways of knowing as a physician. The majority (67%) had not spent time in an Indigenous community previously. Higher self-confidence scores were noted post-session across multiple domains, including providing culturally safe care, recognizing discrimination, understanding impact of past experiences, understanding impact of social factors on health outcome, awareness of resources, aware of terminology, and awareness of Treaty obligations regarding health coverage.##Conclusion This pilot land-based teaching initiative provides an example of how curricular innovations can:1) be acts of reconciliation; 2) promote equity towards Indigenous physicians and scholars; 3) provide an alternative learning experience with significant and lasting impact to participants. |
Wayne | Clark | Indigenous Health Initiatives Program, University of Alberta |
| 0 | _Nehiyô miyomahcihowin ekwa kiskinwahamakosiwin_ (“Cree Health and Learning”): Land-based Learning Experience - a novel approach to Indigenous Health learning for residency programs | ["Medical education", "Indigenous health", "decolonization", "experiential learning"] | Jaime C. Yu, Jaspreet K. Khangura, Carol S. Hodgson, James Makokis, Wayne Clark | 2nd place, education | Abstract | ##Context Major gaps in health outcomes exist for Indigenous populations in Canada. The 2015 Truth and Reconciliation calls to action included improving acceptance of Indigenous healing practices, providing cultural competency training and developing skills in anti-racism. The Royal College of Physicians and Surgeons of Canada (RCPSC) has identified a critical need for healthcare providers to develop the knowledge, skills and tools to address Indigenous health issues and foster culturally safe environments. Most Canadian residency programs lack formal educational programming and connections to Indigenous communities. This project involved collaboration amongst specialty residency programs and a local Indigenous physician, where a novel land-based Indigenous health curriculum was piloted and evaluated, with the aim to decolonize the medical curriculum and empower Indigenous communities.##Methods Residents and selected faculty from 3 residency programs (Physical Medicine and Rehabilitation, Emergency Medicine and Psychiatry) participated in half-day learning sessions held in an Indigenous ceremonial space. The sessions were hosted by an Indigenous physician outside the university setting and all teachings were led by Indigenous Elders and Knowledge Keepers from local communities, in a targeted effort to decolonize the learning environment and situate Indigenous teaching appropriately on the land. The curriculum was designed and delivered by Indigenous physicians, scholars, and Elders. Participants completed pre- and post-session anonymous surveys regarding knowledge, attitude and skills related to Indigenous health in the context of their current educational experiences.##Results A total of 52 residents and faculty attended 1 of 4 half-day sessions offered. Pre-session survey response rate was 83% and post-session 77%. Regarding general experiences, 95% of respondents rated the session as very good or excellent for overall quality, 95% indicated the session provided a safe space for questions and discussions, and 98% indicated the land-based session was better than typical classroom teaching. In addition, 98% indicated they felt it was important for them to learn more about Indigenous ways of knowing as a physician. The majority (67%) had not spent time in an Indigenous community previously. Higher self-confidence scores were noted post-session across multiple domains, including providing culturally safe care, recognizing discrimination, understanding impact of past experiences, understanding impact of social factors on health outcome, awareness of resources, aware of terminology, and awareness of Treaty obligations regarding health coverage.##Conclusion This pilot land-based teaching initiative provides an example of how curricular innovations can:1) be acts of reconciliation; 2) promote equity towards Indigenous physicians and scholars; 3) provide an alternative learning experience with significant and lasting impact to participants. |
James | Makokis | Department of Family Medicine, University of Alberta |
| 0 | _Nehiyô miyomahcihowin ekwa kiskinwahamakosiwin_ (“Cree Health and Learning”): Land-based Learning Experience - a novel approach to Indigenous Health learning for residency programs | ["Medical education", "Indigenous health", "decolonization", "experiential learning"] | Jaime C. Yu, Jaspreet K. Khangura, Carol S. Hodgson, James Makokis, Wayne Clark | 2nd place, education | Abstract | ##Context Major gaps in health outcomes exist for Indigenous populations in Canada. The 2015 Truth and Reconciliation calls to action included improving acceptance of Indigenous healing practices, providing cultural competency training and developing skills in anti-racism. The Royal College of Physicians and Surgeons of Canada (RCPSC) has identified a critical need for healthcare providers to develop the knowledge, skills and tools to address Indigenous health issues and foster culturally safe environments. Most Canadian residency programs lack formal educational programming and connections to Indigenous communities. This project involved collaboration amongst specialty residency programs and a local Indigenous physician, where a novel land-based Indigenous health curriculum was piloted and evaluated, with the aim to decolonize the medical curriculum and empower Indigenous communities.##Methods Residents and selected faculty from 3 residency programs (Physical Medicine and Rehabilitation, Emergency Medicine and Psychiatry) participated in half-day learning sessions held in an Indigenous ceremonial space. The sessions were hosted by an Indigenous physician outside the university setting and all teachings were led by Indigenous Elders and Knowledge Keepers from local communities, in a targeted effort to decolonize the learning environment and situate Indigenous teaching appropriately on the land. The curriculum was designed and delivered by Indigenous physicians, scholars, and Elders. Participants completed pre- and post-session anonymous surveys regarding knowledge, attitude and skills related to Indigenous health in the context of their current educational experiences.##Results A total of 52 residents and faculty attended 1 of 4 half-day sessions offered. Pre-session survey response rate was 83% and post-session 77%. Regarding general experiences, 95% of respondents rated the session as very good or excellent for overall quality, 95% indicated the session provided a safe space for questions and discussions, and 98% indicated the land-based session was better than typical classroom teaching. In addition, 98% indicated they felt it was important for them to learn more about Indigenous ways of knowing as a physician. The majority (67%) had not spent time in an Indigenous community previously. Higher self-confidence scores were noted post-session across multiple domains, including providing culturally safe care, recognizing discrimination, understanding impact of past experiences, understanding impact of social factors on health outcome, awareness of resources, aware of terminology, and awareness of Treaty obligations regarding health coverage.##Conclusion This pilot land-based teaching initiative provides an example of how curricular innovations can:1) be acts of reconciliation; 2) promote equity towards Indigenous physicians and scholars; 3) provide an alternative learning experience with significant and lasting impact to participants. |
Carol S. | Hodgson | Department of Pediatrics, University of Alberta |
| 0 | _Nehiyô miyomahcihowin ekwa kiskinwahamakosiwin_ (“Cree Health and Learning”): Land-based Learning Experience - a novel approach to Indigenous Health learning for residency programs | ["Medical education", "Indigenous health", "decolonization", "experiential learning"] | Jaime C. Yu, Jaspreet K. Khangura, Carol S. Hodgson, James Makokis, Wayne Clark | 2nd place, education | Abstract | ##Context Major gaps in health outcomes exist for Indigenous populations in Canada. The 2015 Truth and Reconciliation calls to action included improving acceptance of Indigenous healing practices, providing cultural competency training and developing skills in anti-racism. The Royal College of Physicians and Surgeons of Canada (RCPSC) has identified a critical need for healthcare providers to develop the knowledge, skills and tools to address Indigenous health issues and foster culturally safe environments. Most Canadian residency programs lack formal educational programming and connections to Indigenous communities. This project involved collaboration amongst specialty residency programs and a local Indigenous physician, where a novel land-based Indigenous health curriculum was piloted and evaluated, with the aim to decolonize the medical curriculum and empower Indigenous communities.##Methods Residents and selected faculty from 3 residency programs (Physical Medicine and Rehabilitation, Emergency Medicine and Psychiatry) participated in half-day learning sessions held in an Indigenous ceremonial space. The sessions were hosted by an Indigenous physician outside the university setting and all teachings were led by Indigenous Elders and Knowledge Keepers from local communities, in a targeted effort to decolonize the learning environment and situate Indigenous teaching appropriately on the land. The curriculum was designed and delivered by Indigenous physicians, scholars, and Elders. Participants completed pre- and post-session anonymous surveys regarding knowledge, attitude and skills related to Indigenous health in the context of their current educational experiences.##Results A total of 52 residents and faculty attended 1 of 4 half-day sessions offered. Pre-session survey response rate was 83% and post-session 77%. Regarding general experiences, 95% of respondents rated the session as very good or excellent for overall quality, 95% indicated the session provided a safe space for questions and discussions, and 98% indicated the land-based session was better than typical classroom teaching. In addition, 98% indicated they felt it was important for them to learn more about Indigenous ways of knowing as a physician. The majority (67%) had not spent time in an Indigenous community previously. Higher self-confidence scores were noted post-session across multiple domains, including providing culturally safe care, recognizing discrimination, understanding impact of past experiences, understanding impact of social factors on health outcome, awareness of resources, aware of terminology, and awareness of Treaty obligations regarding health coverage.##Conclusion This pilot land-based teaching initiative provides an example of how curricular innovations can:1) be acts of reconciliation; 2) promote equity towards Indigenous physicians and scholars; 3) provide an alternative learning experience with significant and lasting impact to participants. |
Jaspreet K. | Khangura | Department of Emergency Medicine, University of Alberta |
| 0 | _Nehiyô miyomahcihowin ekwa kiskinwahamakosiwin_ (“Cree Health and Learning”): Land-based Learning Experience - a novel approach to Indigenous Health learning for residency programs | ["Medical education", "Indigenous health", "decolonization", "experiential learning"] | Jaime C. Yu, Jaspreet K. Khangura, Carol S. Hodgson, James Makokis, Wayne Clark | 2nd place, education | Abstract | ##Context Major gaps in health outcomes exist for Indigenous populations in Canada. The 2015 Truth and Reconciliation calls to action included improving acceptance of Indigenous healing practices, providing cultural competency training and developing skills in anti-racism. The Royal College of Physicians and Surgeons of Canada (RCPSC) has identified a critical need for healthcare providers to develop the knowledge, skills and tools to address Indigenous health issues and foster culturally safe environments. Most Canadian residency programs lack formal educational programming and connections to Indigenous communities. This project involved collaboration amongst specialty residency programs and a local Indigenous physician, where a novel land-based Indigenous health curriculum was piloted and evaluated, with the aim to decolonize the medical curriculum and empower Indigenous communities.##Methods Residents and selected faculty from 3 residency programs (Physical Medicine and Rehabilitation, Emergency Medicine and Psychiatry) participated in half-day learning sessions held in an Indigenous ceremonial space. The sessions were hosted by an Indigenous physician outside the university setting and all teachings were led by Indigenous Elders and Knowledge Keepers from local communities, in a targeted effort to decolonize the learning environment and situate Indigenous teaching appropriately on the land. The curriculum was designed and delivered by Indigenous physicians, scholars, and Elders. Participants completed pre- and post-session anonymous surveys regarding knowledge, attitude and skills related to Indigenous health in the context of their current educational experiences.##Results A total of 52 residents and faculty attended 1 of 4 half-day sessions offered. Pre-session survey response rate was 83% and post-session 77%. Regarding general experiences, 95% of respondents rated the session as very good or excellent for overall quality, 95% indicated the session provided a safe space for questions and discussions, and 98% indicated the land-based session was better than typical classroom teaching. In addition, 98% indicated they felt it was important for them to learn more about Indigenous ways of knowing as a physician. The majority (67%) had not spent time in an Indigenous community previously. Higher self-confidence scores were noted post-session across multiple domains, including providing culturally safe care, recognizing discrimination, understanding impact of past experiences, understanding impact of social factors on health outcome, awareness of resources, aware of terminology, and awareness of Treaty obligations regarding health coverage.##Conclusion This pilot land-based teaching initiative provides an example of how curricular innovations can:1) be acts of reconciliation; 2) promote equity towards Indigenous physicians and scholars; 3) provide an alternative learning experience with significant and lasting impact to participants. |
Jaime C. | Yu | Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Alberta |
| 0 | An anatomical approach to decreased range of motion in physical medicine and rehabilitation. | ["muscle spasticity", "Range of Motion", "contracture", "muscle hypertonia", "heterotopic ossification"] | Rachel L Whittaker | Medical Student Essay Contest |
Context:A reduction in joint motion is often encountered throughout the rehabilitation process. Such deficits frequently cause difficulty performing activities of daily living and lead to a reduction in quality of life. Several causes result from pathology of different neuromuscular, periarticular, or articular tissues. Treatments to restore joint range of motion and the associated functional impairments differ based on the aetiology.Methods:Seven causes of reduced range of joint motion encountered during a one-month clinical learning experience in physical medicine and rehabilitation in Kingston, Ontario are included in this essay. Literature review included physical medicine and rehabilitation focused textbooks, review articles and systematic reviews obtained using PubMed and Ovid database searches.Results:The selected conditions were organized by the overall cause of the reduced range of motion (hypertonia or increased mechanical resistance) and then by the affected tissue (nervous, muscle, tendon, fascia, joint capsule, bone). A brief discussion of the pathophysiology, clinical presentation and features, and an overview of treatment of each condition is presented.Conclusion:Consideration of the various articular and peri-articular structures that may contribute to reduced joint motion can help guide clinical assessment and inform appropriate management focused on regaining function and mobility at the joint. |
Rachel L | Whittaker | Medicine, Queens University | |
| 0 | An anatomical approach to joint stiffness in physical medicine and rehabilitation. | ["muscle spasticity", "Range of Motion", "contracture", "muscle hypertonia", "heterotopic ossification"] | Rachel L Whittaker | Medical Student Essay Contest |
Context:Joint stiffness describes an increased resistance to motion at a joint and is often encountered throughout the rehabilitation process. Joint stiffness is associated with difficulty performing activities of daily living and a reduction in quality of life. Several causes result from pathology of different neuromuscular, periarticular or articular tissues. Treatments to reduce joint stiffness and the associated functional impairments differ based on the aetiology.Methods:Seven causes of joint stiffness encountered during a one-month clinical learning experience in physical medicine and rehabilitation in Kingston, Ontario are included in this essay. Literature review included physical medicine and rehabilitation focused textbooks, review articles and systematic reviews obtained using PubMed and Ovid database searches.Results:The selected conditions were organized by the overall cause of the reduced range of motion (hypertonia or increased mechanical resistance to joint motion) and then by the affected tissue (nervous, muscle, tendon, fascia, joint capsule, bone). A brief discussion of the pathophysiology, clinical presentation and features, and an overview of treatment of each condition is presented.Conclusion:Consideration of the various articular and peri-articular structures that may contribute to joint stiffness can help guide clinical assessment and inform appropriate management focused on regaining function at the joint. |
Rachel L | Whittaker | Medicine, Queens University | |
| 0 | Exploring the Potential of Virtual Reality in Para-Swimming Rehabilitation: A Narrative Review of Pain Management, Functional Recovery, and Promising Applications—With a Focus on Individuals with Spinal Cord Injuries | ["athletes", "chronic pain", "para-sport", "rehabilitation", "spinal cord injury", "swimming", "virtual reality"] | Aaron P van der Leek | Medical Student Essay Contest | Para-sport and the Paralympic Games have emerged as crucial areas of distinct relevance for those specializing in physical medicine and rehabilitation--presenting unique challenges for athlete training and recovery that require the expertise of physiatrists. Common issues such as musculoskeletal injuries, chronic pain, and motor function deficits disproportionately affect para-athletes, particularly those in para-swimming. In recent years, virtual reality (VR) has shown promise as an effective intervention to address these concerns. VR has demonstrated efficacy in treating lower back pain (LBP) and neurogenic pain while supporting rehabilitation in individuals with spinal cord injuries. Through a narrative review of the literature, these topics of recovery, with a specific focus on para-swimming, will be explored. Doing so will provide a brief historical overview of para-sport, and three key areas where para-athletes can benefit from VR rehabilitation will be highlighted. Given the diverse nature of this unique population and the research surrounding AR/VR rehabilitation, the concentration will be on the use of extended reality in treating spinal cord injuries. This review will provide an overview of the research on VR in addressing LBP, neurogenic pain, and aiding in functional recovery and performance, ultimately illustrating the potential for extended reality to assist para-swimmers in achieving higher levels of success. | Aaron P | van der Leek | Medicine, University of Alberta Hospital | |
| 0 | The Gap in Knowledge Keeping Us Up at Night: Sleep Disturbance in Adults with Persistent Post-Concussive Symptoms | ["Concussion", "mild Traumatic Brain Injury", "Persistent Post-Concussive Symptoms", "Sleep"] | Samantha McIntosh | 2nd place | Medical Student Essay Contest | While most individuals who suffer a mild traumatic brain injury (mTBI) recover in 10-14 days, up to 30% experience persistent post-concussive symptoms (PPCS) and up to 50% report sleep disturbance after their injury. It is hypothesized that poor sleep may exacerbate or prolong other post-concussive symptoms including headaches, depression, and fatigue. However, sleep disturbance is understudied in this population and is commonly assessed using only subjective measures. The gold-standard method of sleep measurement, polysomnography, is costly and largely inaccessible for those with PPCS. In lieu, there is a need for objective sleep measurement devices that are easy to use and cost-effective to better understand sleep disturbance in this population. Evaluation of non-invasive technologies, such as actigraphy, that could be used clinically to inform post-traumatic sleep disturbance should be pursued. Characterizing how sleep is disturbed in this population would help to guide and tailor treatment for adults with PPCS. The purpose of this paper is to review the current literature on sleep disturbance in adults with PPCS and highlight a gap in knowledge in the objective measurement of sleep in this population. Closing this gap is clinically relevant and would allow for individualized care of a common post-concussive complaint. | Samantha | McIntosh | Clinical Neuroscience, University of Calgary |
| 0 | The Neglect of Sexual Dysfunction Post-Stroke: Evaluation and Recommendations From A Biopsychosocial Lens | ["Stroke", "Sexual Dysfunction", "Rehabilitation", "Biopsychosocial"] | Kennedy Dirk | 1st place | Medical Student Essay Contest | Stroke is a prevalent contributor to disability in Canada and has many biological, psychological, and social impacts on survivors. One common complication that is often a neglected component of rehabilitation post-stroke is sexual dysfunction. When assessing sexual dysfunction, it is crucial to first frame normal sexual function with a biopsychosocial lens to evaluate the convergence of influences. Stroke adds another layer of complexity as it has been well-established to have impacts across all components of the biopsychosocial model of care. The common sexual dysfunction complications to consider include caregiver burden, low libido, erectile dysfunction, vaginal dryness, difficulty with orgasm, neuromuscular changes, and dyspareunia. In addition to a literature review, I met with a Registered Nurse from the Sexual Health Clinic at the Glenrose Rehabilitation Hospital for common clinical presentations and strategies. A patient’s sexual dysfunction needs to be adequately assessed with validated scales touching on all contributing components of dysfunction, counselled with evidence-based information, and treated with targeted interventions. Healthcare providers should be aware of the resources in their area to refer patients and caregivers for additional support when necessary. Normal sexual function should be a target for a holistic recovery in the patient’s rehabilitation journey. | Kennedy | Dirk | Faculty of Medicine and Dentistry, University of Alberta |
| 0 | Transcutaneous Electrical Nerve Stimulation for Spasticity Management; Narrative Review and a Creation of a Patient Handout | ["Transcutaneous electrical nerve stimulation", "Spasticity"] | Taha Qaiser, Rajiv Reebye | Medical Student Essay Contest |
Background:Spasticity is characterized by intermittent or sustained involuntary activation of muscles. There is evidence that transcutaneous electrical nerve stimulation (TENS) can be helpful as part of a multi-modal treatment approach for spasticity management. This treatment modality is of great interest for physicians and patients as it is affordable and can be self-administered. Even with various literature demonstrating positive outcomes, there is little consensus on TENS operating parameters. With contradicting parameters, it can be difficult for patients to find clarity on how to use TENS to manage their spasticity.Methods:A narrative review of studies (N=12) involving the use of TENS for spasticity management was conducted. Key parameters for TENS machine settings from the reviewed studies were extracted to help in designing the patient oriented resource/brochure.Results:We reviewed randomized-control trials (N=7), systematic reviews (N=2), case control studies (N=2), and meta-analysis (N=1). TENS parameters such as electrode placement, intensity, pulse, frequency, and duration of treatment were compiled. The narrative review demonstrated a variability in electrode positioning and key settings with TENS utilization. An easy-to-understand patient oriented resource/brochure was then created based on the common themes (including the mechanism of action, pathophysiology and TENS parameters).Conclusion:This is the first narrative review involving the use of TENS for spasticity to help design an education brochure/resource that can help patients incorporate TENS as part of their multi-modal spasticity treatment. This resource could help busy clinicians reinforce patient education regarding proper electrode placement and TENS parameters in order to manage spasticity. Future research can be used to validate our parameters through patient satisfaction projects. |
Rajiv | Reebye | Medicine, University of British Columbia | |
| 0 | Transcutaneous Electrical Nerve Stimulation for Spasticity Management; Narrative Review and a Creation of a Patient Handout | ["Transcutaneous electrical nerve stimulation", "Spasticity"] | Taha Qaiser, Rajiv Reebye | Medical Student Essay Contest |
Background:Spasticity is characterized by intermittent or sustained involuntary activation of muscles. There is evidence that transcutaneous electrical nerve stimulation (TENS) can be helpful as part of a multi-modal treatment approach for spasticity management. This treatment modality is of great interest for physicians and patients as it is affordable and can be self-administered. Even with various literature demonstrating positive outcomes, there is little consensus on TENS operating parameters. With contradicting parameters, it can be difficult for patients to find clarity on how to use TENS to manage their spasticity.Methods:A narrative review of studies (N=12) involving the use of TENS for spasticity management was conducted. Key parameters for TENS machine settings from the reviewed studies were extracted to help in designing the patient oriented resource/brochure.Results:We reviewed randomized-control trials (N=7), systematic reviews (N=2), case control studies (N=2), and meta-analysis (N=1). TENS parameters such as electrode placement, intensity, pulse, frequency, and duration of treatment were compiled. The narrative review demonstrated a variability in electrode positioning and key settings with TENS utilization. An easy-to-understand patient oriented resource/brochure was then created based on the common themes (including the mechanism of action, pathophysiology and TENS parameters).Conclusion:This is the first narrative review involving the use of TENS for spasticity to help design an education brochure/resource that can help patients incorporate TENS as part of their multi-modal spasticity treatment. This resource could help busy clinicians reinforce patient education regarding proper electrode placement and TENS parameters in order to manage spasticity. Future research can be used to validate our parameters through patient satisfaction projects. |
Taha | Qaiser | Medicine, University of British Columbia | |
| 0 | Using a multidisciplinary team approach for multiple sclerosis rehabilitation: Education and insight from a patient’s perspective | ["exercise", "lifestyle", "mental health", "multiple sclerosis", "rehabilitation"] | Griffin Mumby | 3rd place | Medical Student Essay Contest |
Context:Multiple sclerosis (MS) is the most common chronic neurologic disease diagnosed in people aged 20-40. Relapsing-remitting MS accounts for 85% of initial diagnoses and is characterized by acute symptom exacerbations resulting in progressive disability interspersed between periods of stability. Symptoms of MS include fatigue, gait and balance disturbances, pain, spasticity, weakness, and mood disorders. Early diagnosis and treatment are critical in delaying disease progression. In addition, rehabilitation strategies are essential for improving patient functioning and quality of life.Methods:In this essay, I review rehabilitation recommendations for MS patients with evidence gathered from Cochrane Reviews, meta-analyses, and systematic reviews.Results:Recent literature suggests that patients see significant improvement in their symptoms, function, and quality of life when their care involves a multidisciplinary team approach that focuses on exercise interventions and treating psychiatric conditions. There is also limited but emerging evidence for treating patients’ pain and spasticity, encouraging them to adopt a healthy lifestyle, and manage their comorbidities. To conclude, I will share a patient’s story about their MS diagnosis and rehabilitation journey.Conclusion:By using a multidisciplinary team approach and implementing lifestyle changes, MS patients have the opportunity to significantly improve their rehabilitation outcomes, quality of life, and function. |
Griffin | Mumby | Faculty of Medicine and Dentistry, University of Alberta |
| 0 | Analysis of side effects of cryoneurolysis for the treatment of spasticity | ["Nerve block", "side effects", "safety", "cryoneurolysis"] | Fraser MacRae, Paul Winston, Shanika Rajapakshe, Isabella Morrissey, Eve Boissonnault, Daniel Vincent, Mahdis Hashemi | Medical Student Research Contest | Objective To report side effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity.Design Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial).Results Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59F, 54M, average age 54.4 years). One patient had a local skin infection, two patients had bruising or swelling; all resolved within one month. 9 reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients' symptoms remained until three months, one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum three months follow-up; seven withdrew (x̄ = 5.4 months), four passed away. None of these eleven reported side effects.Conclusions 96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond three months. Cryoneurolysis has potential to be a safe spasticity treatment with manageable side effects. |
Eve | Boissonnault | Canadian Advances in Neuro-Orthopedics for Spasticity Consortium; Physical Medicine and Rehabilitation, Island Health; Physical Medicine and Rehabilitation, Centre Hospitalier de l’Université de Montréal | |
| 0 | Analysis of side effects of cryoneurolysis for the treatment of spasticity | ["Nerve block", "side effects", "safety", "cryoneurolysis"] | Fraser MacRae, Paul Winston, Shanika Rajapakshe, Isabella Morrissey, Eve Boissonnault, Daniel Vincent, Mahdis Hashemi | Medical Student Research Contest | Objective To report side effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity.Design Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial).Results Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59F, 54M, average age 54.4 years). One patient had a local skin infection, two patients had bruising or swelling; all resolved within one month. 9 reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients' symptoms remained until three months, one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum three months follow-up; seven withdrew (x̄ = 5.4 months), four passed away. None of these eleven reported side effects.Conclusions 96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond three months. Cryoneurolysis has potential to be a safe spasticity treatment with manageable side effects. |
Shanika | Rajapakshe | Faculty of Medicine, University of British Columbia | |
| 0 | Analysis of side effects of cryoneurolysis for the treatment of spasticity | ["Nerve block", "side effects", "safety", "cryoneurolysis"] | Fraser MacRae, Paul Winston, Shanika Rajapakshe, Isabella Morrissey, Eve Boissonnault, Daniel Vincent, Mahdis Hashemi | Medical Student Research Contest | Objective To report side effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity.Design Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial).Results Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59F, 54M, average age 54.4 years). One patient had a local skin infection, two patients had bruising or swelling; all resolved within one month. 9 reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients' symptoms remained until three months, one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum three months follow-up; seven withdrew (x̄ = 5.4 months), four passed away. None of these eleven reported side effects.Conclusions 96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond three months. Cryoneurolysis has potential to be a safe spasticity treatment with manageable side effects. |
Daniel | Vincent | Anaesthesiology, Island Health | |
| 0 | Analysis of side effects of cryoneurolysis for the treatment of spasticity | ["Nerve block", "side effects", "safety", "cryoneurolysis"] | Fraser MacRae, Paul Winston, Shanika Rajapakshe, Isabella Morrissey, Eve Boissonnault, Daniel Vincent, Mahdis Hashemi | Medical Student Research Contest | Objective To report side effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity.Design Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial).Results Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59F, 54M, average age 54.4 years). One patient had a local skin infection, two patients had bruising or swelling; all resolved within one month. 9 reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients' symptoms remained until three months, one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum three months follow-up; seven withdrew (x̄ = 5.4 months), four passed away. None of these eleven reported side effects.Conclusions 96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond three months. Cryoneurolysis has potential to be a safe spasticity treatment with manageable side effects. |
Mahdis | Hashemi | Physical Medicine and Rehabilitation, Island Health; University of British Columbia | |
| 0 | Analysis of side effects of cryoneurolysis for the treatment of spasticity | ["Nerve block", "side effects", "safety", "cryoneurolysis"] | Fraser MacRae, Paul Winston, Shanika Rajapakshe, Isabella Morrissey, Eve Boissonnault, Daniel Vincent, Mahdis Hashemi | Medical Student Research Contest | Objective To report side effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity.Design Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial).Results Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59F, 54M, average age 54.4 years). One patient had a local skin infection, two patients had bruising or swelling; all resolved within one month. 9 reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients' symptoms remained until three months, one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum three months follow-up; seven withdrew (x̄ = 5.4 months), four passed away. None of these eleven reported side effects.Conclusions 96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond three months. Cryoneurolysis has potential to be a safe spasticity treatment with manageable side effects. |
Isabella | Morrissey | Faculty of Sciences, University of Victoria | |
| 0 | Analysis of side effects of cryoneurolysis for the treatment of spasticity | ["Nerve block", "side effects", "safety", "cryoneurolysis"] | Fraser MacRae, Paul Winston, Shanika Rajapakshe, Isabella Morrissey, Eve Boissonnault, Daniel Vincent, Mahdis Hashemi | Medical Student Research Contest | Objective To report side effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity.Design Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial).Results Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59F, 54M, average age 54.4 years). One patient had a local skin infection, two patients had bruising or swelling; all resolved within one month. 9 reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients' symptoms remained until three months, one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum three months follow-up; seven withdrew (x̄ = 5.4 months), four passed away. None of these eleven reported side effects.Conclusions 96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond three months. Cryoneurolysis has potential to be a safe spasticity treatment with manageable side effects. |
Fraser | MacRae | Faculty of Health Sciences, Western University; Physical Medicine and Rehabilitation, Island Health | |
| 0 | Analysis of side effects of cryoneurolysis for the treatment of spasticity | ["Nerve block", "side effects", "safety", "cryoneurolysis"] | Fraser MacRae, Paul Winston, Shanika Rajapakshe, Isabella Morrissey, Eve Boissonnault, Daniel Vincent, Mahdis Hashemi | Medical Student Research Contest | Objective To report side effects from clinical studies on ultrasound-guided percutaneous cryoneurolysis for spasticity.Design Patients were prospectively enrolled in three studies at a single institution. Cryoneurolysis was performed to primarily motor nerve branches (medial and lateral pectoral, musculocutaneous, radial, median, ulnar, tibial, obturator) and mixed motor sensory nerve trunks (median, ulnar, suprascapular, radial, and tibial).Results Cryoneurolysis was performed for 277 nerves (99 mixed motor sensory), on 113 patients (59F, 54M, average age 54.4 years). One patient had a local skin infection, two patients had bruising or swelling; all resolved within one month. 9 reported nerve pain or dysesthesia (two motor, seven mixed motor sensory nerves). Four received no treatment, four oral or topical medications, two perineural injections, one botulinum toxin. Three patients' symptoms remained until three months, one had numbness at six. One patient had botulinum toxin injections for cramping. All had at minimum three months follow-up; seven withdrew (x̄ = 5.4 months), four passed away. None of these eleven reported side effects.Conclusions 96.75% of nerve treatments had no pain or dysesthesias beyond treatment. Few had pain or numbness beyond three months. Cryoneurolysis has potential to be a safe spasticity treatment with manageable side effects. |
Paul | Winston | Faculty of Medicine, University of British Columbia; Canadian Advances in Neuro-orthopedics for Spasticity Consortium; Physical Medicine and Rehabilitation, Island Health | |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick F Yao, Yi D Diao, Eric P McMullen, Marlin Manka, Jessica Murphy, Celina Lin | Medical Student Research Contest | **Objective**: This systematic review synthesized the existing literature describing the effectiveness of machine learning models predicting amputation of varying etiologies. **Design**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. Performance variables were recorded and PROBAST scores were used to assess for risk of bias.**Subjects/Patients**: Data from 2,261,790 patients were included.**Methods**: 1376 studies were screened; 15 articles were included.**Results**: Amputation etiologies were categorized as diabetes, trauma, and other. In the diabetic population, models ranged from sub-optimal to excellent performance (AUC: 0.6-0.94). In trauma patients, models had strong to excellent performance (AUC: 0.88-0.95). In patients who received amputation secondary to other etiologies (e.g. burns and peripheral vascular disease), models had strong performance (AUC: 0.81-1.0). Many studies had a high PROBAST risk of bias.**Conclusion**: Multiple machine learning models have been successfully developed that have the potential to be superior to traditional modeling techniques and prospective clinical judgment in predicting amputation. This could benefit care teams in making treatment decisions and plans to best support patients. Further research is needed to overcome the limitations of current studies and to bring applicability to a clinical setting. | Jessica | Murphy | Division of Physical Medicine and Rehabilitation, McMaster University | |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick F Yao, Yi D Diao, Eric P McMullen, Marlin Manka, Jessica Murphy, Celina Lin | Medical Student Research Contest | **Objective**: This systematic review synthesized the existing literature describing the effectiveness of machine learning models predicting amputation of varying etiologies. **Design**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. Performance variables were recorded and PROBAST scores were used to assess for risk of bias.**Subjects/Patients**: Data from 2,261,790 patients were included.**Methods**: 1376 studies were screened; 15 articles were included.**Results**: Amputation etiologies were categorized as diabetes, trauma, and other. In the diabetic population, models ranged from sub-optimal to excellent performance (AUC: 0.6-0.94). In trauma patients, models had strong to excellent performance (AUC: 0.88-0.95). In patients who received amputation secondary to other etiologies (e.g. burns and peripheral vascular disease), models had strong performance (AUC: 0.81-1.0). Many studies had a high PROBAST risk of bias.**Conclusion**: Multiple machine learning models have been successfully developed that have the potential to be superior to traditional modeling techniques and prospective clinical judgment in predicting amputation. This could benefit care teams in making treatment decisions and plans to best support patients. Further research is needed to overcome the limitations of current studies and to bring applicability to a clinical setting. | Celina | Lin | Division of Physical Medicine and Rehabilitation, Hamilton Health Sciences; Division of Physical Medicine and Rehabilitation, McMaster University | |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick F Yao, Yi D Diao, Eric P McMullen, Marlin Manka, Jessica Murphy, Celina Lin | Medical Student Research Contest | **Objective**: This systematic review synthesized the existing literature describing the effectiveness of machine learning models predicting amputation of varying etiologies. **Design**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. Performance variables were recorded and PROBAST scores were used to assess for risk of bias.**Subjects/Patients**: Data from 2,261,790 patients were included.**Methods**: 1376 studies were screened; 15 articles were included.**Results**: Amputation etiologies were categorized as diabetes, trauma, and other. In the diabetic population, models ranged from sub-optimal to excellent performance (AUC: 0.6-0.94). In trauma patients, models had strong to excellent performance (AUC: 0.88-0.95). In patients who received amputation secondary to other etiologies (e.g. burns and peripheral vascular disease), models had strong performance (AUC: 0.81-1.0). Many studies had a high PROBAST risk of bias.**Conclusion**: Multiple machine learning models have been successfully developed that have the potential to be superior to traditional modeling techniques and prospective clinical judgment in predicting amputation. This could benefit care teams in making treatment decisions and plans to best support patients. Further research is needed to overcome the limitations of current studies and to bring applicability to a clinical setting. | Yi D | Diao | Michael G. DeGroote School of Medicine, McMaster University | |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick F Yao, Yi D Diao, Eric P McMullen, Marlin Manka, Jessica Murphy, Celina Lin | Medical Student Research Contest | **Objective**: This systematic review synthesized the existing literature describing the effectiveness of machine learning models predicting amputation of varying etiologies. **Design**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. Performance variables were recorded and PROBAST scores were used to assess for risk of bias.**Subjects/Patients**: Data from 2,261,790 patients were included.**Methods**: 1376 studies were screened; 15 articles were included.**Results**: Amputation etiologies were categorized as diabetes, trauma, and other. In the diabetic population, models ranged from sub-optimal to excellent performance (AUC: 0.6-0.94). In trauma patients, models had strong to excellent performance (AUC: 0.88-0.95). In patients who received amputation secondary to other etiologies (e.g. burns and peripheral vascular disease), models had strong performance (AUC: 0.81-1.0). Many studies had a high PROBAST risk of bias.**Conclusion**: Multiple machine learning models have been successfully developed that have the potential to be superior to traditional modeling techniques and prospective clinical judgment in predicting amputation. This could benefit care teams in making treatment decisions and plans to best support patients. Further research is needed to overcome the limitations of current studies and to bring applicability to a clinical setting. | Patrick F | Yao | Michael G. DeGroote School of Medicine, McMaster University | |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick F Yao, Yi D Diao, Eric P McMullen, Marlin Manka, Jessica Murphy, Celina Lin | Medical Student Research Contest | **Objective**: This systematic review synthesized the existing literature describing the effectiveness of machine learning models predicting amputation of varying etiologies. **Design**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. Performance variables were recorded and PROBAST scores were used to assess for risk of bias.**Subjects/Patients**: Data from 2,261,790 patients were included.**Methods**: 1376 studies were screened; 15 articles were included.**Results**: Amputation etiologies were categorized as diabetes, trauma, and other. In the diabetic population, models ranged from sub-optimal to excellent performance (AUC: 0.6-0.94). In trauma patients, models had strong to excellent performance (AUC: 0.88-0.95). In patients who received amputation secondary to other etiologies (e.g. burns and peripheral vascular disease), models had strong performance (AUC: 0.81-1.0). Many studies had a high PROBAST risk of bias.**Conclusion**: Multiple machine learning models have been successfully developed that have the potential to be superior to traditional modeling techniques and prospective clinical judgment in predicting amputation. This could benefit care teams in making treatment decisions and plans to best support patients. Further research is needed to overcome the limitations of current studies and to bring applicability to a clinical setting. | Marlin | Manka | Department of Computer Science, Western University | |
| 0 | Predicting Amputation Using Machine Learning: A Systematic Review | ["Amputation", "Artificial intelligence", "Diabetes Mellitus", "Forecasting", "Machine learning"] | Patrick F Yao, Yi D Diao, Eric P McMullen, Marlin Manka, Jessica Murphy, Celina Lin | Medical Student Research Contest | **Objective**: This systematic review synthesized the existing literature describing the effectiveness of machine learning models predicting amputation of varying etiologies. **Design**: OVID Embase, OVID Medline, ACM Digital Library, Scopus, Web of Science, and IEEE Xplore were searched from inception to March 5, 2023. Performance variables were recorded and PROBAST scores were used to assess for risk of bias.**Subjects/Patients**: Data from 2,261,790 patients were included.**Methods**: 1376 studies were screened; 15 articles were included.**Results**: Amputation etiologies were categorized as diabetes, trauma, and other. In the diabetic population, models ranged from sub-optimal to excellent performance (AUC: 0.6-0.94). In trauma patients, models had strong to excellent performance (AUC: 0.88-0.95). In patients who received amputation secondary to other etiologies (e.g. burns and peripheral vascular disease), models had strong performance (AUC: 0.81-1.0). Many studies had a high PROBAST risk of bias.**Conclusion**: Multiple machine learning models have been successfully developed that have the potential to be superior to traditional modeling techniques and prospective clinical judgment in predicting amputation. This could benefit care teams in making treatment decisions and plans to best support patients. Further research is needed to overcome the limitations of current studies and to bring applicability to a clinical setting. | Eric P | McMullen | Michael G. DeGroote School of Medicine, McMaster University | |
| 0 | Strength-based rehabilitation on clinical outcomes in patients post-partial meniscectomy: a systematic review and meta-analysis | ["recovery", "weight-bearing", "meniscus", "resection", "rehabilitation"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Ben Murphy, Darren de SA | winner | Medical Student Research Contest |
Abstract:Objective:To determine the effect of strength-based rehabilitation programs on patients who underwent partial meniscectomy proceduresDesign:Three databases MEDLINE, PubMed and EMBASE were searched from inception to May 9th, 2022. Data on functional outcomes such as quadriceps and hamstring strengths, as well as patient-reported outcomes such as Knee Osteoarthritis and Outcome Score (KOOS) and Visual-Analogue Scale (VAS) were recorded.Results:A total of nine studies comprising 417 patients were included in this review. There were no significant differences in quadriceps or hamstring strength measures between pre and post-intervention for both groups. KOOS scores significantly increased from pre and post-intervention in both control and exercise groups. VAS scores changed from 5.0cm to 1.4cm in the exercise arm and 3.1cm to 1.9cm in the control arm.Conclusion:Strength-based exercise programs for patients post-partial meniscectomy did not result in significantly different improvements in quadriceps or hamstring strength compared to control programs. However, strength-based exercise programs resulted in significantly higher KOOS scores and a greater decrease in VAS scores. Further studies, specifically well-designed systematic randomized controlled trials are necessary in order to elucidate the specifics behind what type of exercises to use in addition to load progression and frequency of training. |
Dan | Cohen | Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre |
| 0 | Strength-based rehabilitation on clinical outcomes in patients post-partial meniscectomy: a systematic review and meta-analysis | ["recovery", "weight-bearing", "meniscus", "resection", "rehabilitation"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Ben Murphy, Darren de SA | winner | Medical Student Research Contest |
Abstract:Objective:To determine the effect of strength-based rehabilitation programs on patients who underwent partial meniscectomy proceduresDesign:Three databases MEDLINE, PubMed and EMBASE were searched from inception to May 9th, 2022. Data on functional outcomes such as quadriceps and hamstring strengths, as well as patient-reported outcomes such as Knee Osteoarthritis and Outcome Score (KOOS) and Visual-Analogue Scale (VAS) were recorded.Results:A total of nine studies comprising 417 patients were included in this review. There were no significant differences in quadriceps or hamstring strength measures between pre and post-intervention for both groups. KOOS scores significantly increased from pre and post-intervention in both control and exercise groups. VAS scores changed from 5.0cm to 1.4cm in the exercise arm and 3.1cm to 1.9cm in the control arm.Conclusion:Strength-based exercise programs for patients post-partial meniscectomy did not result in significantly different improvements in quadriceps or hamstring strength compared to control programs. However, strength-based exercise programs resulted in significantly higher KOOS scores and a greater decrease in VAS scores. Further studies, specifically well-designed systematic randomized controlled trials are necessary in order to elucidate the specifics behind what type of exercises to use in addition to load progression and frequency of training. |
Ben | Murphy | School of Rehabilitation Science, Faculty of Health Sciences, McMaster University |
| 0 | Strength-based rehabilitation on clinical outcomes in patients post-partial meniscectomy: a systematic review and meta-analysis | ["recovery", "weight-bearing", "meniscus", "resection", "rehabilitation"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Ben Murphy, Darren de SA | winner | Medical Student Research Contest |
Abstract:Objective:To determine the effect of strength-based rehabilitation programs on patients who underwent partial meniscectomy proceduresDesign:Three databases MEDLINE, PubMed and EMBASE were searched from inception to May 9th, 2022. Data on functional outcomes such as quadriceps and hamstring strengths, as well as patient-reported outcomes such as Knee Osteoarthritis and Outcome Score (KOOS) and Visual-Analogue Scale (VAS) were recorded.Results:A total of nine studies comprising 417 patients were included in this review. There were no significant differences in quadriceps or hamstring strength measures between pre and post-intervention for both groups. KOOS scores significantly increased from pre and post-intervention in both control and exercise groups. VAS scores changed from 5.0cm to 1.4cm in the exercise arm and 3.1cm to 1.9cm in the control arm.Conclusion:Strength-based exercise programs for patients post-partial meniscectomy did not result in significantly different improvements in quadriceps or hamstring strength compared to control programs. However, strength-based exercise programs resulted in significantly higher KOOS scores and a greater decrease in VAS scores. Further studies, specifically well-designed systematic randomized controlled trials are necessary in order to elucidate the specifics behind what type of exercises to use in addition to load progression and frequency of training. |
Prushoth | Vivekanantha | Faculty of Medicine, McMaster University |
| 0 | Strength-based rehabilitation on clinical outcomes in patients post-partial meniscectomy: a systematic review and meta-analysis | ["recovery", "weight-bearing", "meniscus", "resection", "rehabilitation"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Ben Murphy, Darren de SA | winner | Medical Student Research Contest |
Abstract:Objective:To determine the effect of strength-based rehabilitation programs on patients who underwent partial meniscectomy proceduresDesign:Three databases MEDLINE, PubMed and EMBASE were searched from inception to May 9th, 2022. Data on functional outcomes such as quadriceps and hamstring strengths, as well as patient-reported outcomes such as Knee Osteoarthritis and Outcome Score (KOOS) and Visual-Analogue Scale (VAS) were recorded.Results:A total of nine studies comprising 417 patients were included in this review. There were no significant differences in quadriceps or hamstring strength measures between pre and post-intervention for both groups. KOOS scores significantly increased from pre and post-intervention in both control and exercise groups. VAS scores changed from 5.0cm to 1.4cm in the exercise arm and 3.1cm to 1.9cm in the control arm.Conclusion:Strength-based exercise programs for patients post-partial meniscectomy did not result in significantly different improvements in quadriceps or hamstring strength compared to control programs. However, strength-based exercise programs resulted in significantly higher KOOS scores and a greater decrease in VAS scores. Further studies, specifically well-designed systematic randomized controlled trials are necessary in order to elucidate the specifics behind what type of exercises to use in addition to load progression and frequency of training. |
Darren | de SA | Division of Orthopaedic Surgery, Department of Surgery, McMaster University Medical Centre |
| 0 | Strength-based rehabilitation on clinical outcomes in patients post-partial meniscectomy: a systematic review and meta-analysis | ["recovery", "weight-bearing", "meniscus", "resection", "rehabilitation"] | Yi (David) Diao, Prushoth Vivekanantha, Dan Cohen, Ben Murphy, Darren de SA | winner | Medical Student Research Contest |
Abstract:Objective:To determine the effect of strength-based rehabilitation programs on patients who underwent partial meniscectomy proceduresDesign:Three databases MEDLINE, PubMed and EMBASE were searched from inception to May 9th, 2022. Data on functional outcomes such as quadriceps and hamstring strengths, as well as patient-reported outcomes such as Knee Osteoarthritis and Outcome Score (KOOS) and Visual-Analogue Scale (VAS) were recorded.Results:A total of nine studies comprising 417 patients were included in this review. There were no significant differences in quadriceps or hamstring strength measures between pre and post-intervention for both groups. KOOS scores significantly increased from pre and post-intervention in both control and exercise groups. VAS scores changed from 5.0cm to 1.4cm in the exercise arm and 3.1cm to 1.9cm in the control arm.Conclusion:Strength-based exercise programs for patients post-partial meniscectomy did not result in significantly different improvements in quadriceps or hamstring strength compared to control programs. However, strength-based exercise programs resulted in significantly higher KOOS scores and a greater decrease in VAS scores. Further studies, specifically well-designed systematic randomized controlled trials are necessary in order to elucidate the specifics behind what type of exercises to use in addition to load progression and frequency of training. |
Yi (David) | Diao | Faculty of Medicine, McMaster University |
| 0 | Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention | ["radiofrequency ablation", "medial branch", "back pain", "lumbar spine"] | John Tran, Philip Peng, Eldon Loh | Paper of the year |
Background and objectives:Fluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A detailed understanding of the course of medial branches in relation to bony and soft tissue landmarks is paramount to optimizing lumbar denervation procedures, particularly parallel placement of the radiofrequency electrode. The objectives of this study were to investigate the relationship of medial branches to anatomical landmarks and discuss the implications for lumbar denervation.Methods:Ten cadaveric specimens were meticulously dissected. The origin, course, and relationship of lumbar medial branches to bony and soft tissue landmarks were documented.Results:The medial branches followed the lateral neck of superior articular process deep to the intertransversarii mediales muscle at each lumbar vertebral level. In all specimens, the medial branches coursed laterally on the anterior half of the neck and transitioned from parasagittal-to-medial on the posterior half to reach the mamillo-accessory notch. The mamillo-accessory ligament was found to not occlude the nerve on the posterior quarter of the lateral neck but rather at the mamillo-accessory notch located at the posterior margin of the superior articular process.Conclusions:A detailed understanding of the relationship of medial branches to anatomical landmarks is essential to optimizing needle placement for lumbar denervation procedures. The current study suggests that a parasagittal placement, with increased cranial-to-caudal angulation of the electrode, may improve parallel tip alignment with the targeted medial branch and represent a potential alternative to the traditional technique. |
Eldon | Loh | Parkwood Institute Research, Parkwood Institute; Physical Medicine and Rehabilitation, University of Western Ontario | |
| 0 | Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention | ["radiofrequency ablation", "medial branch", "back pain", "lumbar spine"] | John Tran, Philip Peng, Eldon Loh | Paper of the year |
Background and objectives:Fluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A detailed understanding of the course of medial branches in relation to bony and soft tissue landmarks is paramount to optimizing lumbar denervation procedures, particularly parallel placement of the radiofrequency electrode. The objectives of this study were to investigate the relationship of medial branches to anatomical landmarks and discuss the implications for lumbar denervation.Methods:Ten cadaveric specimens were meticulously dissected. The origin, course, and relationship of lumbar medial branches to bony and soft tissue landmarks were documented.Results:The medial branches followed the lateral neck of superior articular process deep to the intertransversarii mediales muscle at each lumbar vertebral level. In all specimens, the medial branches coursed laterally on the anterior half of the neck and transitioned from parasagittal-to-medial on the posterior half to reach the mamillo-accessory notch. The mamillo-accessory ligament was found to not occlude the nerve on the posterior quarter of the lateral neck but rather at the mamillo-accessory notch located at the posterior margin of the superior articular process.Conclusions:A detailed understanding of the relationship of medial branches to anatomical landmarks is essential to optimizing needle placement for lumbar denervation procedures. The current study suggests that a parasagittal placement, with increased cranial-to-caudal angulation of the electrode, may improve parallel tip alignment with the targeted medial branch and represent a potential alternative to the traditional technique. |
John | Tran | Physical Medicine and Rehabilitation, Western University | |
| 0 | Anatomical study of the medial branches of the lumbar dorsal rami: implications for image-guided intervention | ["radiofrequency ablation", "medial branch", "back pain", "lumbar spine"] | John Tran, Philip Peng, Eldon Loh | Paper of the year |
Background and objectives:Fluoroscopic-guided radiofrequency ablation of the lumbar medial branches is commonly performed to manage chronic low back pain originating from the facet joints. A detailed understanding of the course of medial branches in relation to bony and soft tissue landmarks is paramount to optimizing lumbar denervation procedures, particularly parallel placement of the radiofrequency electrode. The objectives of this study were to investigate the relationship of medial branches to anatomical landmarks and discuss the implications for lumbar denervation.Methods:Ten cadaveric specimens were meticulously dissected. The origin, course, and relationship of lumbar medial branches to bony and soft tissue landmarks were documented.Results:The medial branches followed the lateral neck of superior articular process deep to the intertransversarii mediales muscle at each lumbar vertebral level. In all specimens, the medial branches coursed laterally on the anterior half of the neck and transitioned from parasagittal-to-medial on the posterior half to reach the mamillo-accessory notch. The mamillo-accessory ligament was found to not occlude the nerve on the posterior quarter of the lateral neck but rather at the mamillo-accessory notch located at the posterior margin of the superior articular process.Conclusions:A detailed understanding of the relationship of medial branches to anatomical landmarks is essential to optimizing needle placement for lumbar denervation procedures. The current study suggests that a parasagittal placement, with increased cranial-to-caudal angulation of the electrode, may improve parallel tip alignment with the targeted medial branch and represent a potential alternative to the traditional technique. |
Philip | Peng | Anesthesiology and Pain Medicine, University of Toronto | |
| 0 | Canadian Physicians’ Use of Intramuscular Botulinum Toxin Injections for Shoulder Spasticity: A National Cross-Sectional Survey | ["botulinum toxin", "muscle spasticity", "spastic hemiplegia", "surveys and questionnaires"] | Farris Kassam, Brendan Lim | Paper of the year |
Background:Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient’s activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. Objectives:We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. Design/methods:A cross-sectional survey of Canadian physicians with experience in spasticity management was designed and administered via an online platform. Research ethics approval was obtained by the local institutional research ethics board. Participants:50 Canadian Physical Medicine and Rehabilitation (PM&R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. Results:The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Conclusion:Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care. Key contribution:The results of this study demonstrate that despite the absence of official indication for shoulder muscles on the BoNT-A product monographs; Canadian physicians use BoNT-A as a common intervention to treat shoulder spasticity. This has highlighted the need for future investigations to assist in the development of classification systems and treatment algorithms to ensure the optimization of treatment for patients with shoulder spasticity. |
Brendan | Lim | Medicine, University of British Columbia | |
| 0 | Canadian Physicians’ Use of Intramuscular Botulinum Toxin Injections for Shoulder Spasticity: A National Cross-Sectional Survey | ["botulinum toxin", "muscle spasticity", "spastic hemiplegia", "surveys and questionnaires"] | Farris Kassam, Brendan Lim | Paper of the year |
Background:Spasticity of the upper extremity can result in severe pain, along with many complications that can impair a patient’s activities of daily living. Failure to treat patients with spasticity of the upper limb can result in a decrease in the range of motion of joints and contracture development, leading to further restriction in daily activities. Objectives:We aimed to investigate the practice patterns of Canadian physicians who utilize Botulinum toxin type-A (BoNT-A) injections in the management of shoulder spasticity. Design/methods:A cross-sectional survey of Canadian physicians with experience in spasticity management was designed and administered via an online platform. Research ethics approval was obtained by the local institutional research ethics board. Participants:50 Canadian Physical Medicine and Rehabilitation (PM&R) physicians completed a survey with an estimated completion rate of (36.23%). The demographics of the survey participants came from a variety of provinces, clinical settings, and patient populations. Results:The most common muscle injected for shoulder adduction and internal rotation spasticity was the pectoralis major, this was followed by latissimus dorsi, pectoralis minor, subscapularis and teres major. Injection of BoNT-A for problematic post-stroke shoulder spasticity was common, with (81.48%) of participants responding that it was always or often used in their management of post-stroke spasticity (PSS). Dosing of BoNT-A demonstrated variability for the muscle injected as well as the type of toxin used. The goals of the patients, caregivers, and practitioners were used to help guide the management of these patients. As a result, the practice patterns of Canadian physicians who treat shoulder spasticity are varied, due to numerous patient factors. Conclusion:Future studies are needed to analyze optimal treatment patterns, and the development of algorithms to standardize care. Key contribution:The results of this study demonstrate that despite the absence of official indication for shoulder muscles on the BoNT-A product monographs; Canadian physicians use BoNT-A as a common intervention to treat shoulder spasticity. This has highlighted the need for future investigations to assist in the development of classification systems and treatment algorithms to ensure the optimization of treatment for patients with shoulder spasticity. |
Farris | Kassam | Medicine, University of British Columbia | |
| 0 | Effects of music therapy on mood, pain, and satisfaction in the neurologic inpatient setting | ["music therapy", "Spinal cord injury", "brain injury", "mood", "pain", "rehabilitation"] | Stephanie Plamondon | winner | Paper of the year |
Purpose:Music therapy (MT) has been used in health care settings for a wide variety of treatment goals. Many inpatients with neurologic impairments struggle with low mood and pain for which MT may be a novel adjunct treatment. The aims of this study were to:** (1) evaluate change in mood and pain following a single MT session; (2) explore the impact of an MT program on mood, pain and satisfaction from the perspective of the patient, family and staff.Materials and methods:A mixed-methods study was conducted. Forty participants completed pre/post MT surveys evaluating mood, pain and satisfaction. Individual semi-structured interviews and focus groups were conducted with 14 MT program participants (inpatients), 5 family members of participants and 16 staff.Results:There was significant improvement in mood (p<0.001) and decrease in pain (p<0.05) from pre- to-post MT with 74% reporting being “very satisfied” with the session. “Benefits of MT” was the overarching theme of the qualitative data. Subthemes were emotional regulation, pain management, effects on self-concept, enjoyment, and social connectedness.Conclusions:Improvements in mood and pain were reported from pre-to-post MT session and in interviews. Further evaluation of MT effectiveness against standard of care rehabilitation and cost implications is required. |
Stephanie | Plamondon | Clinical Neurosciences, University of Calgary |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Ralph | Chamieh | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Céline | Kfoury | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Christopher | Mares | Physiatry, Université de Montréal | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Lorence | Vanasse | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Mathieu | Boudier-Revéret | Physiatry, Université de Montréal | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Isabelle | Denis | Physiatry, Université de Montréal | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Don | Nguyen | Physiatry, Université de Montréal | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Alexandre | Lavigne | Physiatry, Université de Montréal | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Haïm | Bouhadana | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Olivier | Chartrand-Oberoi | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Stevie | Spiliotopoulos | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Paper of the year |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Brandon | Noyon | ||
| 0 | Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS | ["Complex Regional Pain Syndromes", "Physical and Rehabilitation Medicine", "Telehealth", "Telerehabilitation"] | Emma Loy, Anna Scheidler, Tara Packham, Paul Winston, Heather Dow | Paper of the year |
Background:The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS).Aims:The aim of this study was to perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis, and treatment of CRPS with prednisone are safe and effective.Methods:An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS:** PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pretreatment baseline) and at the time of survey (posttreatment).Results:CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients' experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment.Conclusions:This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS. |
Emma | Loy | Faculty of Medicine, University of British Columbia | |
| 0 | Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS | ["Complex Regional Pain Syndromes", "Physical and Rehabilitation Medicine", "Telehealth", "Telerehabilitation"] | Emma Loy, Anna Scheidler, Tara Packham, Paul Winston, Heather Dow | Paper of the year |
Background:The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS).Aims:The aim of this study was to perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis, and treatment of CRPS with prednisone are safe and effective.Methods:An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS:** PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pretreatment baseline) and at the time of survey (posttreatment).Results:CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients' experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment.Conclusions:This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS. |
Paul | Winston | Division of Physical Medicine and Rehabilitation, University of British Columbia | |
| 0 | Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS | ["Complex Regional Pain Syndromes", "Physical and Rehabilitation Medicine", "Telehealth", "Telerehabilitation"] | Emma Loy, Anna Scheidler, Tara Packham, Paul Winston, Heather Dow | Paper of the year |
Background:The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS).Aims:The aim of this study was to perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis, and treatment of CRPS with prednisone are safe and effective.Methods:An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS:** PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pretreatment baseline) and at the time of survey (posttreatment).Results:CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients' experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment.Conclusions:This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS. |
Tara | Packham | School of Rehabilitation Sciences, McMaster University | |
| 0 | Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS | ["Complex Regional Pain Syndromes", "Physical and Rehabilitation Medicine", "Telehealth", "Telerehabilitation"] | Emma Loy, Anna Scheidler, Tara Packham, Paul Winston, Heather Dow | Paper of the year |
Background:The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS).Aims:The aim of this study was to perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis, and treatment of CRPS with prednisone are safe and effective.Methods:An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS:** PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pretreatment baseline) and at the time of survey (posttreatment).Results:CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients' experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment.Conclusions:This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS. |
Heather | Dow | Canadian Association of Physical Medicine and Rehabilitation | |
| 0 | Patient satisfaction with virtual evaluation, diagnosis, and treatment of CRPS | ["Complex Regional Pain Syndromes", "Physical and Rehabilitation Medicine", "Telehealth", "Telerehabilitation"] | Emma Loy, Anna Scheidler, Tara Packham, Paul Winston, Heather Dow | Paper of the year |
Background:The COVID-19 pandemic has led to an increased reliance on virtual care in the rehabilitation setting for patients with conditions such as complex regional pain syndrome (CRPS).Aims:The aim of this study was to perform a quality improvement initiative to assess patient satisfaction and ensure that outcomes following virtual assessment, diagnosis, and treatment of CRPS with prednisone are safe and effective.Methods:An online survey was distributed to 18 patients with CRPS who had been seen virtually between March and December 2020 through a rehabilitation clinic and treated with oral prednisone. Thirteen participants completed the survey, which was designed de novo by our team to evaluate participant perceptions and satisfaction regarding the virtual care experience. Also included in the survey was a CRPS-specific validated patient-report questionnaire (Hamilton Inventory for CRPS:** PR-HI-CRPS), which allowed participants to describe their specific symptoms and associated functional and psychosocial impacts, both previously (pretreatment baseline) and at the time of survey (posttreatment).Results:CRPS symptoms and related impacts were scored as significantly improved from baseline following treatment with prednisone. Likert scale results from survey responses related to patients' experiences and satisfaction with the virtual care process were analyzed; the majority of patients reported satisfaction with a virtual appointment for evaluation of CRPS, as well as with subsequent treatment decisions based on virtual assessment.Conclusions:This quality improvement study suggests that virtual care is a potential option for a patient-accepted approach to overcoming challenges with in-person care imposed by the COVID-19 pandemic and could help inform future considerations in addressing geographic and patient-specific disparities in access to specialist care for CRPS. |
Anna | Scheidler | Faculty of Medicine, Dalhousie University | |
| 0 | Recommendations for Ultrasound Guidance for Diagnostic Nerve Blocks for Spasticity. What are the Advantages? | ["Muscle Spasticity", "Nerve Block", "Interventional Ultrasonography", "Lidocaine"] | Paul Winston, Eve Boissonnault, Rajiv Reebye, Romain David, Alessandro Picelli | Paper of the year |
The diagnostic nerve block (DNB) for spasticity is the percutaneous application of an anesthetic to an individual peripheral nerve trunk (mixed motor sensory nerve), nerve branch to a muscle or an intramuscular branch. The DNB causes a temporary paralysis to assess the contribution of muscle(s) on the spastic pattern and may unmask a fully or partially increased joint range of motion. The anesthetic literature supports the use of ultrasound (US) guidance to improve nerve blocks for sensory targets. This communication summarizes the potential advantages that support the use of US to improve DNB technique. Nerves are much smaller than muscle targets and have various known innervation patterns. US allows for rapid localization of the target before injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent to or encapsulating blood vessels, which can be quickly identified with or without color Doppler, allowing the clinician to scan from the vessels to the target and avoid intravascular injection. Lower stimulation levels can be used as the targeted muscle(s) can be seen stimulating rather than only on the surface. A shorter needle insertion time and lower stimulation levels should cause less discomfort to the patient. Smaller volumes of anesthetic may be used as the fluid is seen reaching its target and cessation of stimulation is observed. Further study is needed to identify evidence supporting US utilization with e-stimulation in DNBs for spasticity management, as US use during nerve blocks for perineurial anesthesia has demonstrated improved patient safety and procedural efficiency. Keywords: |
Eve | Boissonnault | PMR, University of Montreal | |
| 0 | Recommendations for Ultrasound Guidance for Diagnostic Nerve Blocks for Spasticity. What are the Advantages? | ["Muscle Spasticity", "Nerve Block", "Interventional Ultrasonography", "Lidocaine"] | Paul Winston, Eve Boissonnault, Rajiv Reebye, Romain David, Alessandro Picelli | Paper of the year |
The diagnostic nerve block (DNB) for spasticity is the percutaneous application of an anesthetic to an individual peripheral nerve trunk (mixed motor sensory nerve), nerve branch to a muscle or an intramuscular branch. The DNB causes a temporary paralysis to assess the contribution of muscle(s) on the spastic pattern and may unmask a fully or partially increased joint range of motion. The anesthetic literature supports the use of ultrasound (US) guidance to improve nerve blocks for sensory targets. This communication summarizes the potential advantages that support the use of US to improve DNB technique. Nerves are much smaller than muscle targets and have various known innervation patterns. US allows for rapid localization of the target before injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent to or encapsulating blood vessels, which can be quickly identified with or without color Doppler, allowing the clinician to scan from the vessels to the target and avoid intravascular injection. Lower stimulation levels can be used as the targeted muscle(s) can be seen stimulating rather than only on the surface. A shorter needle insertion time and lower stimulation levels should cause less discomfort to the patient. Smaller volumes of anesthetic may be used as the fluid is seen reaching its target and cessation of stimulation is observed. Further study is needed to identify evidence supporting US utilization with e-stimulation in DNBs for spasticity management, as US use during nerve blocks for perineurial anesthesia has demonstrated improved patient safety and procedural efficiency. Keywords: |
Paul | Winston | ||
| 0 | Recommendations for Ultrasound Guidance for Diagnostic Nerve Blocks for Spasticity. What are the Advantages? | ["Muscle Spasticity", "Nerve Block", "Interventional Ultrasonography", "Lidocaine"] | Paul Winston, Eve Boissonnault, Rajiv Reebye, Romain David, Alessandro Picelli | Paper of the year |
The diagnostic nerve block (DNB) for spasticity is the percutaneous application of an anesthetic to an individual peripheral nerve trunk (mixed motor sensory nerve), nerve branch to a muscle or an intramuscular branch. The DNB causes a temporary paralysis to assess the contribution of muscle(s) on the spastic pattern and may unmask a fully or partially increased joint range of motion. The anesthetic literature supports the use of ultrasound (US) guidance to improve nerve blocks for sensory targets. This communication summarizes the potential advantages that support the use of US to improve DNB technique. Nerves are much smaller than muscle targets and have various known innervation patterns. US allows for rapid localization of the target before injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent to or encapsulating blood vessels, which can be quickly identified with or without color Doppler, allowing the clinician to scan from the vessels to the target and avoid intravascular injection. Lower stimulation levels can be used as the targeted muscle(s) can be seen stimulating rather than only on the surface. A shorter needle insertion time and lower stimulation levels should cause less discomfort to the patient. Smaller volumes of anesthetic may be used as the fluid is seen reaching its target and cessation of stimulation is observed. Further study is needed to identify evidence supporting US utilization with e-stimulation in DNBs for spasticity management, as US use during nerve blocks for perineurial anesthesia has demonstrated improved patient safety and procedural efficiency. Keywords: |
Rajiv | Reebye | PMR, UBC | |
| 0 | Recommendations for Ultrasound Guidance for Diagnostic Nerve Blocks for Spasticity. What are the Advantages? | ["Muscle Spasticity", "Nerve Block", "Interventional Ultrasonography", "Lidocaine"] | Paul Winston, Eve Boissonnault, Rajiv Reebye, Romain David, Alessandro Picelli | Paper of the year |
The diagnostic nerve block (DNB) for spasticity is the percutaneous application of an anesthetic to an individual peripheral nerve trunk (mixed motor sensory nerve), nerve branch to a muscle or an intramuscular branch. The DNB causes a temporary paralysis to assess the contribution of muscle(s) on the spastic pattern and may unmask a fully or partially increased joint range of motion. The anesthetic literature supports the use of ultrasound (US) guidance to improve nerve blocks for sensory targets. This communication summarizes the potential advantages that support the use of US to improve DNB technique. Nerves are much smaller than muscle targets and have various known innervation patterns. US allows for rapid localization of the target before injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent to or encapsulating blood vessels, which can be quickly identified with or without color Doppler, allowing the clinician to scan from the vessels to the target and avoid intravascular injection. Lower stimulation levels can be used as the targeted muscle(s) can be seen stimulating rather than only on the surface. A shorter needle insertion time and lower stimulation levels should cause less discomfort to the patient. Smaller volumes of anesthetic may be used as the fluid is seen reaching its target and cessation of stimulation is observed. Further study is needed to identify evidence supporting US utilization with e-stimulation in DNBs for spasticity management, as US use during nerve blocks for perineurial anesthesia has demonstrated improved patient safety and procedural efficiency. Keywords: |
Alessandro | Picelli | PMR, Unversity of Verona | |
| 0 | Recommendations for Ultrasound Guidance for Diagnostic Nerve Blocks for Spasticity. What are the Advantages? | ["Muscle Spasticity", "Nerve Block", "Interventional Ultrasonography", "Lidocaine"] | Paul Winston, Eve Boissonnault, Rajiv Reebye, Romain David, Alessandro Picelli | Paper of the year |
The diagnostic nerve block (DNB) for spasticity is the percutaneous application of an anesthetic to an individual peripheral nerve trunk (mixed motor sensory nerve), nerve branch to a muscle or an intramuscular branch. The DNB causes a temporary paralysis to assess the contribution of muscle(s) on the spastic pattern and may unmask a fully or partially increased joint range of motion. The anesthetic literature supports the use of ultrasound (US) guidance to improve nerve blocks for sensory targets. This communication summarizes the potential advantages that support the use of US to improve DNB technique. Nerves are much smaller than muscle targets and have various known innervation patterns. US allows for rapid localization of the target before injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent injection, particularly in complex anatomy patterns. The nerve trunks are typically found adjacent to or encapsulating blood vessels, which can be quickly identified with or without color Doppler, allowing the clinician to scan from the vessels to the target and avoid intravascular injection. Lower stimulation levels can be used as the targeted muscle(s) can be seen stimulating rather than only on the surface. A shorter needle insertion time and lower stimulation levels should cause less discomfort to the patient. Smaller volumes of anesthetic may be used as the fluid is seen reaching its target and cessation of stimulation is observed. Further study is needed to identify evidence supporting US utilization with e-stimulation in DNBs for spasticity management, as US use during nerve blocks for perineurial anesthesia has demonstrated improved patient safety and procedural efficiency. Keywords: |
Romain | David | PMR, University of Poities | |
| 0 | Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis | ["meta-analysis", "osteoarthritis", "range of motion", "stretching", "systematic review"] | T Mark Campbell, Marie Westby, Elizabeth T Ghogomu, John Fournier, Bahareh B Ghaedi, Vivian Welch | Paper of the year |
Context:Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking.Objective:A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA.Data sources:Seven databases, English-language.Study selection:Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM.Study design:Systematic review and meta-analysis.Level of evidence:Level 2.Data extraction:Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs).Results:We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate.Conclusion:There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty. |
Bahareh B | Ghaedi | The Ottawa Hospital | |
| 0 | Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis | ["meta-analysis", "osteoarthritis", "range of motion", "stretching", "systematic review"] | T Mark Campbell, Marie Westby, Elizabeth T Ghogomu, John Fournier, Bahareh B Ghaedi, Vivian Welch | Paper of the year |
Context:Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking.Objective:A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA.Data sources:Seven databases, English-language.Study selection:Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM.Study design:Systematic review and meta-analysis.Level of evidence:Level 2.Data extraction:Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs).Results:We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate.Conclusion:There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty. |
Vivian | Welch | Bruyère Research Institute | |
| 0 | Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis | ["meta-analysis", "osteoarthritis", "range of motion", "stretching", "systematic review"] | T Mark Campbell, Marie Westby, Elizabeth T Ghogomu, John Fournier, Bahareh B Ghaedi, Vivian Welch | Paper of the year |
Context:Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking.Objective:A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA.Data sources:Seven databases, English-language.Study selection:Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM.Study design:Systematic review and meta-analysis.Level of evidence:Level 2.Data extraction:Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs).Results:We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate.Conclusion:There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty. |
John | Fournier | University of Ottawa | |
| 0 | Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis | ["meta-analysis", "osteoarthritis", "range of motion", "stretching", "systematic review"] | T Mark Campbell, Marie Westby, Elizabeth T Ghogomu, John Fournier, Bahareh B Ghaedi, Vivian Welch | Paper of the year |
Context:Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking.Objective:A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA.Data sources:Seven databases, English-language.Study selection:Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM.Study design:Systematic review and meta-analysis.Level of evidence:Level 2.Data extraction:Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs).Results:We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate.Conclusion:There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty. |
T Mark | Campbell | Ottawa Hospital Research Institute | |
| 0 | Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis | ["meta-analysis", "osteoarthritis", "range of motion", "stretching", "systematic review"] | T Mark Campbell, Marie Westby, Elizabeth T Ghogomu, John Fournier, Bahareh B Ghaedi, Vivian Welch | Paper of the year |
Context:Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking.Objective:A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA.Data sources:Seven databases, English-language.Study selection:Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM.Study design:Systematic review and meta-analysis.Level of evidence:Level 2.Data extraction:Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs).Results:We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate.Conclusion:There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty. |
Marie | Westby | Centre for Hip Health and Mobility, Vancouver Coastal Health Research Institute | |
| 0 | Stretching, Bracing, and Devices for the Treatment of Osteoarthritis-Associated Joint Contractures in Nonoperated Joints: A Systematic Review and Meta-Analysis | ["meta-analysis", "osteoarthritis", "range of motion", "stretching", "systematic review"] | T Mark Campbell, Marie Westby, Elizabeth T Ghogomu, John Fournier, Bahareh B Ghaedi, Vivian Welch | Paper of the year |
Context:Many patients with osteoarthritis (OA) develop range of motion (ROM) restrictions in their affected joints (contractures), associated with worse outcomes and rising healthcare costs. Effective treatment guidance for lost ROM in OA-affected joints is lacking.Objective:A systematic review and meta-analysis evaluating the effectiveness of stretching and/or bracing protocols on native (nonoperated) joint ROM in the setting of radiographically diagnosed OA.Data sources:Seven databases, English-language.Study selection:Studies including participants with radiographically diagnosed OA in any native joint evaluating the effect of stretching or bracing on ROM.Study design:Systematic review and meta-analysis.Level of evidence:Level 2.Data extraction:Two reviewers independently screened articles for inclusion and assessed risk of bias in included trials. Primary outcomes were ROM, pain, and adverse events (AEs).Results:We identified 6284 articles. A total of 9 randomized controlled trials, all evaluating the knee, met eligibility criteria. For stretching, 3 pooled studies reported total ROM, which improved by mean difference (MD) of 9.3° (95% CI 5.0°,13.5°) versus controls. Two pooled studies showed improved knee flexion ROM (MD 10.8° [7.3°,14.2°]) versus controls. Five studies were pooled for knee extension with mean improvement 9.1° [3.4°,14.8°] versus controls. Seven pooled studies showed reduced pain (standardized MD 1.9 [1.2,2.6]). One study reported improved knee extension of 3.7° [2.9°,4.5°] with use of a device. No studies used orthoses. One study reported on AEs, with none noted. Performance bias was present in all included studies, and only 3 studies clearly reported blinding of outcome assessors. Strength of evidence for primary outcomes was considered moderate.Conclusion:There was moderate-quality evidence that stretching is an effective strategy for improving knee total, flexion and extension ROM, and pain. Our findings suggest that stretching to regain joint ROM in OA is not futile and that stretching appears to be an appropriate conservative intervention to improve patient outcomes as part of a comprehensive knee OA treatment plan before arthroplasty. |
Elizabeth T | Ghogomu | Bruyère Research Institute | |
| 0 | Transanal irrigation bowel routine for people with Cauda Equina Syndrome | ["Transanal irrigation", "Fecal incontinence", "Constipation", "Cauda equina syndrome", "Quality of life"] | Karen Ethans, Karen Smith, Avni Khandelwal, Mayur Nankar, Jessie Shea, Alan Casey | Paper of the year | Objective Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES.Design Clinical Trial.Setting Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg.Methods Twelve participants with a mean age of 46.2 years (range 34–72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks.Outcome Measures Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes:Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method.ResultsTen participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05).Conclusion Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail. |
Mayur | Nankar | ||
| 0 | Transanal irrigation bowel routine for people with Cauda Equina Syndrome | ["Transanal irrigation", "Fecal incontinence", "Constipation", "Cauda equina syndrome", "Quality of life"] | Karen Ethans, Karen Smith, Avni Khandelwal, Mayur Nankar, Jessie Shea, Alan Casey | Paper of the year | Objective Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES.Design Clinical Trial.Setting Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg.Methods Twelve participants with a mean age of 46.2 years (range 34–72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks.Outcome Measures Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes:Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method.ResultsTen participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05).Conclusion Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail. |
Jessie | Shea | ||
| 0 | Transanal irrigation bowel routine for people with Cauda Equina Syndrome | ["Transanal irrigation", "Fecal incontinence", "Constipation", "Cauda equina syndrome", "Quality of life"] | Karen Ethans, Karen Smith, Avni Khandelwal, Mayur Nankar, Jessie Shea, Alan Casey | Paper of the year | Objective Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES.Design Clinical Trial.Setting Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg.Methods Twelve participants with a mean age of 46.2 years (range 34–72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks.Outcome Measures Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes:Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method.ResultsTen participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05).Conclusion Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail. |
Avni | Khandelwal | ||
| 0 | Transanal irrigation bowel routine for people with Cauda Equina Syndrome | ["Transanal irrigation", "Fecal incontinence", "Constipation", "Cauda equina syndrome", "Quality of life"] | Karen Ethans, Karen Smith, Avni Khandelwal, Mayur Nankar, Jessie Shea, Alan Casey | Paper of the year | Objective Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES.Design Clinical Trial.Setting Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg.Methods Twelve participants with a mean age of 46.2 years (range 34–72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks.Outcome Measures Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes:Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method.ResultsTen participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05).Conclusion Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail. |
Alan | Casey | Department of Medicine, Section of Physical Medicine and Rehabilitation, University of Manitoba | |
| 0 | Transanal irrigation bowel routine for people with Cauda Equina Syndrome | ["Transanal irrigation", "Fecal incontinence", "Constipation", "Cauda equina syndrome", "Quality of life"] | Karen Ethans, Karen Smith, Avni Khandelwal, Mayur Nankar, Jessie Shea, Alan Casey | Paper of the year | Objective Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES.Design Clinical Trial.Setting Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg.Methods Twelve participants with a mean age of 46.2 years (range 34–72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks.Outcome Measures Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes:Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method.ResultsTen participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05).Conclusion Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail. |
Karen | Ethans | Department of Medicine, Section of Physical Medicine and Rehabilitation, University of Manitoba | |
| 0 | Transanal irrigation bowel routine for people with Cauda Equina Syndrome | ["Transanal irrigation", "Fecal incontinence", "Constipation", "Cauda equina syndrome", "Quality of life"] | Karen Ethans, Karen Smith, Avni Khandelwal, Mayur Nankar, Jessie Shea, Alan Casey | Paper of the year | Objective Neurologic bowel incontinence and dysfunction are common with Cauda Equina Syndrome (CES). The study objective was to evaluate the efficacy of Peristeen Anal Irrigation System (PAIS)TM in people with CES.Design Clinical Trial.Setting Spinal Cord Rehabilitation outpatient clinic at the Health Sciences Centre in Winnipeg.Methods Twelve participants with a mean age of 46.2 years (range 34–72 years, 4 females) with CES used PAISTM bowel routine for 10 weeks.Outcome Measures Change in Neurogenic Bowel Dysfunction Score (NBD) over 10 weeks relative to baseline. Secondary outcomes:Change in St. Mark's Fecal Incontinence score (SMFI), Cleveland Clinic Constipation score (CCC), and modified Rectal Surgeons Fecal Incontinence Quality of Life Score (QOL) at week 1, 2, 4, 6, 8 and 10 compared to baseline, and self-rating of bowel function at baseline and 10 weeks. Additionally, colonic transit times were assessed using the radioactive markers (Sitzmarks) method.ResultsTen participants completed the study. Post-intervention primary outcome NBD score improved (p < 0.01). Secondary outcomes also improved significantly, including SMFI (p < 0.01), CCC (p < 0.01), QOL (p < 0.01), self-rating of bowel function (p < 0.01), and transit time improved by 22% (p < 0.05).Conclusion Overall, a significant improvement was observed with the PAISTM for both primary, as well as secondary outcome measures, without any significant adverse effects. As this non-pharmaceutical method of bowel management is effective and has the potential to improve symptoms of bowel dysfunction in people with CES, it should be considered for those in which traditional methods of managing neurogenic bowel fail. |
Karen | Smith | Department of Physical Medicine and Rehabilitation, Queens University | |
| 0 | Orthobiologic injections for shoulder pathologies | ["Rotator cuff", "Tendinopathy", "Glenohumeral osteoarthritis", "PRP", "stem cells"] | Alexandre Lavigne, Andy Hiett, Kenneth Mautner, Michael Khadavi | Resident Essay Contest | This essay explores the literature on regenerative medicine for shoulder pathologies. It summarizes the outcomes of studies examining orthobiologics for treating rotator cuff tendinopathy and glenohumeral osteoarthritis. Platelet-rich plasma and cellular treatments seem to be valuable options in the arsenal of treatments for rotator cuff tendinopathy. Orthobiologics have shown exceedingly rare local and systemic adverse effects when used for various shoulder pathologies. Furthermore, they have shown promising results in terms of pain and functional improvement, particularly for rotator cuff tendinopathies, and may be preferred for this diagnosis over glucocorticoid injections. There is insufficient evidence to support the use of orthobiologics in treating glenohumeral osteoarthritis. Indeed, the literature is still too scarce to fully understand the potential of orthobiologics for these shoulder pathologies. This essay also describes certain techniques that need to be taken into consideration when injecting orthobiologics into and around the shoulder. | Alexandre | Lavigne | Physiatry, Université de Montréal | |
| 0 | Orthobiologic injections for shoulder pathologies | ["Rotator cuff", "Tendinopathy", "Glenohumeral osteoarthritis", "PRP", "stem cells"] | Alexandre Lavigne, Andy Hiett, Kenneth Mautner, Michael Khadavi | Resident Essay Contest | This essay explores the literature on regenerative medicine for shoulder pathologies. It summarizes the outcomes of studies examining orthobiologics for treating rotator cuff tendinopathy and glenohumeral osteoarthritis. Platelet-rich plasma and cellular treatments seem to be valuable options in the arsenal of treatments for rotator cuff tendinopathy. Orthobiologics have shown exceedingly rare local and systemic adverse effects when used for various shoulder pathologies. Furthermore, they have shown promising results in terms of pain and functional improvement, particularly for rotator cuff tendinopathies, and may be preferred for this diagnosis over glucocorticoid injections. There is insufficient evidence to support the use of orthobiologics in treating glenohumeral osteoarthritis. Indeed, the literature is still too scarce to fully understand the potential of orthobiologics for these shoulder pathologies. This essay also describes certain techniques that need to be taken into consideration when injecting orthobiologics into and around the shoulder. | Michael | Khadavi | ||
| 0 | Orthobiologic injections for shoulder pathologies | ["Rotator cuff", "Tendinopathy", "Glenohumeral osteoarthritis", "PRP", "stem cells"] | Alexandre Lavigne, Andy Hiett, Kenneth Mautner, Michael Khadavi | Resident Essay Contest | This essay explores the literature on regenerative medicine for shoulder pathologies. It summarizes the outcomes of studies examining orthobiologics for treating rotator cuff tendinopathy and glenohumeral osteoarthritis. Platelet-rich plasma and cellular treatments seem to be valuable options in the arsenal of treatments for rotator cuff tendinopathy. Orthobiologics have shown exceedingly rare local and systemic adverse effects when used for various shoulder pathologies. Furthermore, they have shown promising results in terms of pain and functional improvement, particularly for rotator cuff tendinopathies, and may be preferred for this diagnosis over glucocorticoid injections. There is insufficient evidence to support the use of orthobiologics in treating glenohumeral osteoarthritis. Indeed, the literature is still too scarce to fully understand the potential of orthobiologics for these shoulder pathologies. This essay also describes certain techniques that need to be taken into consideration when injecting orthobiologics into and around the shoulder. | Kenneth | Mautner | ||
| 0 | Orthobiologic injections for shoulder pathologies | ["Rotator cuff", "Tendinopathy", "Glenohumeral osteoarthritis", "PRP", "stem cells"] | Alexandre Lavigne, Andy Hiett, Kenneth Mautner, Michael Khadavi | Resident Essay Contest | This essay explores the literature on regenerative medicine for shoulder pathologies. It summarizes the outcomes of studies examining orthobiologics for treating rotator cuff tendinopathy and glenohumeral osteoarthritis. Platelet-rich plasma and cellular treatments seem to be valuable options in the arsenal of treatments for rotator cuff tendinopathy. Orthobiologics have shown exceedingly rare local and systemic adverse effects when used for various shoulder pathologies. Furthermore, they have shown promising results in terms of pain and functional improvement, particularly for rotator cuff tendinopathies, and may be preferred for this diagnosis over glucocorticoid injections. There is insufficient evidence to support the use of orthobiologics in treating glenohumeral osteoarthritis. Indeed, the literature is still too scarce to fully understand the potential of orthobiologics for these shoulder pathologies. This essay also describes certain techniques that need to be taken into consideration when injecting orthobiologics into and around the shoulder. | Andy | Hiett | ||
| 0 | Sleep: A wake up call. _An evidenced-based narrative review of sleep in physiatry training and practice_ | ["Cognitive Function", "Medical education", "Medical errors", "Sleep"] | Michael Ruiz-Peters | Resident Essay Contest |
Objectives:With the term ‘resident’ being coined for the number of hours medical trainees spend in hospitals, sleeplessness is a deep-rooted aspect of medical culture. Through a non-systematic rehabilitation medicine focused narrative review of sleep, this essay explores the effects of sleeplessness on health, learning, and professional decision-making. Design/methods:Data acquisition was conducted in a non-systematic fashion with MeSH term searches. Databases used include Ovid, Pubmed, Embase, and Medline. Evidence search was conducted between May 2022 and August 2022. Review was limited to articles in English, and grey literature was included. Results:Sleep loss has been associated with increases in all-cause mortality, cancer, diabetes, stroke, and coronary artery disease. Sleep loss also has a strong correlation with immunologic function, as well as the onset of neurodegenerative disease. Pharmacologic methods for treating sleep counterintuitively decrease the quality and restorative nature of sleep. Additionally, patients with strokes who had better quality of sleep showed increased motor recovery, with sleep quality being determined a predictor motor and functional skill recovery. Sleep loss also decreases information retention by 40%, reduces sleep-induced deficit perception, and memory consolidation. In resident training, sleep deprivation is associated with an increase of 460% diagnostic errors, 36% serious medical errors, and 300% for preventable fatigue related adverse events that resulted in fatality. This is similar in attending physicians, with a 170% increased risk of inflicting a serious surgical error. Conversely, even marginally improving sleep reduces the number of serious medical errors by 20%. Conclusion:There remains a compelling mismatch between best available evidence and current practices, and there exists opportunity for sleep optimization in rehabilitation medicine and training. Additionally, this review consolidates high value information to inform our current practices, trainee education, and highlights practical areas for intervention. |
Michael | Ruiz-Peters | Medicine, University of British Columbia | |
| 0 | Trigger Finger: A Literature Review on the Impact of Corticosteroid Injection Technique on Effectiveness and Pain | ["Corticosteroid", "Injections", "Trigger Finger Disorder"] | Kyung Joon Mun | 3rd place | Resident Essay Contest |
Context:Trigger finger is a common cause of hand pain and disability that can be effectively managed with corticosteroid injections. No review to date has evaluated the impact of injection technique on effectiveness and pain.Methods:A literature search was performed using MEDLINE and EMBASE databases for English-language articles describing randomized controlled trials (RCTs) of corticosteroid injection techniques in adults aged 18 and older with trigger finger.Results:The search yielded 312 unique abstracts, of which seven RCTs fulfilled the inclusion criteria. Three studies evaluated intra-sheath versus extra-sheath injections. Three studies compared blind dorsal web space, volar proximal phalanx, or mid-axial techniques to blind conventional technique. Finally, one study compared ultrasound-guided versus blind conventional technique. Overall, there were no statistically significant differences in effectiveness between comparison groups. There were statistically significant differences in injection pain favouring the blind dorsal web space, volar proximal phalanx, and mid-axial techniques compared to the blind conventional technique.Conclusions:There is some RCT evidence to suggest that corticosteroid injection technique does not make a difference in effectiveness. Some techniques may be useful for decreasing injection pain. Additional research with standardized injection solutions and outcome measures are needed to better compare various injection techniques. |
Kyung Joon | Mun | Department of Medicine, Division of Physical Medicien & Rehabilitation, University of Toronto |
| 0 | What should every physiatrist know about Artificial Intelligence? | ["Artificial Intelligence"] | Tiffany Got | Resident Essay Contest | Artificial intelligence (AI) refers to computational technologies that mimic human cognitive functions such as perception, learning and problem-solving. AI-based tools may be applied along the spectrum of diagnosis, prognosis and treatment, such as radiographic diagnostic aids, clinical decision support tools, predictive modelling for recovery, personalized rehabilitation and robotics. Beyond the domain of clinical care, AI tools may optimize health system management and resource utilization within rehabilitation. Limitations to AI include ethical, legal and infrastructural barriers. Validated implementation strategies specific to AI-based tools can address concerns regarding transparency and clinical integration. To leverage AI as an adjunct in clinical care, physiatrists will need to understand the fundamental concepts and process of AI, as well as their strengths and limitations. | Tiffany | Got | Medicine, University of Toronto | |
| 0 | What should every physiatrist know about Artificial Intelligence? | ["Artificial Intelligence"] | Tiffany Got | 1st place | Resident Essay Contest | Artificial intelligence (AI) refers to computational technologies that mimic human cognitive functions such as perception, learning and problem-solving. AI-based tools may be applied along the spectrum of diagnosis, prognosis and treatment, such as radiographic diagnostic aids, clinical decision support tools, predictive modelling for recovery, personalized rehabilitation and robotics. Beyond the domain of clinical care, AI tools may optimize health system management and resource utilization within rehabilitation. Limitations to AI include ethical, legal and infrastructural barriers. Validated implementation strategies specific to AI-based tools can address concerns regarding transparency and clinical integration. To leverage AI as an adjunct in clinical care, physiatrists will need to understand the fundamental concepts and process of AI, as well as their strengths and limitations. | Tiffany | Got | Medicine, University of Toronto |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | winner | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Matthew | Pasquali | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | winner | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Ramona | Neferu | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | winner | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Courtney | Frengopoulos | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | winner | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Michael WC | Payne | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | winner | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Tom | Miller | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | winner | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Ricardo | Viana | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Ricardo | Viana | Physical Medicine and Rehabilitation, Parkwood Institute; Physical Medicine and Rehabilitation, Western University | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Matthew | Pasquali | McMaster University | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Ramona | Neferu | Physical Medicine and Rehabilitation, McMaster University | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Courtney | Frengopoulos | Physical Medicine and Rehabilitation, McMaster University | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Michael WC | Payne | Physical Medicine and Rehabilitation, Parkwood Institute; Physical Medicine and Rehabilitation, Western University | |
| 0 | Botulinum toxin therapy for management of phantom and residual limb pain following amputation: A Systematic Review | ["Amputation stumps", "Botulinum toxins", "Congenital limb deformities", "Pain Management", "Phantom limb pain"] | Courtney Frengopoulos, Ramona Neferu, Matthew Pasquali, Ricardo Viana, Tom Miller, Michael WC Payne | Resident Research Contest |
Context:Chronic pain following amputation is debilitating. The etiology of post amputation pain is multifactorial and involves nociceptive and neuropathic pathways. Due to its pain modulatory mechanisms, botulinum toxin has been proposed as treatment for phantom limb pain (PLP) and residual limb pain (RLP).Objectives:To determine the efficacy of botulinum toxin injection in the management of PLP and RLP following major limb amputation.Methods:Medline, CINAHL, EMBASE, Scopus, Web of Science and Cochrane were searched from inception through January 11, 2023. Inclusion criteria: Major extremity amputation or congenital limb deficiency, use of botulinum toxin for management of PLP or RLP, study involved human subjects.Results:Of 327 articles identified from databases, 37 underwent full-text review and 11 were included in the final review. Included articles demonstrated significant variation in botulinum toxin type, injection method and dosage. Twenty-one (53.9%) and 27 (64.3%) participants had improvement in PLP and RLP following botulinum toxin injection, respectively.Conclusion:Botulinum toxin has the potential to be utilized as a treatment for post-amputation pain. However, due to the minimal number of studies, small sample sizes, and heterogenous methodologies, our ability to conclude with certainty the efficacy of botulinum toxin injection on treatment of PLP and RLP following amputation is limited. |
Tom | Miller | Physical Medicine and Rehabilitation, Parkwood Institute; Physical Medicine and Rehabilitation, Western University | |
| 0 | Development and Satisfaction Assessment of a Mobile App that Monitored Potential Achilles Tendinopathy Rehabilitation Determinants: A Survey Study | ["Mobile app", "Rehabilitation", "Achilles", "Tendinopathy"] | Alexandre Lavigne, Martin Lamontagne, Christopher Mares, Dany H. Gagnon | Resident Research Contest |
Objective:To verify if using a mobile app in a tendinopathy clinical trial is a convenient way to collect data about pain and rehabilitation determinants.Design:Participants of a clinical trial that assessed their pain evolution of Achilles tendinopathy when performing Alfredson’s eccentric strengthening exercises were surveyed to measure their satisfaction with the use of a mobile app to collect research data.Setting:Survey study.Participants:Adults affected by Achilles tendinopathy (n=31).Intervention:Participants had to write their weekly pain level in their mobile app according to the visual analog scale and their weekly number of minutes of physical activity. They also had to confirm on the mobile app twice daily if they had performed their eccentric strengthening exercise.Main outcome measures:Level of satisfaction with different aspects of the research mobile app.Results:According to the survey, 96.4% agreed that using a mobile app was more convenient than filling out online forms or answering emails and 82.1% agreed that it increased their motivation to perform the rehabilitation exercises.Conclusion:Using a mobile app to collect data in a tendinopathy clinical trial is convenient for both participants and researchers. |
Dany H. | Gagnon | ||
| 0 | Development and Satisfaction Assessment of a Mobile App that Monitored Potential Achilles Tendinopathy Rehabilitation Determinants: A Survey Study | ["Mobile app", "Rehabilitation", "Achilles", "Tendinopathy"] | Alexandre Lavigne, Martin Lamontagne, Christopher Mares, Dany H. Gagnon | Resident Research Contest |
Objective:To verify if using a mobile app in a tendinopathy clinical trial is a convenient way to collect data about pain and rehabilitation determinants.Design:Participants of a clinical trial that assessed their pain evolution of Achilles tendinopathy when performing Alfredson’s eccentric strengthening exercises were surveyed to measure their satisfaction with the use of a mobile app to collect research data.Setting:Survey study.Participants:Adults affected by Achilles tendinopathy (n=31).Intervention:Participants had to write their weekly pain level in their mobile app according to the visual analog scale and their weekly number of minutes of physical activity. They also had to confirm on the mobile app twice daily if they had performed their eccentric strengthening exercise.Main outcome measures:Level of satisfaction with different aspects of the research mobile app.Results:According to the survey, 96.4% agreed that using a mobile app was more convenient than filling out online forms or answering emails and 82.1% agreed that it increased their motivation to perform the rehabilitation exercises.Conclusion:Using a mobile app to collect data in a tendinopathy clinical trial is convenient for both participants and researchers. |
Christopher | Mares | ||
| 0 | Development and Satisfaction Assessment of a Mobile App that Monitored Potential Achilles Tendinopathy Rehabilitation Determinants: A Survey Study | ["Mobile app", "Rehabilitation", "Achilles", "Tendinopathy"] | Alexandre Lavigne, Martin Lamontagne, Christopher Mares, Dany H. Gagnon | Resident Research Contest |
Objective:To verify if using a mobile app in a tendinopathy clinical trial is a convenient way to collect data about pain and rehabilitation determinants.Design:Participants of a clinical trial that assessed their pain evolution of Achilles tendinopathy when performing Alfredson’s eccentric strengthening exercises were surveyed to measure their satisfaction with the use of a mobile app to collect research data.Setting:Survey study.Participants:Adults affected by Achilles tendinopathy (n=31).Intervention:Participants had to write their weekly pain level in their mobile app according to the visual analog scale and their weekly number of minutes of physical activity. They also had to confirm on the mobile app twice daily if they had performed their eccentric strengthening exercise.Main outcome measures:Level of satisfaction with different aspects of the research mobile app.Results:According to the survey, 96.4% agreed that using a mobile app was more convenient than filling out online forms or answering emails and 82.1% agreed that it increased their motivation to perform the rehabilitation exercises.Conclusion:Using a mobile app to collect data in a tendinopathy clinical trial is convenient for both participants and researchers. |
Alexandre | Lavigne | Physiatry, Université de Montréal | |
| 0 | Development and Satisfaction Assessment of a Mobile App that Monitored Potential Achilles Tendinopathy Rehabilitation Determinants: A Survey Study | ["Mobile app", "Rehabilitation", "Achilles", "Tendinopathy"] | Alexandre Lavigne, Martin Lamontagne, Christopher Mares, Dany H. Gagnon | Resident Research Contest |
Objective:To verify if using a mobile app in a tendinopathy clinical trial is a convenient way to collect data about pain and rehabilitation determinants.Design:Participants of a clinical trial that assessed their pain evolution of Achilles tendinopathy when performing Alfredson’s eccentric strengthening exercises were surveyed to measure their satisfaction with the use of a mobile app to collect research data.Setting:Survey study.Participants:Adults affected by Achilles tendinopathy (n=31).Intervention:Participants had to write their weekly pain level in their mobile app according to the visual analog scale and their weekly number of minutes of physical activity. They also had to confirm on the mobile app twice daily if they had performed their eccentric strengthening exercise.Main outcome measures:Level of satisfaction with different aspects of the research mobile app.Results:According to the survey, 96.4% agreed that using a mobile app was more convenient than filling out online forms or answering emails and 82.1% agreed that it increased their motivation to perform the rehabilitation exercises.Conclusion:Using a mobile app to collect data in a tendinopathy clinical trial is convenient for both participants and researchers. |
Martin | Lamontagne | ||
| 0 | Educational Impacts of a Peer-Led Shoulder Ultrasound Session on Medical Learners | ["Humans", "Internship and Residency", "Musculoskeletal System/ diagnostic imaging*", "Peer Group", "Physical Medicine and Rehabilitation"] | Brett Cameron, Nicholas Miller, Davyd Hooper, Terry Li | Resident Research Contest |
Context:Most Canadian Physical Medicine and Rehabilitation (PM&R) residents are interested in using musculoskeletal ultrasound (MSUS) in their future careers but have limited exposure over the course of their residency training. The most impactful barriers to MSUS exposure are the lack of preceptors using ultrasound and the lack of formal ultrasound education. To address these deficiencies we designed and implemented an exclusively peer-led MSUS curriculum that was carried out in a Canadian PM&R residency program. As part of the MSUS curriculum, the shoulder ultrasound session served as a model to evaluate the effectiveness of this educational format.Objective:To provide exposure and instruction on the ultrasound evaluation of the shoulder and to evaluate the educational effects and reception among the learners.Design:Single cohort interventional study.Setting:Classroom.Participants:Ten participants consisting of four PM&R residents, four medical students and two sports medicine fellows from a single institution.Interventions:A peer-led shoulder ultrasound session. The session was led by two senior PM&R residents and consisted of a 30-minute lecture covering shoulder anatomy and ultrasound technique followed by 120 minutes of hands-on scanning. Participants were divided into two groups of five with a peer instructor working with each group to guide them through the scanning protocol.Outcome measures:A multiple choice question (MCQ) test and survey were completed before and after the session. The MC Q test consisted of ten questions used to assess participants’ shoulder ultrasound knowledge. A Likert scale survey measured participants’ perceptions of interest and confidence in MSUS and satisfaction with the session.Results:There was a statistically significant increase in test scores from the pre-curriculum mean score of 4.4 to the post-curriculum mean score of 8.8 (two-tailed paired t-test, p<0.001). The increase in test scores was similar for learners across the different levels of training. Survey responses revealed a significant increase in confidence performing MSUS of the shoulder from a score of 1.6 to 3.4 (one-tailed Wilcoxon signed-rank test, p=0.004) measured on a 1-5 scale ranging from “not at all confident” to “very confident”.Conclusions:Our session demonstrated that a peer-led PM&R MSUS session improved resident knowledge and confidence in shoulder ultrasound. The results are encouraging and suggest that this model can provide a positive initial exposure to ultrasound concepts and skills in the absence of a subject expert. |
Brett | Cameron | Physical Medicine and Rehabilitation, University of Manitoba | |
| 0 | Educational Impacts of a Peer-Led Shoulder Ultrasound Session on Medical Learners | ["Humans", "Internship and Residency", "Musculoskeletal System/ diagnostic imaging*", "Peer Group", "Physical Medicine and Rehabilitation"] | Brett Cameron, Nicholas Miller, Davyd Hooper, Terry Li | Resident Research Contest |
Context:Most Canadian Physical Medicine and Rehabilitation (PM&R) residents are interested in using musculoskeletal ultrasound (MSUS) in their future careers but have limited exposure over the course of their residency training. The most impactful barriers to MSUS exposure are the lack of preceptors using ultrasound and the lack of formal ultrasound education. To address these deficiencies we designed and implemented an exclusively peer-led MSUS curriculum that was carried out in a Canadian PM&R residency program. As part of the MSUS curriculum, the shoulder ultrasound session served as a model to evaluate the effectiveness of this educational format.Objective:To provide exposure and instruction on the ultrasound evaluation of the shoulder and to evaluate the educational effects and reception among the learners.Design:Single cohort interventional study.Setting:Classroom.Participants:Ten participants consisting of four PM&R residents, four medical students and two sports medicine fellows from a single institution.Interventions:A peer-led shoulder ultrasound session. The session was led by two senior PM&R residents and consisted of a 30-minute lecture covering shoulder anatomy and ultrasound technique followed by 120 minutes of hands-on scanning. Participants were divided into two groups of five with a peer instructor working with each group to guide them through the scanning protocol.Outcome measures:A multiple choice question (MCQ) test and survey were completed before and after the session. The MC Q test consisted of ten questions used to assess participants’ shoulder ultrasound knowledge. A Likert scale survey measured participants’ perceptions of interest and confidence in MSUS and satisfaction with the session.Results:There was a statistically significant increase in test scores from the pre-curriculum mean score of 4.4 to the post-curriculum mean score of 8.8 (two-tailed paired t-test, p<0.001). The increase in test scores was similar for learners across the different levels of training. Survey responses revealed a significant increase in confidence performing MSUS of the shoulder from a score of 1.6 to 3.4 (one-tailed Wilcoxon signed-rank test, p=0.004) measured on a 1-5 scale ranging from “not at all confident” to “very confident”.Conclusions:Our session demonstrated that a peer-led PM&R MSUS session improved resident knowledge and confidence in shoulder ultrasound. The results are encouraging and suggest that this model can provide a positive initial exposure to ultrasound concepts and skills in the absence of a subject expert. |
Davyd | Hooper | Physical Medicine and Rehabilitation, University of Manitoba | |
| 0 | Educational Impacts of a Peer-Led Shoulder Ultrasound Session on Medical Learners | ["Humans", "Internship and Residency", "Musculoskeletal System/ diagnostic imaging*", "Peer Group", "Physical Medicine and Rehabilitation"] | Brett Cameron, Nicholas Miller, Davyd Hooper, Terry Li | Resident Research Contest |
Context:Most Canadian Physical Medicine and Rehabilitation (PM&R) residents are interested in using musculoskeletal ultrasound (MSUS) in their future careers but have limited exposure over the course of their residency training. The most impactful barriers to MSUS exposure are the lack of preceptors using ultrasound and the lack of formal ultrasound education. To address these deficiencies we designed and implemented an exclusively peer-led MSUS curriculum that was carried out in a Canadian PM&R residency program. As part of the MSUS curriculum, the shoulder ultrasound session served as a model to evaluate the effectiveness of this educational format.Objective:To provide exposure and instruction on the ultrasound evaluation of the shoulder and to evaluate the educational effects and reception among the learners.Design:Single cohort interventional study.Setting:Classroom.Participants:Ten participants consisting of four PM&R residents, four medical students and two sports medicine fellows from a single institution.Interventions:A peer-led shoulder ultrasound session. The session was led by two senior PM&R residents and consisted of a 30-minute lecture covering shoulder anatomy and ultrasound technique followed by 120 minutes of hands-on scanning. Participants were divided into two groups of five with a peer instructor working with each group to guide them through the scanning protocol.Outcome measures:A multiple choice question (MCQ) test and survey were completed before and after the session. The MC Q test consisted of ten questions used to assess participants’ shoulder ultrasound knowledge. A Likert scale survey measured participants’ perceptions of interest and confidence in MSUS and satisfaction with the session.Results:There was a statistically significant increase in test scores from the pre-curriculum mean score of 4.4 to the post-curriculum mean score of 8.8 (two-tailed paired t-test, p<0.001). The increase in test scores was similar for learners across the different levels of training. Survey responses revealed a significant increase in confidence performing MSUS of the shoulder from a score of 1.6 to 3.4 (one-tailed Wilcoxon signed-rank test, p=0.004) measured on a 1-5 scale ranging from “not at all confident” to “very confident”.Conclusions:Our session demonstrated that a peer-led PM&R MSUS session improved resident knowledge and confidence in shoulder ultrasound. The results are encouraging and suggest that this model can provide a positive initial exposure to ultrasound concepts and skills in the absence of a subject expert. |
Nicholas | Miller | Physical Medicine and Rehabilitation, University of Manitoba | |
| 0 | Educational Impacts of a Peer-Led Shoulder Ultrasound Session on Medical Learners | ["Humans", "Internship and Residency", "Musculoskeletal System/ diagnostic imaging*", "Peer Group", "Physical Medicine and Rehabilitation"] | Brett Cameron, Nicholas Miller, Davyd Hooper, Terry Li | Resident Research Contest |
Context:Most Canadian Physical Medicine and Rehabilitation (PM&R) residents are interested in using musculoskeletal ultrasound (MSUS) in their future careers but have limited exposure over the course of their residency training. The most impactful barriers to MSUS exposure are the lack of preceptors using ultrasound and the lack of formal ultrasound education. To address these deficiencies we designed and implemented an exclusively peer-led MSUS curriculum that was carried out in a Canadian PM&R residency program. As part of the MSUS curriculum, the shoulder ultrasound session served as a model to evaluate the effectiveness of this educational format.Objective:To provide exposure and instruction on the ultrasound evaluation of the shoulder and to evaluate the educational effects and reception among the learners.Design:Single cohort interventional study.Setting:Classroom.Participants:Ten participants consisting of four PM&R residents, four medical students and two sports medicine fellows from a single institution.Interventions:A peer-led shoulder ultrasound session. The session was led by two senior PM&R residents and consisted of a 30-minute lecture covering shoulder anatomy and ultrasound technique followed by 120 minutes of hands-on scanning. Participants were divided into two groups of five with a peer instructor working with each group to guide them through the scanning protocol.Outcome measures:A multiple choice question (MCQ) test and survey were completed before and after the session. The MC Q test consisted of ten questions used to assess participants’ shoulder ultrasound knowledge. A Likert scale survey measured participants’ perceptions of interest and confidence in MSUS and satisfaction with the session.Results:There was a statistically significant increase in test scores from the pre-curriculum mean score of 4.4 to the post-curriculum mean score of 8.8 (two-tailed paired t-test, p<0.001). The increase in test scores was similar for learners across the different levels of training. Survey responses revealed a significant increase in confidence performing MSUS of the shoulder from a score of 1.6 to 3.4 (one-tailed Wilcoxon signed-rank test, p=0.004) measured on a 1-5 scale ranging from “not at all confident” to “very confident”.Conclusions:Our session demonstrated that a peer-led PM&R MSUS session improved resident knowledge and confidence in shoulder ultrasound. The results are encouraging and suggest that this model can provide a positive initial exposure to ultrasound concepts and skills in the absence of a subject expert. |
Terry | Li | Human Anatomy and Cell Science, University of Manitoba | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Céline | Kfoury | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Christopher | Mares | Physiatry, Université de Montréal |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Stevie | Spiliotopoulos | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Lorence | Vanasse | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Haïm | Bouhadana | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Ralph | Chamieh | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Isabelle | Denis | Physiatry, Université de Montréal |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Mathieu | Boudier-Revéret | Physiatry, Université de Montréal |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Olivier | Chartrand-Oberoi | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Brandon | Noyon | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Alexandre | Lavigne | Physiatry, Université de Montréal |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | withdrawn | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Don | Nguyen | Physiatrie, Université de Montréal |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Isabelle | Denis | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Christopher | Mares | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Alexandre | Lavigne | Physiatry, Université de Montréal | |
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Don | Nguyen | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Olivier | Chartrand-Oberoi | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Brandon | Noyon | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Ralph | Chamieh | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Lorence | Vanasse | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Stevie | Spiliotopoulos | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Céline | Kfoury | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Haïm | Bouhadana | ||
| 0 | Incidence and Risk Factors of Systemic Side Effects and Complications of Ultrasound- and Fluoroscopy-Guided Glucocorticoid Injections: A Cohort Study | ["Glucocorticoid injection", "corticosteroid injection", "side effects", "complication"] | Alexandre Lavigne, Don Nguyen, Olivier Chartrand-Oberoi, Brandon Noyon, Stevie Spiliotopoulos, Céline Kfoury, Lorence Vanasse, Ralph Chamieh, Haïm Bouhadana, Mathieu Boudier-Revéret, Isabelle Denis, Christopher Mares | Resident Research Contest |
Objective:To assess the incidence of systemic side effects and complications of ultrasound-guided and fluoroscopy-guided glucocorticoid injections (GCIs) and to identify associated risk factors.Design:This retrospective cohort study compared participants who received a GCI at the outpatient clinic and participants who had an appointment but did not receive a GCI. Participants were called to verify if they had experienced any of the predetermined systemic side effects and complications. Medical history, medication, and characteristics of the GCIs were documented.Results:There were 1010 participants in the GCI group and 328 in the non-GCI group, and the average age was 62.1 and 56.1, respectively. In the GCI group, 17.6% had ultrasound-guided GCIs and 82.4% had fluoroscopy-guided spinal GCIs. There was no statistically significant difference in the occurrence of COVID-19 infection between the two groups. In the GCI group, 7.0% developed abnormal uterine bleeding (among women), 12.7% had flushing, 10.8% had insomnia, 7.1% had hyperglycemia, and 4.5% had an increased blood pressure increase. Younger age, female sex, diabetes, tobacco use, and higher GCI doses were associated with an increased risk of developing systemic side effects.Conclusion:The findings of this study will be helpful in informing patients about the systemic side effects of GCIs. |
Mathieu | Boudier-Revéret | ||
| 0 | Reducing wait times for access to inpatient rehabilitation for patients with acquired brain injury: a quality improvement initiative | ["Brain Injuries", "Health Services Accessibility", "Quality Improvement", "Rehabilitation"] | Ramona Neferu, Rebecca Fleck, Justine Best | Resident Research Contest | **Background**: Acquired brain injury (ABI) is a major cause of disability in Canada. Timely access to inpatient ABI rehabilitation is associated with improved outcomes at the patient, system, and societal levels. **Problem**: Wait times to access the local inpatient ABI rehabilitation program by patients referred from community hospitals have been consistently greater than provincial targets and benchmarks.**Objective**: This initiative aimed to reduce the mean wait times from referral to admission by 30% (from 27 to 19 days) during the 12-month project period. The sub-aim was to concurrently achieve a reduction in the mean wait times for decisions from 9.5 to 5 days during the same period.**Methods**: A non-randomized time-series design was undertaken. Baseline and post-intervention wait times were obtained from patient intake charts. Process mapping, value analysis, and 5-why analysis were used to identify root causes for delays in the intake process. Referring hospital staff and the ABI rehab interdisciplinary team members were engaged in change idea development and refinement. Iterative Plan-Do-Study-Act cycles were used to improve the change ideas’ usability and uptake. Data analysis was performed using the QI Macros package in Microsoft Excel.**Results**: Root causes for delays in the intake process included frequent incomplete referrals due to unclear and inaccessible admission criteria, variability in the intake process, and limitations in rehab bed availability. Two change ideas were introduced: i) a standardized intake protocol, and ii) a referral checklist to assist referring hospitals in completing referrals based on updated admission criteria. The fidelity for the standardized intake protocol was consistently above 70% but was variable for the referral checklist, with identified barriers including a lack of a centralized communication system through which to provide education and awareness about the checklist. Balancing measures (staff workload and satisfaction level with the intake process) remained stable. Within 3 months, the mean decision wait times were reduced to 4 days (58% reduction), and the mean admission wait times were reduced to 12 days (54% reduction). Wait time variability also decreased.**Conclusion**: This initiative led to the systematic standardization of the admission criteria and intake process for the local ABI rehab program. Improvements surpassing the initial aims of this initiative were observed for decision and admission wait times and may inform future benchmarks. Sustainability efforts are ongoing. | Justine | Best | Acquired Brain Injury Rehabilitation, Hamilton Health Sciences | |
| 0 | Reducing wait times for access to inpatient rehabilitation for patients with acquired brain injury: a quality improvement initiative | ["Brain Injuries", "Health Services Accessibility", "Quality Improvement", "Rehabilitation"] | Ramona Neferu, Rebecca Fleck, Justine Best | Resident Research Contest | **Background**: Acquired brain injury (ABI) is a major cause of disability in Canada. Timely access to inpatient ABI rehabilitation is associated with improved outcomes at the patient, system, and societal levels. **Problem**: Wait times to access the local inpatient ABI rehabilitation program by patients referred from community hospitals have been consistently greater than provincial targets and benchmarks.**Objective**: This initiative aimed to reduce the mean wait times from referral to admission by 30% (from 27 to 19 days) during the 12-month project period. The sub-aim was to concurrently achieve a reduction in the mean wait times for decisions from 9.5 to 5 days during the same period.**Methods**: A non-randomized time-series design was undertaken. Baseline and post-intervention wait times were obtained from patient intake charts. Process mapping, value analysis, and 5-why analysis were used to identify root causes for delays in the intake process. Referring hospital staff and the ABI rehab interdisciplinary team members were engaged in change idea development and refinement. Iterative Plan-Do-Study-Act cycles were used to improve the change ideas’ usability and uptake. Data analysis was performed using the QI Macros package in Microsoft Excel.**Results**: Root causes for delays in the intake process included frequent incomplete referrals due to unclear and inaccessible admission criteria, variability in the intake process, and limitations in rehab bed availability. Two change ideas were introduced: i) a standardized intake protocol, and ii) a referral checklist to assist referring hospitals in completing referrals based on updated admission criteria. The fidelity for the standardized intake protocol was consistently above 70% but was variable for the referral checklist, with identified barriers including a lack of a centralized communication system through which to provide education and awareness about the checklist. Balancing measures (staff workload and satisfaction level with the intake process) remained stable. Within 3 months, the mean decision wait times were reduced to 4 days (58% reduction), and the mean admission wait times were reduced to 12 days (54% reduction). Wait time variability also decreased.**Conclusion**: This initiative led to the systematic standardization of the admission criteria and intake process for the local ABI rehab program. Improvements surpassing the initial aims of this initiative were observed for decision and admission wait times and may inform future benchmarks. Sustainability efforts are ongoing. | Rebecca | Fleck | Regional Rehabilitation & Integrated Stroke Program, Adult Regional Care, Hamilton Health Sciences | |
| 0 | Reducing wait times for access to inpatient rehabilitation for patients with acquired brain injury: a quality improvement initiative | ["Brain Injuries", "Health Services Accessibility", "Quality Improvement", "Rehabilitation"] | Ramona Neferu, Rebecca Fleck, Justine Best | Resident Research Contest | **Background**: Acquired brain injury (ABI) is a major cause of disability in Canada. Timely access to inpatient ABI rehabilitation is associated with improved outcomes at the patient, system, and societal levels. **Problem**: Wait times to access the local inpatient ABI rehabilitation program by patients referred from community hospitals have been consistently greater than provincial targets and benchmarks.**Objective**: This initiative aimed to reduce the mean wait times from referral to admission by 30% (from 27 to 19 days) during the 12-month project period. The sub-aim was to concurrently achieve a reduction in the mean wait times for decisions from 9.5 to 5 days during the same period.**Methods**: A non-randomized time-series design was undertaken. Baseline and post-intervention wait times were obtained from patient intake charts. Process mapping, value analysis, and 5-why analysis were used to identify root causes for delays in the intake process. Referring hospital staff and the ABI rehab interdisciplinary team members were engaged in change idea development and refinement. Iterative Plan-Do-Study-Act cycles were used to improve the change ideas’ usability and uptake. Data analysis was performed using the QI Macros package in Microsoft Excel.**Results**: Root causes for delays in the intake process included frequent incomplete referrals due to unclear and inaccessible admission criteria, variability in the intake process, and limitations in rehab bed availability. Two change ideas were introduced: i) a standardized intake protocol, and ii) a referral checklist to assist referring hospitals in completing referrals based on updated admission criteria. The fidelity for the standardized intake protocol was consistently above 70% but was variable for the referral checklist, with identified barriers including a lack of a centralized communication system through which to provide education and awareness about the checklist. Balancing measures (staff workload and satisfaction level with the intake process) remained stable. Within 3 months, the mean decision wait times were reduced to 4 days (58% reduction), and the mean admission wait times were reduced to 12 days (54% reduction). Wait time variability also decreased.**Conclusion**: This initiative led to the systematic standardization of the admission criteria and intake process for the local ABI rehab program. Improvements surpassing the initial aims of this initiative were observed for decision and admission wait times and may inform future benchmarks. Sustainability efforts are ongoing. | Ramona | Neferu | Physical Medicine and Rehabilitation, McMaster University | |
| 0 | The Role of Footwear, Foot Orthosis and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis | ["bone stress injury", "prevention", "footwear", "foot orthosis", "systematic review"] | Alexandre Lavigne, Dominic Chicoine, Jean-François Esculier, François Desmeules, Pierre Fremont, Blaise Dubois | Resident Research Contest |
Objective:To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design:Systematic review and meta-analysis. Data sources:Four bibliographic databases (from inception until November 2021):Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL.Eligibility criteria:Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results:Eleven studies were included in this systematic review and were all considered at high risk of bias. When wearing foot orthoses, the risk ratio of developing a BSI on any bone of the lower extremity is 0.47 (95% CI 0.26 to 0.87; p=0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p=0.79). The low number of studies prevented us from performing meta-analyses for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion:This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. |
Alexandre | Lavigne | Physiatry, Université de Montréal | |
| 0 | The Role of Footwear, Foot Orthosis and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis | ["bone stress injury", "prevention", "footwear", "foot orthosis", "systematic review"] | Alexandre Lavigne, Dominic Chicoine, Jean-François Esculier, François Desmeules, Pierre Fremont, Blaise Dubois | Resident Research Contest |
Objective:To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design:Systematic review and meta-analysis. Data sources:Four bibliographic databases (from inception until November 2021):Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL.Eligibility criteria:Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results:Eleven studies were included in this systematic review and were all considered at high risk of bias. When wearing foot orthoses, the risk ratio of developing a BSI on any bone of the lower extremity is 0.47 (95% CI 0.26 to 0.87; p=0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p=0.79). The low number of studies prevented us from performing meta-analyses for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion:This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. |
Blaise | Dubois | ||
| 0 | The Role of Footwear, Foot Orthosis and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis | ["bone stress injury", "prevention", "footwear", "foot orthosis", "systematic review"] | Alexandre Lavigne, Dominic Chicoine, Jean-François Esculier, François Desmeules, Pierre Fremont, Blaise Dubois | Resident Research Contest |
Objective:To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design:Systematic review and meta-analysis. Data sources:Four bibliographic databases (from inception until November 2021):Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL.Eligibility criteria:Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results:Eleven studies were included in this systematic review and were all considered at high risk of bias. When wearing foot orthoses, the risk ratio of developing a BSI on any bone of the lower extremity is 0.47 (95% CI 0.26 to 0.87; p=0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p=0.79). The low number of studies prevented us from performing meta-analyses for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion:This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. |
Pierre | Fremont | ||
| 0 | The Role of Footwear, Foot Orthosis and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis | ["bone stress injury", "prevention", "footwear", "foot orthosis", "systematic review"] | Alexandre Lavigne, Dominic Chicoine, Jean-François Esculier, François Desmeules, Pierre Fremont, Blaise Dubois | Resident Research Contest |
Objective:To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design:Systematic review and meta-analysis. Data sources:Four bibliographic databases (from inception until November 2021):Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL.Eligibility criteria:Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results:Eleven studies were included in this systematic review and were all considered at high risk of bias. When wearing foot orthoses, the risk ratio of developing a BSI on any bone of the lower extremity is 0.47 (95% CI 0.26 to 0.87; p=0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p=0.79). The low number of studies prevented us from performing meta-analyses for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion:This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. |
François | Desmeules | ||
| 0 | The Role of Footwear, Foot Orthosis and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis | ["bone stress injury", "prevention", "footwear", "foot orthosis", "systematic review"] | Alexandre Lavigne, Dominic Chicoine, Jean-François Esculier, François Desmeules, Pierre Fremont, Blaise Dubois | Resident Research Contest |
Objective:To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design:Systematic review and meta-analysis. Data sources:Four bibliographic databases (from inception until November 2021):Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL.Eligibility criteria:Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results:Eleven studies were included in this systematic review and were all considered at high risk of bias. When wearing foot orthoses, the risk ratio of developing a BSI on any bone of the lower extremity is 0.47 (95% CI 0.26 to 0.87; p=0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p=0.79). The low number of studies prevented us from performing meta-analyses for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion:This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. |
Jean-François | Esculier | ||
| 0 | The Role of Footwear, Foot Orthosis and Training-Related Strategies in the Prevention of Bone Stress Injuries: A Systematic Review and Meta-Analysis | ["bone stress injury", "prevention", "footwear", "foot orthosis", "systematic review"] | Alexandre Lavigne, Dominic Chicoine, Jean-François Esculier, François Desmeules, Pierre Fremont, Blaise Dubois | Resident Research Contest |
Objective:To evaluate the effectiveness of footwear, foot orthoses and training-related strategies to prevent lower extremity bone stress injury (BSI). Design:Systematic review and meta-analysis. Data sources:Four bibliographic databases (from inception until November 2021):Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE and CINAHL.Eligibility criteria:Randomised controlled trials (RCTs) that assessed the risk of developing a BSI when using particular footwear, foot orthoses or training-related strategies such as muscle strengthening, stretching, and mechanical loading exercises. Results:Eleven studies were included in this systematic review and were all considered at high risk of bias. When wearing foot orthoses, the risk ratio of developing a BSI on any bone of the lower extremity is 0.47 (95% CI 0.26 to 0.87; p=0.02). When doing pre-exercise dynamic stretching, the risk ratio of suffering a tibial BSI is 1.06 (95% CI 0.67 to 1.68; p=0.79). The low number of studies prevented us from performing meta-analyses for footwear or training-related strategies. The quality of evidence for all these results is low considering the high risk of bias in each study, the low number of studies and the low number of cases in each study. Conclusion:This systematic review reveals the lack of high-quality studies in BSI prevention. Based on studies at high risk of bias, foot orthoses could potentially help prevent BSIs in the military setting. It is still unknown whether footwear and training-related strategies have any benefits. It is crucial to further investigate potential BSI prevention strategies in women and athletes. Research is also needed to assess the influence of running shoes and loading management on BSI incidence. |
Dominic | Chicoine | ||
| 0 | The importance of timely access to electrodiagnostic testing in inpatient rehabilitation, as demonstrated by a case of closely synchronous bilateral foot drop. | ["Electromyography", "Peroneal Neuropathies"] | Geoffrey Hartin | Resident Research Contest |
Context:A 60-year-old female with a complex medical history including Ehlers-Danlos syndrome was admitted to the inpatient Acquired Brain Injury Rehabilitation service at Hennick Bridgepoint Hospital, after undergoing a PCOMM aneurysm repair two weeks prior. On admission, she endorsed a few-day history of new numbness and tingling in the left lateral leg with footdrop. Two weeks later, she suddenly developed similar symptoms in the contralateral leg, including a dense foot drop, without an identifiable trigger or new injury. She was transferred to the Emergency Department for further investigation, where an MRI revealed multilevel spondylosis of the lumbosacral spine. The Spine service queried a diagnosis of bilateral lumbosacral polyradiculopathy and offered surgical decompression, but the patient elected to defer surgery until she could discuss treatment further with her inpatient rehabilitation team. She was seen in EMG clinic three days later.Findings:In clinic, she endorsed persisting bilateral foot drop with numbness and paresthesiae in her anterolateral legs radiating to the dorsal aspects of the feet. She denied back pain, clear radicular symptoms, or bowel/bladder symptoms. On examination, she exhibited a bilateral high steppage gait, with 1/5 MRC grade strength in bilateral ankle/great toe dorsiflexion and ankle eversion. Aside from mild give-way weakness in ankle inversion bilaterally, she had otherwise full lower extremity strength. Reflexes were present and symmetric. Electrodiagnostic evaluation revealed features consistent with bilateral fibular neuropathies at the fibular head, with conduction block. Needle EMG did not find further features suggestive of a significant lumbosacral radiculopathy or other causes of bilateral foot drop.Conclusion/clinical relevance:Closely synchronous bilateral foot drop is rare but may occur due to central and peripheral causes. In this patient, electrodiagnostic evaluation was able to identify bilateral fibular neuropathies localized to the fibular heads, and in conjunction with imaging, ruled out polyradiculopathy or a central cause. Considering these findings, spine surgery was no longer felt to be indicated, and a targeted management plan was recommended. This case highlights the importance of timely access to NCS/EMG testing in the inpatient rehab setting, as it directly influenced management, and potentially prevented a likely unnecessary spinal surgery in a patient with multiple comorbidities. |
Geoffrey | Hartin | Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto | |
| 1 | A Comparison of the Effectiveness and Procedural Characteristics of Cervical Facet Joint Radiofrequency Neurotomy Using a Multitined (Trident) Cannula versus Conventional Monopolar Cannula | ["interventions", "physiatry", "pain"] | shyane wiegers, Ashley Smith, Robert Burnham | Abstract |
Background:cervical facet radiofrequency neurotomy (CRFN) is a common procedure used to treat refractory cervical facet pain. The traditional method uses a monopolar cannula and a parallel approach to the medial branch nerves of the facet joints. The development and configuration of a multitined (Trident) cannula allows for a perpendicular approach to the medial branch nerves that may carry potential procedural and safety advantages over the traditional method. The effectiveness and procedural characteristics of Trident CRFN have not been described or compared to the standard monopolar cannula.Objective:compare the effect of fluoroscopic guided CRFN using a Trident cannula and perpendicular approach to the conventional monopolar cannula with parallel approach on pain, disability, and quality of life. Compare the procedural characteristics of total procedure time and fluoroscopic exposure time of the two approaches.MethodsDesign:retrospective registry data audit of prospective CRFN cohort performed at two Alberta community multidisciplinary chronic musculoskeletal pain clinics between 2003-2009 (monopolar) and 2016-2021 (Trident).Selection criteria:facetogenic neck pain confirmed by ≥50% pain relief following dual or single medial branch block(s).Interventions:first time fluoroscopically guided CRFN targeting the same facet joint(s) performed with either the conventional monopolar cannula with a parallel approach to the nerve or with the Trident cannula and a perpendicular approach to the nerve by the same interventional physiatrist. Lesion temperature was 80°C and duration was two minutes.Outcome measures:Effectiveness of CRFN: Pre-and three-month post-CRFN numerical rating scale of pain intensity and Pain Disability Quality-Of-Life Questionnaire-Spine score. Procedural characteristics:** total procedure and fluoroscopy exposure time.Data analysis:linear mixed models to assess the interactive effect of group (type of cannula) over time for each of the primary outcome measures. Procedure time and fluoroscopic exposure time were evaluated via linear regression.Results:147 people were included in the study (mean age = 56.9 ± 12.4 (SD) years; 57% female).When controlling for age, working status, number of levels performed and baseline pain, there was a significant group time effect, with people receiving cervical RFN using the Trident cannula reporting a greater reduction in pain [F(1,288) = 12.4, p < 0.001] and PDQQ scores [F(1,288) = 9.01, p = 0.003] over time compared to those performed with the monopolar cannula. CRFN was quicker to perform [12.1 min (± 5.4) vs 35.0 min (± 14.3), p<0.001]; with less fluoroscopy time required [(34.7 sec (± 16.6) vs. 100.4 sec(± 61.4), p<0.001] with the Trident cannula per facet joint performed. Conclusions:There was a significantly greater reduction in perceived pain, disability, and quality of life disruption, as well as reduced procedure time and less fluoroscopic exposure in those who received CRFN with the Trident cannula. CRFN with the Trident cannula and perpendicular approach appears to be a more effective, quick, and safe (less radiation) procedure than the traditional monopolar cannula with parallel approach. |
shyane | wiegers | Physical Medicine and Rehabilitation, University of Calgary | |
| 1 | A Comparison of the Effectiveness and Procedural Characteristics of Cervical Facet Joint Radiofrequency Neurotomy Using a Multitined (Trident) Cannula versus Conventional Monopolar Cannula | ["interventions", "physiatry", "pain"] | shyane wiegers, Ashley Smith, Robert Burnham | Abstract |
Background:cervical facet radiofrequency neurotomy (CRFN) is a common procedure used to treat refractory cervical facet pain. The traditional method uses a monopolar cannula and a parallel approach to the medial branch nerves of the facet joints. The development and configuration of a multitined (Trident) cannula allows for a perpendicular approach to the medial branch nerves that may carry potential procedural and safety advantages over the traditional method. The effectiveness and procedural characteristics of Trident CRFN have not been described or compared to the standard monopolar cannula.Objective:compare the effect of fluoroscopic guided CRFN using a Trident cannula and perpendicular approach to the conventional monopolar cannula with parallel approach on pain, disability, and quality of life. Compare the procedural characteristics of total procedure time and fluoroscopic exposure time of the two approaches.MethodsDesign:retrospective registry data audit of prospective CRFN cohort performed at two Alberta community multidisciplinary chronic musculoskeletal pain clinics between 2003-2009 (monopolar) and 2016-2021 (Trident).Selection criteria:facetogenic neck pain confirmed by ≥50% pain relief following dual or single medial branch block(s).Interventions:first time fluoroscopically guided CRFN targeting the same facet joint(s) performed with either the conventional monopolar cannula with a parallel approach to the nerve or with the Trident cannula and a perpendicular approach to the nerve by the same interventional physiatrist. Lesion temperature was 80°C and duration was two minutes.Outcome measures:Effectiveness of CRFN: Pre-and three-month post-CRFN numerical rating scale of pain intensity and Pain Disability Quality-Of-Life Questionnaire-Spine score. Procedural characteristics:** total procedure and fluoroscopy exposure time.Data analysis:linear mixed models to assess the interactive effect of group (type of cannula) over time for each of the primary outcome measures. Procedure time and fluoroscopic exposure time were evaluated via linear regression.Results:147 people were included in the study (mean age = 56.9 ± 12.4 (SD) years; 57% female).When controlling for age, working status, number of levels performed and baseline pain, there was a significant group time effect, with people receiving cervical RFN using the Trident cannula reporting a greater reduction in pain [F(1,288) = 12.4, p < 0.001] and PDQQ scores [F(1,288) = 9.01, p = 0.003] over time compared to those performed with the monopolar cannula. CRFN was quicker to perform [12.1 min (± 5.4) vs 35.0 min (± 14.3), p<0.001]; with less fluoroscopy time required [(34.7 sec (± 16.6) vs. 100.4 sec(± 61.4), p<0.001] with the Trident cannula per facet joint performed. Conclusions:There was a significantly greater reduction in perceived pain, disability, and quality of life disruption, as well as reduced procedure time and less fluoroscopic exposure in those who received CRFN with the Trident cannula. CRFN with the Trident cannula and perpendicular approach appears to be a more effective, quick, and safe (less radiation) procedure than the traditional monopolar cannula with parallel approach. |
Ashley | Smith | Vivo Cura Clinic, Calgary Alberta | |
| 1 | A Comparison of the Effectiveness and Procedural Characteristics of Cervical Facet Joint Radiofrequency Neurotomy Using a Multitined (Trident) Cannula versus Conventional Monopolar Cannula | ["interventions", "physiatry", "pain"] | shyane wiegers, Ashley Smith, Robert Burnham | Abstract |
Background:cervical facet radiofrequency neurotomy (CRFN) is a common procedure used to treat refractory cervical facet pain. The traditional method uses a monopolar cannula and a parallel approach to the medial branch nerves of the facet joints. The development and configuration of a multitined (Trident) cannula allows for a perpendicular approach to the medial branch nerves that may carry potential procedural and safety advantages over the traditional method. The effectiveness and procedural characteristics of Trident CRFN have not been described or compared to the standard monopolar cannula.Objective:compare the effect of fluoroscopic guided CRFN using a Trident cannula and perpendicular approach to the conventional monopolar cannula with parallel approach on pain, disability, and quality of life. Compare the procedural characteristics of total procedure time and fluoroscopic exposure time of the two approaches.MethodsDesign:retrospective registry data audit of prospective CRFN cohort performed at two Alberta community multidisciplinary chronic musculoskeletal pain clinics between 2003-2009 (monopolar) and 2016-2021 (Trident).Selection criteria:facetogenic neck pain confirmed by ≥50% pain relief following dual or single medial branch block(s).Interventions:first time fluoroscopically guided CRFN targeting the same facet joint(s) performed with either the conventional monopolar cannula with a parallel approach to the nerve or with the Trident cannula and a perpendicular approach to the nerve by the same interventional physiatrist. Lesion temperature was 80°C and duration was two minutes.Outcome measures:Effectiveness of CRFN: Pre-and three-month post-CRFN numerical rating scale of pain intensity and Pain Disability Quality-Of-Life Questionnaire-Spine score. Procedural characteristics:** total procedure and fluoroscopy exposure time.Data analysis:linear mixed models to assess the interactive effect of group (type of cannula) over time for each of the primary outcome measures. Procedure time and fluoroscopic exposure time were evaluated via linear regression.Results:147 people were included in the study (mean age = 56.9 ± 12.4 (SD) years; 57% female).When controlling for age, working status, number of levels performed and baseline pain, there was a significant group time effect, with people receiving cervical RFN using the Trident cannula reporting a greater reduction in pain [F(1,288) = 12.4, p < 0.001] and PDQQ scores [F(1,288) = 9.01, p = 0.003] over time compared to those performed with the monopolar cannula. CRFN was quicker to perform [12.1 min (± 5.4) vs 35.0 min (± 14.3), p<0.001]; with less fluoroscopy time required [(34.7 sec (± 16.6) vs. 100.4 sec(± 61.4), p<0.001] with the Trident cannula per facet joint performed. Conclusions:There was a significantly greater reduction in perceived pain, disability, and quality of life disruption, as well as reduced procedure time and less fluoroscopic exposure in those who received CRFN with the Trident cannula. CRFN with the Trident cannula and perpendicular approach appears to be a more effective, quick, and safe (less radiation) procedure than the traditional monopolar cannula with parallel approach. |
Robert | Burnham | Physical Medicine and Rehabilitation, University of Alberta | |
| 1 | A National Virtual Physiatry Quality Improvement Forum to Enhance Resident QI Education | ["formative feedback", "internship and residency", "curriculum", "quality improvement", "physical medicine and rehabilitation"] | Jing Shi, Alexander Lo | 2nd place, quality improvement | Abstract |
Objective:Formative feedback is recognized as an important component of resident quality improvement (QI) education, yet opportunities for feedback are limited in many Canadian physiatry residency programs due to small numbers of QI experts within individual institutions. An annual National Virtual Physiatry Resident QI Forum was created with the aim of enhancing Canadian physiatry residency QI education by bringing together physiatry residents working on QI projects with QI experts from across Canada.Methods:All Canadian physiatry residency programs were invited to have their residents present their QI projects at the forum. Members of the Canadian Association of Physical Medicine and Rehabilitation (CAPMR) QI Special Interest Group were invited to participate as QI experts. The QI forum was held on Zoom with two breakout rooms to allow for small group discussion. Residents presented their QI projects to peers and physiatry faculty with QI expertise. Project feedback was provided with the goals of identifying actionable steps towards more robust application of QI concepts and tools, enhancing QI project success, and identifying suitability for academic dissemination. The participants completed an anonymized survey to evaluate satisfaction and perceived value of the virtual forum in improving their current QI education.Results:16 residents and 13 faculty members from 7 Canadian physiatry programs participated in the virtual forum. Survey completion rate was 11/16 (69%) for residents and 6/13 (46%) for faculty. Almost all participants (94%) were satisfied with the QI forum and felt it enhanced their program’s own QI curriculum. 76% felt more knowledgeable and confident in applying QI concepts and tools. 100% felt there was sufficient time allocated for interaction. Qualitatively, residents found the feedback on the scope of their project, knowledge translation strategies, publication considerations, project communication, and project write-up to be particularly helpful. In addition, the QI form provided a "safe space" to share QI work and helped to generate ideas for future QI projects, while providing residents the opportunity to learn about the QI process from start to finish. Lastly, participants appreciated being able to connect with and learn from other physiatrists and residents from across Canada, indicating its value as an informal physiatry networking event. Future recommendations for improving the QI forum include having the opportunity to see all projects, attaching a QI educational session to the forum, and bringing awareness of the forum to the broader CAPMR community.Conclusion:A National Virtual Resident QI forum is a feasible and simple solution to enhance resident QI training with high levels of satisfaction and perceived value amongst the participants. With increased familiarity with virtual platforms since the COVID-19 pandemic, the concept of bringing QI experts together virtually to provide formative feedback on QI projects can be considered in similar residency programs. |
Alexander | Lo | University of Toronto |
| 1 | A National Virtual Physiatry Quality Improvement Forum to Enhance Resident QI Education | ["formative feedback", "internship and residency", "curriculum", "quality improvement", "physical medicine and rehabilitation"] | Jing Shi, Alexander Lo | 2nd place, quality improvement | Abstract |
Objective:Formative feedback is recognized as an important component of resident quality improvement (QI) education, yet opportunities for feedback are limited in many Canadian physiatry residency programs due to small numbers of QI experts within individual institutions. An annual National Virtual Physiatry Resident QI Forum was created with the aim of enhancing Canadian physiatry residency QI education by bringing together physiatry residents working on QI projects with QI experts from across Canada.Methods:All Canadian physiatry residency programs were invited to have their residents present their QI projects at the forum. Members of the Canadian Association of Physical Medicine and Rehabilitation (CAPMR) QI Special Interest Group were invited to participate as QI experts. The QI forum was held on Zoom with two breakout rooms to allow for small group discussion. Residents presented their QI projects to peers and physiatry faculty with QI expertise. Project feedback was provided with the goals of identifying actionable steps towards more robust application of QI concepts and tools, enhancing QI project success, and identifying suitability for academic dissemination. The participants completed an anonymized survey to evaluate satisfaction and perceived value of the virtual forum in improving their current QI education.Results:16 residents and 13 faculty members from 7 Canadian physiatry programs participated in the virtual forum. Survey completion rate was 11/16 (69%) for residents and 6/13 (46%) for faculty. Almost all participants (94%) were satisfied with the QI forum and felt it enhanced their program’s own QI curriculum. 76% felt more knowledgeable and confident in applying QI concepts and tools. 100% felt there was sufficient time allocated for interaction. Qualitatively, residents found the feedback on the scope of their project, knowledge translation strategies, publication considerations, project communication, and project write-up to be particularly helpful. In addition, the QI form provided a "safe space" to share QI work and helped to generate ideas for future QI projects, while providing residents the opportunity to learn about the QI process from start to finish. Lastly, participants appreciated being able to connect with and learn from other physiatrists and residents from across Canada, indicating its value as an informal physiatry networking event. Future recommendations for improving the QI forum include having the opportunity to see all projects, attaching a QI educational session to the forum, and bringing awareness of the forum to the broader CAPMR community.Conclusion:A National Virtual Resident QI forum is a feasible and simple solution to enhance resident QI training with high levels of satisfaction and perceived value amongst the participants. With increased familiarity with virtual platforms since the COVID-19 pandemic, the concept of bringing QI experts together virtually to provide formative feedback on QI projects can be considered in similar residency programs. |
Jing | Shi | University of Saskatchewan |
| 1 | A qualitative study of resident experiences of vulnerability in postgraduate medical education | ["Competency-based education", "Graduate medical education", "Internship and residency", "Interpersonal relations", "Social environment"] | Heather Nichol, Jennifer Turnnidge, Nancy Dalgarno, Jessica Trier | 3rd place, education | Abstract |
Context:Vulnerability plays an important role in residency education. Although vulnerability can help to facilitate learning and growth, expressing vulnerability in competency-based educational contexts can be challenging. As such, this study aims to understand residents’ experiences of vulnerability and identify the factors that influence vulnerability in residency education. Methods:Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Themes were identified and their relationships were examined using the constant comparative method of analysis. Results:Three themes were developed to represent participants’ experiences of vulnerability in residency:(a) Courage in the face of uncertainty, (b) Worth the risk?, and (c) A double-edged sword. Vulnerability was described as a relational process shaped by personal, social, and contextual influences. Residents viewed vulnerability as a fundamental cornerstone of learning and growth, that can be both valuable and challenging. Given the risks and uncertainties involved, residents engaged in reflective processes before expressing vulnerability. The sociocultural context of residency (e.g., assessment approaches, views on professionalism) influenced residents’ intentions to engage in vulnerability. For instance, tensions existed between expressing vulnerability to foster learning and demonstrating competence to achieve entrustment. Social agents, such as clinical teachers and peers, shaped both the experience of, and outcomes derived from, vulnerability. The positive or negative influence of vulnerability on professional and personal outcomes was thus contingent on the nature of the task, and the social and environmental contexts in which it was experienced.Conclusion:This study positions residents as active agents in their learning, who reflect on the potential benefits and risks of vulnerability. The results can inform how vulnerability can be understood and experienced in residency education. These findings capture the nuance and complexity of vulnerability in residency and the need to create supportive learning environments that leverage the value of vulnerability while acknowledging its risks. |
Nancy | Dalgarno | Office of Professional Development and Education Scholarship, Queen's University |
| 1 | A qualitative study of resident experiences of vulnerability in postgraduate medical education | ["Competency-based education", "Graduate medical education", "Internship and residency", "Interpersonal relations", "Social environment"] | Heather Nichol, Jennifer Turnnidge, Nancy Dalgarno, Jessica Trier | 3rd place, education | Abstract |
Context:Vulnerability plays an important role in residency education. Although vulnerability can help to facilitate learning and growth, expressing vulnerability in competency-based educational contexts can be challenging. As such, this study aims to understand residents’ experiences of vulnerability and identify the factors that influence vulnerability in residency education. Methods:Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Themes were identified and their relationships were examined using the constant comparative method of analysis. Results:Three themes were developed to represent participants’ experiences of vulnerability in residency:(a) Courage in the face of uncertainty, (b) Worth the risk?, and (c) A double-edged sword. Vulnerability was described as a relational process shaped by personal, social, and contextual influences. Residents viewed vulnerability as a fundamental cornerstone of learning and growth, that can be both valuable and challenging. Given the risks and uncertainties involved, residents engaged in reflective processes before expressing vulnerability. The sociocultural context of residency (e.g., assessment approaches, views on professionalism) influenced residents’ intentions to engage in vulnerability. For instance, tensions existed between expressing vulnerability to foster learning and demonstrating competence to achieve entrustment. Social agents, such as clinical teachers and peers, shaped both the experience of, and outcomes derived from, vulnerability. The positive or negative influence of vulnerability on professional and personal outcomes was thus contingent on the nature of the task, and the social and environmental contexts in which it was experienced.Conclusion:This study positions residents as active agents in their learning, who reflect on the potential benefits and risks of vulnerability. The results can inform how vulnerability can be understood and experienced in residency education. These findings capture the nuance and complexity of vulnerability in residency and the need to create supportive learning environments that leverage the value of vulnerability while acknowledging its risks. |
Jessica | Trier | Department of Physical Medicine and Rehabilitation, Queen's University; Department of Physical Medicine and Rehabilitation, Providence Care Hospital |
| 1 | A qualitative study of resident experiences of vulnerability in postgraduate medical education | ["Competency-based education", "Graduate medical education", "Internship and residency", "Interpersonal relations", "Social environment"] | Heather Nichol, Jennifer Turnnidge, Nancy Dalgarno, Jessica Trier | 3rd place, education | Abstract |
Context:Vulnerability plays an important role in residency education. Although vulnerability can help to facilitate learning and growth, expressing vulnerability in competency-based educational contexts can be challenging. As such, this study aims to understand residents’ experiences of vulnerability and identify the factors that influence vulnerability in residency education. Methods:Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Themes were identified and their relationships were examined using the constant comparative method of analysis. Results:Three themes were developed to represent participants’ experiences of vulnerability in residency:(a) Courage in the face of uncertainty, (b) Worth the risk?, and (c) A double-edged sword. Vulnerability was described as a relational process shaped by personal, social, and contextual influences. Residents viewed vulnerability as a fundamental cornerstone of learning and growth, that can be both valuable and challenging. Given the risks and uncertainties involved, residents engaged in reflective processes before expressing vulnerability. The sociocultural context of residency (e.g., assessment approaches, views on professionalism) influenced residents’ intentions to engage in vulnerability. For instance, tensions existed between expressing vulnerability to foster learning and demonstrating competence to achieve entrustment. Social agents, such as clinical teachers and peers, shaped both the experience of, and outcomes derived from, vulnerability. The positive or negative influence of vulnerability on professional and personal outcomes was thus contingent on the nature of the task, and the social and environmental contexts in which it was experienced.Conclusion:This study positions residents as active agents in their learning, who reflect on the potential benefits and risks of vulnerability. The results can inform how vulnerability can be understood and experienced in residency education. These findings capture the nuance and complexity of vulnerability in residency and the need to create supportive learning environments that leverage the value of vulnerability while acknowledging its risks. |
Jennifer | Turnnidge | Office of Professional Development and Education Scholarship, Queen's University |
| 1 | A qualitative study of resident experiences of vulnerability in postgraduate medical education | ["Competency-based education", "Graduate medical education", "Internship and residency", "Interpersonal relations", "Social environment"] | Heather Nichol, Jennifer Turnnidge, Nancy Dalgarno, Jessica Trier | 3rd place, education | Abstract |
Context:Vulnerability plays an important role in residency education. Although vulnerability can help to facilitate learning and growth, expressing vulnerability in competency-based educational contexts can be challenging. As such, this study aims to understand residents’ experiences of vulnerability and identify the factors that influence vulnerability in residency education. Methods:Using a constructivist grounded theory approach, individual semi-structured interviews were conducted with 15 residents from 10 different specialities. Themes were identified and their relationships were examined using the constant comparative method of analysis. Results:Three themes were developed to represent participants’ experiences of vulnerability in residency:(a) Courage in the face of uncertainty, (b) Worth the risk?, and (c) A double-edged sword. Vulnerability was described as a relational process shaped by personal, social, and contextual influences. Residents viewed vulnerability as a fundamental cornerstone of learning and growth, that can be both valuable and challenging. Given the risks and uncertainties involved, residents engaged in reflective processes before expressing vulnerability. The sociocultural context of residency (e.g., assessment approaches, views on professionalism) influenced residents’ intentions to engage in vulnerability. For instance, tensions existed between expressing vulnerability to foster learning and demonstrating competence to achieve entrustment. Social agents, such as clinical teachers and peers, shaped both the experience of, and outcomes derived from, vulnerability. The positive or negative influence of vulnerability on professional and personal outcomes was thus contingent on the nature of the task, and the social and environmental contexts in which it was experienced.Conclusion:This study positions residents as active agents in their learning, who reflect on the potential benefits and risks of vulnerability. The results can inform how vulnerability can be understood and experienced in residency education. These findings capture the nuance and complexity of vulnerability in residency and the need to create supportive learning environments that leverage the value of vulnerability while acknowledging its risks. |
Heather | Nichol | Department of Physical Medicine and Rehabilitation, Queen's University |
| 1 | Achilles tendons change shape after 21 days of bedrest | ["Tendons", "Bed Rest", "Magnetic Resonance Imaging"] | T Mark Campbell, Charles Godbout, Guy Trudel | Abstract |
Context/objective:Following a period of immobility, the Achilles tendon is at-risk of rupture once returning to activity, but clinical risk indicators are lacking. Whether an alkalinized whey protein diet influences Achilles tendon rupture vulnerability is unknown. We assessed morphometric changes in Achilles tendon before, during, and following 21 days bedrest and evaluated whether whey protein diet could counteract immobility-associated changes.Design:Prospective randomized control trial with cross-over design evaluating two groups (control versus intervention), registered on clinicaltrials.gov (NCT01655979). All participants provided written informed consent. Both groups underwent seven days of environmental and dietary adaptation, followed by 21 days of 6° head-down tilt (HDT) bedrest (24 hours/day) and 5 days of within-institution reambulation.Setting:German Aerospace Center in Cologne, GermanyParticipants:Ten healthy male volunteers.Intervention:Alkalinized whey-supplemented diet - 0.6g of whey protein/kg body weight/day and 90mmol of KHCO3/day.Outcome measures:Measurement of width, depth, and cross-sectional area at 2, 4,and 6 cm from the insertion of the Achilles tendon on the calcaneus, as well as tendon volume calculation, using magnetic resonance (MR) imaging. Time points included baseline data collection (BDC), bedrest day 10 and 20 (HDT10, HDT20), reambulation day 3 and 28 (R3, R28)Results:Results are summarized in Tables 1 and 2. There was an increase in width at 2cm from HDT10 (mean 15.6[14.6, 16.7]) versus R3 (17.1[16.4, 17.8]; p=0.005) and R28 (16.9[16.0, 17.7]; p=0.005). There was also an increase from HDT20 (15.7[14.6, 16.7]) to R3 (p=0.045). For width at 4cm, there was a decrease from BDC (12.4[11.8,12.9]) to HDT10 (11.4[10.9,12.0]; p=0.003), with recovery at the proceeding timepoints. For depth at 4cm, there was a decrease from the immobilization periods to the recovery periods that exceeded BDC:** R3 (5.3[5.0,5.5]) versus BDC (5.5[5.2,5.8]; p=0.030) and R28 (5.3, [5.0,5.5]) versus BDC (p=0.039). CSA and volume did not change at any level. The diet intervention did not show any consistent effect on Achilles tendon dimensions.Conclusions:Following two consecutive periods of 21 days bedrest, Achilles tendons demonstrated characteristic changes in shape, without volume change on MR. The observed shape change may constitute a risk of rupture at remobilization, detectable with serial MR imaging. |
Guy | Trudel | Bone and Joint Research Laboratory, The Ottawa Hospital Research Institute, Ottawa, Ontario, Canada | |
| 1 | Achilles tendons change shape after 21 days of bedrest | ["Tendons", "Bed Rest", "Magnetic Resonance Imaging"] | T Mark Campbell, Charles Godbout, Guy Trudel | Abstract |
Context/objective:Following a period of immobility, the Achilles tendon is at-risk of rupture once returning to activity, but clinical risk indicators are lacking. Whether an alkalinized whey protein diet influences Achilles tendon rupture vulnerability is unknown. We assessed morphometric changes in Achilles tendon before, during, and following 21 days bedrest and evaluated whether whey protein diet could counteract immobility-associated changes.Design:Prospective randomized control trial with cross-over design evaluating two groups (control versus intervention), registered on clinicaltrials.gov (NCT01655979). All participants provided written informed consent. Both groups underwent seven days of environmental and dietary adaptation, followed by 21 days of 6° head-down tilt (HDT) bedrest (24 hours/day) and 5 days of within-institution reambulation.Setting:German Aerospace Center in Cologne, GermanyParticipants:Ten healthy male volunteers.Intervention:Alkalinized whey-supplemented diet - 0.6g of whey protein/kg body weight/day and 90mmol of KHCO3/day.Outcome measures:Measurement of width, depth, and cross-sectional area at 2, 4,and 6 cm from the insertion of the Achilles tendon on the calcaneus, as well as tendon volume calculation, using magnetic resonance (MR) imaging. Time points included baseline data collection (BDC), bedrest day 10 and 20 (HDT10, HDT20), reambulation day 3 and 28 (R3, R28)Results:Results are summarized in Tables 1 and 2. There was an increase in width at 2cm from HDT10 (mean 15.6[14.6, 16.7]) versus R3 (17.1[16.4, 17.8]; p=0.005) and R28 (16.9[16.0, 17.7]; p=0.005). There was also an increase from HDT20 (15.7[14.6, 16.7]) to R3 (p=0.045). For width at 4cm, there was a decrease from BDC (12.4[11.8,12.9]) to HDT10 (11.4[10.9,12.0]; p=0.003), with recovery at the proceeding timepoints. For depth at 4cm, there was a decrease from the immobilization periods to the recovery periods that exceeded BDC:** R3 (5.3[5.0,5.5]) versus BDC (5.5[5.2,5.8]; p=0.030) and R28 (5.3, [5.0,5.5]) versus BDC (p=0.039). CSA and volume did not change at any level. The diet intervention did not show any consistent effect on Achilles tendon dimensions.Conclusions:Following two consecutive periods of 21 days bedrest, Achilles tendons demonstrated characteristic changes in shape, without volume change on MR. The observed shape change may constitute a risk of rupture at remobilization, detectable with serial MR imaging. |
Charles | Godbout | ||
| 1 | Achilles tendons change shape after 21 days of bedrest | ["Tendons", "Bed Rest", "Magnetic Resonance Imaging"] | T Mark Campbell, Charles Godbout, Guy Trudel | Abstract |
Context/objective:Following a period of immobility, the Achilles tendon is at-risk of rupture once returning to activity, but clinical risk indicators are lacking. Whether an alkalinized whey protein diet influences Achilles tendon rupture vulnerability is unknown. We assessed morphometric changes in Achilles tendon before, during, and following 21 days bedrest and evaluated whether whey protein diet could counteract immobility-associated changes.Design:Prospective randomized control trial with cross-over design evaluating two groups (control versus intervention), registered on clinicaltrials.gov (NCT01655979). All participants provided written informed consent. Both groups underwent seven days of environmental and dietary adaptation, followed by 21 days of 6° head-down tilt (HDT) bedrest (24 hours/day) and 5 days of within-institution reambulation.Setting:German Aerospace Center in Cologne, GermanyParticipants:Ten healthy male volunteers.Intervention:Alkalinized whey-supplemented diet - 0.6g of whey protein/kg body weight/day and 90mmol of KHCO3/day.Outcome measures:Measurement of width, depth, and cross-sectional area at 2, 4,and 6 cm from the insertion of the Achilles tendon on the calcaneus, as well as tendon volume calculation, using magnetic resonance (MR) imaging. Time points included baseline data collection (BDC), bedrest day 10 and 20 (HDT10, HDT20), reambulation day 3 and 28 (R3, R28)Results:Results are summarized in Tables 1 and 2. There was an increase in width at 2cm from HDT10 (mean 15.6[14.6, 16.7]) versus R3 (17.1[16.4, 17.8]; p=0.005) and R28 (16.9[16.0, 17.7]; p=0.005). There was also an increase from HDT20 (15.7[14.6, 16.7]) to R3 (p=0.045). For width at 4cm, there was a decrease from BDC (12.4[11.8,12.9]) to HDT10 (11.4[10.9,12.0]; p=0.003), with recovery at the proceeding timepoints. For depth at 4cm, there was a decrease from the immobilization periods to the recovery periods that exceeded BDC:** R3 (5.3[5.0,5.5]) versus BDC (5.5[5.2,5.8]; p=0.030) and R28 (5.3, [5.0,5.5]) versus BDC (p=0.039). CSA and volume did not change at any level. The diet intervention did not show any consistent effect on Achilles tendon dimensions.Conclusions:Following two consecutive periods of 21 days bedrest, Achilles tendons demonstrated characteristic changes in shape, without volume change on MR. The observed shape change may constitute a risk of rupture at remobilization, detectable with serial MR imaging. |
T Mark | Campbell | Physical Medicine and Rehabilitation, Élisabeth Bruyère Hospital | |
| 1 | Addressing Illicit Substance Use in an Inpatient Rehabilitation Setting: A Case Study. | ["Inpatients", "Rehabilitation", "Spinal Cord Injuries", "Substance-Related Disorders"] | Courtney Grotski, Karen Ethans | Abstract |
Objectives:Illustrate a case of illicit substance use in a rehabilitation inpatient setting in Winnipeg, Manitoba. Discuss risks associated with inpatient substance use. Review current hospital policies at our site and current rehabilitation literature on this topic.Context:A 25 year female T2 AIS A secondary to MRSA epidural abscess from rural Manitoba was admitted to inpatient rehabilitation in December 2021 following evacuation of abscess and laminectomy. After six months in rehab, the patient’s rehabilitation gains plateaued, and she become designated as ALC. Multiple discharge barriers existed, including her family’s inability to accommodate her complex care needs. A rural hospital site declined repatriation citing the same reason. She required full-time use of a power wheelchair for mobility, a two-person assist for mechanical lift transfers, and full assistance for bladder and bowel care. The patient declined placement to group housing.Results:While the patient was ALC, ward staff reported multiple events of her being off the ward for prolonged periods, contributing to adverse events in her care. Scheduled medication doses were missed. She developed infection from unknown sources requiring antibiotic therapy. She developed multiple new signs and symptoms requiring added work up and pharmacotherapy, including nausea, auditory hallucinations, tachycardia, and poor sleep. The ICU was consulted multiple times for management of autonomic dysreflexia from unknown triggers. At team rounds, it was suggested that a random drug screen be performed. The urine screen was positive for amphetamines and was suspected as the cause for her symptoms. With patient consent, addiction services were consulted but she frequently was off the ward during their visits.Discussion:Issues with inpatient illicit drug use are multiple, including direct harm, incorrect workup and treatments, interactions, use of hospital resources, and safety of staff and other inpatients. This is balanced with patient autonomy. There is a paucity of published literature of management of inpatient substance use in rehab settings. No formal policies at our center exist regarding inpatient illicit substance use.Conclusions:Hospital policymakers should implement comprehensive harm reduction strategies while ensuring patient respect and empathy. Many hospitals do not have policies about in-hospital illicit substance use and, if they do, clinicians are often unaware of them. More research is needed to better understand and manage in-hospital illicit substance use. |
Karen | Ethans | Physical Medicine and Rehabilitation, University of Manitoba | |
| 1 | Addressing Illicit Substance Use in an Inpatient Rehabilitation Setting: A Case Study. | ["Inpatients", "Rehabilitation", "Spinal Cord Injuries", "Substance-Related Disorders"] | Courtney Grotski, Karen Ethans | Abstract |
Objectives:Illustrate a case of illicit substance use in a rehabilitation inpatient setting in Winnipeg, Manitoba. Discuss risks associated with inpatient substance use. Review current hospital policies at our site and current rehabilitation literature on this topic.Context:A 25 year female T2 AIS A secondary to MRSA epidural abscess from rural Manitoba was admitted to inpatient rehabilitation in December 2021 following evacuation of abscess and laminectomy. After six months in rehab, the patient’s rehabilitation gains plateaued, and she become designated as ALC. Multiple discharge barriers existed, including her family’s inability to accommodate her complex care needs. A rural hospital site declined repatriation citing the same reason. She required full-time use of a power wheelchair for mobility, a two-person assist for mechanical lift transfers, and full assistance for bladder and bowel care. The patient declined placement to group housing.Results:While the patient was ALC, ward staff reported multiple events of her being off the ward for prolonged periods, contributing to adverse events in her care. Scheduled medication doses were missed. She developed infection from unknown sources requiring antibiotic therapy. She developed multiple new signs and symptoms requiring added work up and pharmacotherapy, including nausea, auditory hallucinations, tachycardia, and poor sleep. The ICU was consulted multiple times for management of autonomic dysreflexia from unknown triggers. At team rounds, it was suggested that a random drug screen be performed. The urine screen was positive for amphetamines and was suspected as the cause for her symptoms. With patient consent, addiction services were consulted but she frequently was off the ward during their visits.Discussion:Issues with inpatient illicit drug use are multiple, including direct harm, incorrect workup and treatments, interactions, use of hospital resources, and safety of staff and other inpatients. This is balanced with patient autonomy. There is a paucity of published literature of management of inpatient substance use in rehab settings. No formal policies at our center exist regarding inpatient illicit substance use.Conclusions:Hospital policymakers should implement comprehensive harm reduction strategies while ensuring patient respect and empathy. Many hospitals do not have policies about in-hospital illicit substance use and, if they do, clinicians are often unaware of them. More research is needed to better understand and manage in-hospital illicit substance use. |
Courtney | Grotski | Physical Medicine and Rehabilitation, University of Manitoba | |
| 1 | All falls are not created equal: Exploring the concept of a “Therapeutic Fall” in ABI Rehab | ["Accidental Falls", "Quality Improvement"] | Geoffrey Hartin | Abstract |
Context:Despite efforts towards a just culture, providers still feel shame when their patients fall and often adopt an excessively custodial approach to mobility. This is problematic in ABI Rehab where falls may be a natural outcome for patients striving towards greater independence. For this reason, through this project, we sought to propose an alternative narrative in which falls are not seen as something to be avoided at all costs. Instead, patients who understand and consent to the risks of falling would collaborate with their team to take goal-oriented risks during their rehabilitation. If a fall takes place in this context, it would be considered a “therapeutic fall” rather than an adverse event.Methods:We worked with an advisory group of patients, providers, and leaders to develop, pilot, and evaluate the concept of a "therapeutic fall" on two large ABI rehab units at Toronto Rehabilitation Institute. We defined a therapeutic fall as a fall that occurs during a higher-risk activity that a patient has chosen to participate in as part of their recovery. Interventions included holding interprofessional educational workshops for providers on pilot units, developing a standardized therapeutic falls shared decision-making form, integrating therapeutic falls into unit huddles and team rounds, and developing provider, patient, and family education resources and posters. Data on the project’s outcome, process and balancing measures were recorded and analyzed during the study period from January to December 2022.Results:Staff engagement for this initiative was very high with 96% of the interprofessional team attending the training workshops. The therapeutic falls pathway also became well integrated into team structures and processes. Twenty-one patients were started on the pathway during the study period, which met the target of >10% of patients being provided with the chance for shared decision-making about mobility. Of these patients, there were 5 therapeutic falls with no repeat falls or falls of harm. There was no special cause variation in the total number of falls before or during the pilot portion of the study.Conclusion:Our aim is to facilitate a care environment where values and potential conflicts about the benefits and challenges of risk-taking are recognized through shared decision-making with patients, families, and providers. This project proposes that patients living with brain injury can make shared decisions about risk in collaboration with their healthcare team to lay the foundation for a more prepared and safe discharge. |
Geoffrey | Hartin | Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto | |
| 1 | An arm and a leg: A case report of atypical Neuralgic Amyotrophy | ["Electrodiagnosis", "Mononeuritis multiplex", "Neuralgic amyotrophy"] | Marianne Nury, E. Ali Bateman | Abstract |
Context:Neuralgic amyotrophy (NA) is a rare condition classically described in the upper limb; in rare cases, lower extremity involvement has been described. To our knowledge, NA has never been described in a lower limb following a contralateral upper limb presentation.Findings:A 60-year-old woman with a history of hypertension and dyslipidemia was diagnosed with NA in the setting of right upper limb axonotmesis of the ulnar nerve distal to the flexor digitorum profundus. Her symptoms onset suddenly 6 months prior with severe pain in her right shoulder followed by weakness in her right hand. She was referred for assessment of surgical options in our multidisciplinary peripheral nerve clinic; on the date of assessment, she reported new, sudden onset severe burning pain in her left lateral knee 1 month prior, followed by a severe left drop. She had no systemic symptoms. Electrodiagnostic testing (EDX) confirmed axonotmesis of the right ulnar and left fibular nerves with no evidence of demyelination; EDX of the contralateral arm and leg were normal.In light of this new involvement, the differential diagnosis shifted from NA to mononeuritis multiplex. Bloodwork, including extended autoimmune workup, was normal. Sural nerve biopsy was normal. Chest radiography was normal. CT chest, abdomen, pelvis, and lower extremity CT angiography were normal. MRI cervical spine was noncontributory. Nerve ultrasound showed hourglass abnormalities for right ulnar and left fibular nerves at non-compression sites, consistent with NA. SEPT9 genetic testing is pending. According to all the findings, vasculitis was excluded and a diagnosis of NA was made. To improve her recovery, she underwent surgical decompression of the right ulnar nerve at the elbow, in the forearm, and at Guyon’s canal with a concurrent anterior interosseous end-to-side nerve transfer and decompression of the left fibular nerve distal to the head of the fibula. Conclusion:This case illustrates the importance of keeping in mind NA in the differential diagnosis of mononeuritis multiplex. In addition to diagnostic challenges, this case also raises questions of how to optimally manage persistent axonotmesis from NA. |
Marianne | Nury | Physical Medicine and Rehabilitation, Western University | |
| 1 | An arm and a leg: A case report of atypical Neuralgic Amyotrophy | ["Electrodiagnosis", "Mononeuritis multiplex", "Neuralgic amyotrophy"] | Marianne Nury, E. Ali Bateman | Abstract |
Context:Neuralgic amyotrophy (NA) is a rare condition classically described in the upper limb; in rare cases, lower extremity involvement has been described. To our knowledge, NA has never been described in a lower limb following a contralateral upper limb presentation.Findings:A 60-year-old woman with a history of hypertension and dyslipidemia was diagnosed with NA in the setting of right upper limb axonotmesis of the ulnar nerve distal to the flexor digitorum profundus. Her symptoms onset suddenly 6 months prior with severe pain in her right shoulder followed by weakness in her right hand. She was referred for assessment of surgical options in our multidisciplinary peripheral nerve clinic; on the date of assessment, she reported new, sudden onset severe burning pain in her left lateral knee 1 month prior, followed by a severe left drop. She had no systemic symptoms. Electrodiagnostic testing (EDX) confirmed axonotmesis of the right ulnar and left fibular nerves with no evidence of demyelination; EDX of the contralateral arm and leg were normal.In light of this new involvement, the differential diagnosis shifted from NA to mononeuritis multiplex. Bloodwork, including extended autoimmune workup, was normal. Sural nerve biopsy was normal. Chest radiography was normal. CT chest, abdomen, pelvis, and lower extremity CT angiography were normal. MRI cervical spine was noncontributory. Nerve ultrasound showed hourglass abnormalities for right ulnar and left fibular nerves at non-compression sites, consistent with NA. SEPT9 genetic testing is pending. According to all the findings, vasculitis was excluded and a diagnosis of NA was made. To improve her recovery, she underwent surgical decompression of the right ulnar nerve at the elbow, in the forearm, and at Guyon’s canal with a concurrent anterior interosseous end-to-side nerve transfer and decompression of the left fibular nerve distal to the head of the fibula. Conclusion:This case illustrates the importance of keeping in mind NA in the differential diagnosis of mononeuritis multiplex. In addition to diagnostic challenges, this case also raises questions of how to optimally manage persistent axonotmesis from NA. |
E. Ali | Bateman | Physical Medicine and Rehabilitation, Parkwood Institute; Physical Medicine and Rehabilitation, Western University | |
| 1 | Associations Between Somatic Symptom Disorder and Mild Traumatic Brain Injury: A Systematic Review | ["brain concussion", "conversion disorder"] | Kaiden Jobin, Alison Wilson, Regan King, Chantel T. Debert | 2nd place, systematic review | Abstract |
Context:Somatic symptom disorder (SSD) is characterized by a significant focus on a symptom such as pain, weakness or abnormal movement to the level that it disrupts function and results in major distress. While there is no known mechanism for SSD, an interplay between somatization symptoms and mild traumatic brain injury (mTBI) has been identified by previous literature.Objective:Complete a comprehensive systematic review of the associations between mTBI and somatization symptom disorders and report key findings.Methods:Searches for SSD and mTBI and related terms were performed and then combined in the following databases on January 10th, 2023: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, PsycINFO, Embase, and Scopus. The following criteria had to be met for inclusion: (a) human participants; (b) assessed with a measure of somatization; (c) mild traumatic brain injury; (d) published in a peer-reviewed journal; (e) completed by January 10th, 2023. The following data was extracted:** participant characteristics (age, sex, history of trauma as provided), injury characteristics (mechanism, time since injury, history of previous mTBI), mTBI assessment scores, somatization assessment scores, and assessment scores for any other psychiatric conditions (depression, anxiety, post-traumatic stress disorder). Each of these studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network (SIGN) criteria checklist for cohort studies.Results:Of twenty-nine included studies, ten studies found associations between atypical seizure-like symptoms (e.g., psychogenic non-epileptic seizures) and increased mTBI symptom burden. Thirteen studies found associations between other atypical symptoms (e.g., pain, numbness, visual disturbances) and mTBI symptom burden. Furthermore, three studies found associations between individuals with previous somatization disorders and increased mTBI symptom burden. The three remaining studies included did not find evidence for an association between somatization and mTBI. When considering the quality of evidence, many studies had a risk of bias rating of unacceptable (10/29) and few were considered high quality (4/29).Conclusion:Studies have shown a relationship between symptoms of somatization and mTBI indicating the potential comorbidity of these disorders. However, there are a limited number of high-quality studies currently available and as such, further research on this topic is needed. |
Regan | King | Clinical Neurosciences, University of Calgary |
| 1 | Associations Between Somatic Symptom Disorder and Mild Traumatic Brain Injury: A Systematic Review | ["brain concussion", "conversion disorder"] | Kaiden Jobin, Alison Wilson, Regan King, Chantel T. Debert | 2nd place, systematic review | Abstract |
Context:Somatic symptom disorder (SSD) is characterized by a significant focus on a symptom such as pain, weakness or abnormal movement to the level that it disrupts function and results in major distress. While there is no known mechanism for SSD, an interplay between somatization symptoms and mild traumatic brain injury (mTBI) has been identified by previous literature.Objective:Complete a comprehensive systematic review of the associations between mTBI and somatization symptom disorders and report key findings.Methods:Searches for SSD and mTBI and related terms were performed and then combined in the following databases on January 10th, 2023: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, PsycINFO, Embase, and Scopus. The following criteria had to be met for inclusion: (a) human participants; (b) assessed with a measure of somatization; (c) mild traumatic brain injury; (d) published in a peer-reviewed journal; (e) completed by January 10th, 2023. The following data was extracted:** participant characteristics (age, sex, history of trauma as provided), injury characteristics (mechanism, time since injury, history of previous mTBI), mTBI assessment scores, somatization assessment scores, and assessment scores for any other psychiatric conditions (depression, anxiety, post-traumatic stress disorder). Each of these studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network (SIGN) criteria checklist for cohort studies.Results:Of twenty-nine included studies, ten studies found associations between atypical seizure-like symptoms (e.g., psychogenic non-epileptic seizures) and increased mTBI symptom burden. Thirteen studies found associations between other atypical symptoms (e.g., pain, numbness, visual disturbances) and mTBI symptom burden. Furthermore, three studies found associations between individuals with previous somatization disorders and increased mTBI symptom burden. The three remaining studies included did not find evidence for an association between somatization and mTBI. When considering the quality of evidence, many studies had a risk of bias rating of unacceptable (10/29) and few were considered high quality (4/29).Conclusion:Studies have shown a relationship between symptoms of somatization and mTBI indicating the potential comorbidity of these disorders. However, there are a limited number of high-quality studies currently available and as such, further research on this topic is needed. |
Kaiden | Jobin | Clinical Neurosciences, University of Calgary |
| 1 | Associations Between Somatic Symptom Disorder and Mild Traumatic Brain Injury: A Systematic Review | ["brain concussion", "conversion disorder"] | Kaiden Jobin, Alison Wilson, Regan King, Chantel T. Debert | 2nd place, systematic review | Abstract |
Context:Somatic symptom disorder (SSD) is characterized by a significant focus on a symptom such as pain, weakness or abnormal movement to the level that it disrupts function and results in major distress. While there is no known mechanism for SSD, an interplay between somatization symptoms and mild traumatic brain injury (mTBI) has been identified by previous literature.Objective:Complete a comprehensive systematic review of the associations between mTBI and somatization symptom disorders and report key findings.Methods:Searches for SSD and mTBI and related terms were performed and then combined in the following databases on January 10th, 2023: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, PsycINFO, Embase, and Scopus. The following criteria had to be met for inclusion: (a) human participants; (b) assessed with a measure of somatization; (c) mild traumatic brain injury; (d) published in a peer-reviewed journal; (e) completed by January 10th, 2023. The following data was extracted:** participant characteristics (age, sex, history of trauma as provided), injury characteristics (mechanism, time since injury, history of previous mTBI), mTBI assessment scores, somatization assessment scores, and assessment scores for any other psychiatric conditions (depression, anxiety, post-traumatic stress disorder). Each of these studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network (SIGN) criteria checklist for cohort studies.Results:Of twenty-nine included studies, ten studies found associations between atypical seizure-like symptoms (e.g., psychogenic non-epileptic seizures) and increased mTBI symptom burden. Thirteen studies found associations between other atypical symptoms (e.g., pain, numbness, visual disturbances) and mTBI symptom burden. Furthermore, three studies found associations between individuals with previous somatization disorders and increased mTBI symptom burden. The three remaining studies included did not find evidence for an association between somatization and mTBI. When considering the quality of evidence, many studies had a risk of bias rating of unacceptable (10/29) and few were considered high quality (4/29).Conclusion:Studies have shown a relationship between symptoms of somatization and mTBI indicating the potential comorbidity of these disorders. However, there are a limited number of high-quality studies currently available and as such, further research on this topic is needed. |
Alison | Wilson | Clinical Neurosciences, University of Calgary |
| 1 | Associations Between Somatic Symptom Disorder and Mild Traumatic Brain Injury: A Systematic Review | ["brain concussion", "conversion disorder"] | Kaiden Jobin, Alison Wilson, Regan King, Chantel T. Debert | 2nd place, systematic review | Abstract |
Context:Somatic symptom disorder (SSD) is characterized by a significant focus on a symptom such as pain, weakness or abnormal movement to the level that it disrupts function and results in major distress. While there is no known mechanism for SSD, an interplay between somatization symptoms and mild traumatic brain injury (mTBI) has been identified by previous literature.Objective:Complete a comprehensive systematic review of the associations between mTBI and somatization symptom disorders and report key findings.Methods:Searches for SSD and mTBI and related terms were performed and then combined in the following databases on January 10th, 2023: Ovid MEDLINE, Cochrane Central Register of Controlled Trials, CINAHL, SPORTDiscus, PsycINFO, Embase, and Scopus. The following criteria had to be met for inclusion: (a) human participants; (b) assessed with a measure of somatization; (c) mild traumatic brain injury; (d) published in a peer-reviewed journal; (e) completed by January 10th, 2023. The following data was extracted:** participant characteristics (age, sex, history of trauma as provided), injury characteristics (mechanism, time since injury, history of previous mTBI), mTBI assessment scores, somatization assessment scores, and assessment scores for any other psychiatric conditions (depression, anxiety, post-traumatic stress disorder). Each of these studies were assessed for risk of bias using the Scottish Intercollegiate Guidelines Network (SIGN) criteria checklist for cohort studies.Results:Of twenty-nine included studies, ten studies found associations between atypical seizure-like symptoms (e.g., psychogenic non-epileptic seizures) and increased mTBI symptom burden. Thirteen studies found associations between other atypical symptoms (e.g., pain, numbness, visual disturbances) and mTBI symptom burden. Furthermore, three studies found associations between individuals with previous somatization disorders and increased mTBI symptom burden. The three remaining studies included did not find evidence for an association between somatization and mTBI. When considering the quality of evidence, many studies had a risk of bias rating of unacceptable (10/29) and few were considered high quality (4/29).Conclusion:Studies have shown a relationship between symptoms of somatization and mTBI indicating the potential comorbidity of these disorders. However, there are a limited number of high-quality studies currently available and as such, further research on this topic is needed. |
Chantel T. | Debert | Cumming School of Medicine, Hotchkiss Brain Institute, University of Calgary; Clinical Neurosciences, University of Calgary |
| 1 | Case Report: Addressing problematic sexual behaviours through exploration of sexual health goals for individual with severe TBI | ["neurological rehabilitation", "psychomotor agitation", "sexual behaviour", "sexual dysfunction", "traumatic brain injury"] | Alyssa Prangley, David Furac, Charlie Giurleo, Anna Kras-Dupuis, Luxshmi Nageswaran, Dalton L. Wolfe, E. Ali Bateman | Abstract |
Context:Persons with moderate-to-severe traumatic brain injury (TBI) can experience challenging behaviours, including problematic sexual behaviours. This case report illustrates how the introduction of a safe, patient-centered self-stimulation plan addressed the problematic sexual behaviours of a woman with a severe TBI and underscores the importance and relevance of comprehensive assessment and treatment of sexual health goals and concerns as part of individualized interdisciplinary inpatient TBI rehabilitation.Findings:43-year-old woman was admitted for inpatient TBI rehabilitation 11 months after severe TBI from a car accident. At admission, she was in persistent post-traumatic amnesia (PTA), Ranchos Los Amigos level 4-5, had left hemiplegia, and was dependent for all activities of daily living. Challenging behaviours were observed daily including verbal and physical aggression, refusing care and/or therapies, and sexual behaviours of explicit sexual comments, sexual touching of self and others, and attempts at self-stimulation in public. Behaviours were tracked and documented; over 21 days, there were 5.6 severe sexual behaviours/week on average. Due to their severity, the sexual behaviours interfered with care by staff and deterred family from visiting. Consequently, a sexual behaviour plan was devised together with the substitute decision-maker using Sexual Rehabilitation Framework and guidelines for sexual health and intimacy in care facilities resulting in a plan for self-stimulation using a vibrator privately twice weekly with support from Occupational Therapy and Nursing. In the 21 days after introduction, severe sexual behaviours decreased to 0/week. Sexual behaviours recurred during a 2-week period when the patient’s vibrator was nonfunctional and resolved with replacement of the device. Additional clinical observations included increased care and therapy participation and improved social interactions.Conclusion:When the sexual health concerns of individuals with TBI are addressed, it can result in meaningful improvements in sexually inappropriate behaviours and facilitate progress in rehabilitation. Yet only a small portion of healthcare providers report discussing sexuality during rehabilitation. This case report highlights the utility and potential benefits of comprehensively addressing patient-centered sexual health goals during inpatient TBI rehabilitation. Further research is needed to better understand the optimal timing and impact of sexual health intervention in this area. |
David | Furac | Parkwood Institute | |
| 1 | Case Report: Addressing problematic sexual behaviours through exploration of sexual health goals for individual with severe TBI | ["neurological rehabilitation", "psychomotor agitation", "sexual behaviour", "sexual dysfunction", "traumatic brain injury"] | Alyssa Prangley, David Furac, Charlie Giurleo, Anna Kras-Dupuis, Luxshmi Nageswaran, Dalton L. Wolfe, E. Ali Bateman | Abstract |
Context:Persons with moderate-to-severe traumatic brain injury (TBI) can experience challenging behaviours, including problematic sexual behaviours. This case report illustrates how the introduction of a safe, patient-centered self-stimulation plan addressed the problematic sexual behaviours of a woman with a severe TBI and underscores the importance and relevance of comprehensive assessment and treatment of sexual health goals and concerns as part of individualized interdisciplinary inpatient TBI rehabilitation.Findings:43-year-old woman was admitted for inpatient TBI rehabilitation 11 months after severe TBI from a car accident. At admission, she was in persistent post-traumatic amnesia (PTA), Ranchos Los Amigos level 4-5, had left hemiplegia, and was dependent for all activities of daily living. Challenging behaviours were observed daily including verbal and physical aggression, refusing care and/or therapies, and sexual behaviours of explicit sexual comments, sexual touching of self and others, and attempts at self-stimulation in public. Behaviours were tracked and documented; over 21 days, there were 5.6 severe sexual behaviours/week on average. Due to their severity, the sexual behaviours interfered with care by staff and deterred family from visiting. Consequently, a sexual behaviour plan was devised together with the substitute decision-maker using Sexual Rehabilitation Framework and guidelines for sexual health and intimacy in care facilities resulting in a plan for self-stimulation using a vibrator privately twice weekly with support from Occupational Therapy and Nursing. In the 21 days after introduction, severe sexual behaviours decreased to 0/week. Sexual behaviours recurred during a 2-week period when the patient’s vibrator was nonfunctional and resolved with replacement of the device. Additional clinical observations included increased care and therapy participation and improved social interactions.Conclusion:When the sexual health concerns of individuals with TBI are addressed, it can result in meaningful improvements in sexually inappropriate behaviours and facilitate progress in rehabilitation. Yet only a small portion of healthcare providers report discussing sexuality during rehabilitation. This case report highlights the utility and potential benefits of comprehensively addressing patient-centered sexual health goals during inpatient TBI rehabilitation. Further research is needed to better understand the optimal timing and impact of sexual health intervention in this area. |
Alyssa | Prangley | Parkwood Institute | |
| 1 | Case Report: Addressing problematic sexual behaviours through exploration of sexual health goals for individual with severe TBI | ["neurological rehabilitation", "psychomotor agitation", "sexual behaviour", "sexual dysfunction", "traumatic brain injury"] | Alyssa Prangley, David Furac, Charlie Giurleo, Anna Kras-Dupuis, Luxshmi Nageswaran, Dalton L. Wolfe, E. Ali Bateman | Abstract |
Context:Persons with moderate-to-severe traumatic brain injury (TBI) can experience challenging behaviours, including problematic sexual behaviours. This case report illustrates how the introduction of a safe, patient-centered self-stimulation plan addressed the problematic sexual behaviours of a woman with a severe TBI and underscores the importance and relevance of comprehensive assessment and treatment of sexual health goals and concerns as part of individualized interdisciplinary inpatient TBI rehabilitation.Findings:43-year-old woman was admitted for inpatient TBI rehabilitation 11 months after severe TBI from a car accident. At admission, she was in persistent post-traumatic amnesia (PTA), Ranchos Los Amigos level 4-5, had left hemiplegia, and was dependent for all activities of daily living. Challenging behaviours were observed daily including verbal and physical aggression, refusing care and/or therapies, and sexual behaviours of explicit sexual comments, sexual touching of self and others, and attempts at self-stimulation in public. Behaviours were tracked and documented; over 21 days, there were 5.6 severe sexual behaviours/week on average. Due to their severity, the sexual behaviours interfered with care by staff and deterred family from visiting. Consequently, a sexual behaviour plan was devised together with the substitute decision-maker using Sexual Rehabilitation Framework and guidelines for sexual health and intimacy in care facilities resulting in a plan for self-stimulation using a vibrator privately twice weekly with support from Occupational Therapy and Nursing. In the 21 days after introduction, severe sexual behaviours decreased to 0/week. Sexual behaviours recurred during a 2-week period when the patient’s vibrator was nonfunctional and resolved with replacement of the device. Additional clinical observations included increased care and therapy participation and improved social interactions.Conclusion:When the sexual health concerns of individuals with TBI are addressed, it can result in meaningful improvements in sexually inappropriate behaviours and facilitate progress in rehabilitation. Yet only a small portion of healthcare providers report discussing sexuality during rehabilitation. This case report highlights the utility and potential benefits of comprehensively addressing patient-centered sexual health goals during inpatient TBI rehabilitation. Further research is needed to better understand the optimal timing and impact of sexual health intervention in this area. |
Charlie | Giurleo | Parkwood Institute | |
| 1 | Case Report: Addressing problematic sexual behaviours through exploration of sexual health goals for individual with severe TBI | ["neurological rehabilitation", "psychomotor agitation", "sexual behaviour", "sexual dysfunction", "traumatic brain injury"] | Alyssa Prangley, David Furac, Charlie Giurleo, Anna Kras-Dupuis, Luxshmi Nageswaran, Dalton L. Wolfe, E. Ali Bateman | Abstract |
Context:Persons with moderate-to-severe traumatic brain injury (TBI) can experience challenging behaviours, including problematic sexual behaviours. This case report illustrates how the introduction of a safe, patient-centered self-stimulation plan addressed the problematic sexual behaviours of a woman with a severe TBI and underscores the importance and relevance of comprehensive assessment and treatment of sexual health goals and concerns as part of individualized interdisciplinary inpatient TBI rehabilitation.Findings:43-year-old woman was admitted for inpatient TBI rehabilitation 11 months after severe TBI from a car accident. At admission, she was in persistent post-traumatic amnesia (PTA), Ranchos Los Amigos level 4-5, had left hemiplegia, and was dependent for all activities of daily living. Challenging behaviours were observed daily including verbal and physical aggression, refusing care and/or therapies, and sexual behaviours of explicit sexual comments, sexual touching of self and others, and attempts at self-stimulation in public. Behaviours were tracked and documented; over 21 days, there were 5.6 severe sexual behaviours/week on average. Due to their severity, the sexual behaviours interfered with care by staff and deterred family from visiting. Consequently, a sexual behaviour plan was devised together with the substitute decision-maker using Sexual Rehabilitation Framework and guidelines for sexual health and intimacy in care facilities resulting in a plan for self-stimulation using a vibrator privately twice weekly with support from Occupational Therapy and Nursing. In the 21 days after introduction, severe sexual behaviours decreased to 0/week. Sexual behaviours recurred during a 2-week period when the patient’s vibrator was nonfunctional and resolved with replacement of the device. Additional clinical observations included increased care and therapy participation and improved social interactions.Conclusion:When the sexual health concerns of individuals with TBI are addressed, it can result in meaningful improvements in sexually inappropriate behaviours and facilitate progress in rehabilitation. Yet only a small portion of healthcare providers report discussing sexuality during rehabilitation. This case report highlights the utility and potential benefits of comprehensively addressing patient-centered sexual health goals during inpatient TBI rehabilitation. Further research is needed to better understand the optimal timing and impact of sexual health intervention in this area. |
Anna | Kras-Dupuis | Parkwood Institute | |
| 1 | Case Report: Addressing problematic sexual behaviours through exploration of sexual health goals for individual with severe TBI | ["neurological rehabilitation", "psychomotor agitation", "sexual behaviour", "sexual dysfunction", "traumatic brain injury"] | Alyssa Prangley, David Furac, Charlie Giurleo, Anna Kras-Dupuis, Luxshmi Nageswaran, Dalton L. Wolfe, E. Ali Bateman | Abstract |
Context:Persons with moderate-to-severe traumatic brain injury (TBI) can experience challenging behaviours, including problematic sexual behaviours. This case report illustrates how the introduction of a safe, patient-centered self-stimulation plan addressed the problematic sexual behaviours of a woman with a severe TBI and underscores the importance and relevance of comprehensive assessment and treatment of sexual health goals and concerns as part of individualized interdisciplinary inpatient TBI rehabilitation.Findings:43-year-old woman was admitted for inpatient TBI rehabilitation 11 months after severe TBI from a car accident. At admission, she was in persistent post-traumatic amnesia (PTA), Ranchos Los Amigos level 4-5, had left hemiplegia, and was dependent for all activities of daily living. Challenging behaviours were observed daily including verbal and physical aggression, refusing care and/or therapies, and sexual behaviours of explicit sexual comments, sexual touching of self and others, and attempts at self-stimulation in public. Behaviours were tracked and documented; over 21 days, there were 5.6 severe sexual behaviours/week on average. Due to their severity, the sexual behaviours interfered with care by staff and deterred family from visiting. Consequently, a sexual behaviour plan was devised together with the substitute decision-maker using Sexual Rehabilitation Framework and guidelines for sexual health and intimacy in care facilities resulting in a plan for self-stimulation using a vibrator privately twice weekly with support from Occupational Therapy and Nursing. In the 21 days after introduction, severe sexual behaviours decreased to 0/week. Sexual behaviours recurred during a 2-week period when the patient’s vibrator was nonfunctional and resolved with replacement of the device. Additional clinical observations included increased care and therapy participation and improved social interactions.Conclusion:When the sexual health concerns of individuals with TBI are addressed, it can result in meaningful improvements in sexually inappropriate behaviours and facilitate progress in rehabilitation. Yet only a small portion of healthcare providers report discussing sexuality during rehabilitation. This case report highlights the utility and potential benefits of comprehensively addressing patient-centered sexual health goals during inpatient TBI rehabilitation. Further research is needed to better understand the optimal timing and impact of sexual health intervention in this area. |
Luxshmi | Nageswaran | Faculty of Health Sciences, Western University; Parkwood Institute | |
| 1 | Case Report: Addressing problematic sexual behaviours through exploration of sexual health goals for individual with severe TBI | ["neurological rehabilitation", "psychomotor agitation", "sexual behaviour", "sexual dysfunction", "traumatic brain injury"] | Alyssa Prangley, David Furac, Charlie Giurleo, Anna Kras-Dupuis, Luxshmi Nageswaran, Dalton L. Wolfe, E. Ali Bateman | Abstract |
Context:Persons with moderate-to-severe traumatic brain injury (TBI) can experience challenging behaviours, including problematic sexual behaviours. This case report illustrates how the introduction of a safe, patient-centered self-stimulation plan addressed the problematic sexual behaviours of a woman with a severe TBI and underscores the importance and relevance of comprehensive assessment and treatment of sexual health goals and concerns as part of individualized interdisciplinary inpatient TBI rehabilitation.Findings:43-year-old woman was admitted for inpatient TBI rehabilitation 11 months after severe TBI from a car accident. At admission, she was in persistent post-traumatic amnesia (PTA), Ranchos Los Amigos level 4-5, had left hemiplegia, and was dependent for all activities of daily living. Challenging behaviours were observed daily including verbal and physical aggression, refusing care and/or therapies, and sexual behaviours of explicit sexual comments, sexual touching of self and others, and attempts at self-stimulation in public. Behaviours were tracked and documented; over 21 days, there were 5.6 severe sexual behaviours/week on average. Due to their severity, the sexual behaviours interfered with care by staff and deterred family from visiting. Consequently, a sexual behaviour plan was devised together with the substitute decision-maker using Sexual Rehabilitation Framework and guidelines for sexual health and intimacy in care facilities resulting in a plan for self-stimulation using a vibrator privately twice weekly with support from Occupational Therapy and Nursing. In the 21 days after introduction, severe sexual behaviours decreased to 0/week. Sexual behaviours recurred during a 2-week period when the patient’s vibrator was nonfunctional and resolved with replacement of the device. Additional clinical observations included increased care and therapy participation and improved social interactions.Conclusion:When the sexual health concerns of individuals with TBI are addressed, it can result in meaningful improvements in sexually inappropriate behaviours and facilitate progress in rehabilitation. Yet only a small portion of healthcare providers report discussing sexuality during rehabilitation. This case report highlights the utility and potential benefits of comprehensively addressing patient-centered sexual health goals during inpatient TBI rehabilitation. Further research is needed to better understand the optimal timing and impact of sexual health intervention in this area. |
E. Ali | Bateman | Department of Physical Medicine & Rehabilitation, Schulich School of Medicine & Dentistry, Western University; Parkwood Institute | |
| 1 | Case Report: Addressing problematic sexual behaviours through exploration of sexual health goals for individual with severe TBI | ["neurological rehabilitation", "psychomotor agitation", "sexual behaviour", "sexual dysfunction", "traumatic brain injury"] | Alyssa Prangley, David Furac, Charlie Giurleo, Anna Kras-Dupuis, Luxshmi Nageswaran, Dalton L. Wolfe, E. Ali Bateman | Abstract |
Context:Persons with moderate-to-severe traumatic brain injury (TBI) can experience challenging behaviours, including problematic sexual behaviours. This case report illustrates how the introduction of a safe, patient-centered self-stimulation plan addressed the problematic sexual behaviours of a woman with a severe TBI and underscores the importance and relevance of comprehensive assessment and treatment of sexual health goals and concerns as part of individualized interdisciplinary inpatient TBI rehabilitation.Findings:43-year-old woman was admitted for inpatient TBI rehabilitation 11 months after severe TBI from a car accident. At admission, she was in persistent post-traumatic amnesia (PTA), Ranchos Los Amigos level 4-5, had left hemiplegia, and was dependent for all activities of daily living. Challenging behaviours were observed daily including verbal and physical aggression, refusing care and/or therapies, and sexual behaviours of explicit sexual comments, sexual touching of self and others, and attempts at self-stimulation in public. Behaviours were tracked and documented; over 21 days, there were 5.6 severe sexual behaviours/week on average. Due to their severity, the sexual behaviours interfered with care by staff and deterred family from visiting. Consequently, a sexual behaviour plan was devised together with the substitute decision-maker using Sexual Rehabilitation Framework and guidelines for sexual health and intimacy in care facilities resulting in a plan for self-stimulation using a vibrator privately twice weekly with support from Occupational Therapy and Nursing. In the 21 days after introduction, severe sexual behaviours decreased to 0/week. Sexual behaviours recurred during a 2-week period when the patient’s vibrator was nonfunctional and resolved with replacement of the device. Additional clinical observations included increased care and therapy participation and improved social interactions.Conclusion:When the sexual health concerns of individuals with TBI are addressed, it can result in meaningful improvements in sexually inappropriate behaviours and facilitate progress in rehabilitation. Yet only a small portion of healthcare providers report discussing sexuality during rehabilitation. This case report highlights the utility and potential benefits of comprehensively addressing patient-centered sexual health goals during inpatient TBI rehabilitation. Further research is needed to better understand the optimal timing and impact of sexual health intervention in this area. |
Dalton L. | Wolfe | Faculty of Health Sciences, Western University; Parkwood Institute | |
| 1 | Collaborative Resident-Led Ultrasound Curriculum: Interdisciplinary Teaching Session Overview | ["Medical Education", "Physical and Rehabilitation Medicine", "Cadaver"] | Courtney Grotski, Terry Li | Abstract |
Purpose:To outline a resident-led teaching session on knee ultrasound for Physical Medicine and Rehabilitation (PM&R) residents at the University of Manitoba (U of M), in collaboration with the University’s anatomy lab. The session aimed to provide residents with practical experience in identifying anatomic structures via ultrasound and in ultrasound-guided injections.Context:Ultrasound (US) is being used increasingly in physiatry clinical practice for diagnostic and therapeutic purposes. Traditionally, US training has not been a significant part of the Canadian PM&R curriculum. A resident-led musculoskeletal US curriculum has recently been implemented at the U of M.Methods:One designated PM&R resident lead provided pre-readings, gave a presentation outlining the session objectives, and performed a live demonstration for the PM&R resident audience. Six residents were divided into three junior-and-senior-resident pairs. Each pair shared a hand-held ultrasound device. Residents scanned structures on each other following a protocol created by the lead resident. The knee was divided into anterior, posterior, medial, and lateral compartments, with 30 minutes afforded to each compartment for sonographic identification. Anatomists with experience in ultrasound circulated to provide support throughout the session. The final 45 minutes of the session was devoted to US-guided knee injection. Following a demonstration by the lead resident, the group practiced injecting saline into the suprapatellar recess on a soft-embalmed cadaver. Pre- and post-session reflection questionnaires were completed by the resident lead. Post-session peer-feedback surveys were completed by the remaining five residents.Results:The resident lead expressed that preparing the session enhanced learning in anatomy and ultrasound. The soft-embalmed cadaver was an instrumental resource. Lack of prior clinical exposure was identified as the main challenge. Four peer-feedback surveys were submitted. All resident learners felt more confident about their anatomic knowledge and ultrasound scanning skills following the session. None expressed concerns about the resident lead’s expertise in the subject.Conclusion:The resident-led session established a model for PM&R US learning that incorporates anatomy, sonographic identification, and US-guided intervention. Interdisciplinary collaboration and use of soft-embalmed cadavers are valuable to achieving these goals. Given the novelty of these sessions in resident curriculum, formative feedback should be obtained following every teaching session. |
Terry | Li | Department of Human Anatomy and Cell Science, University of Manitoba | |
| 1 | Collaborative Resident-Led Ultrasound Curriculum: Interdisciplinary Teaching Session Overview | ["Medical Education", "Physical and Rehabilitation Medicine", "Cadaver"] | Courtney Grotski, Terry Li | Abstract |
Purpose:To outline a resident-led teaching session on knee ultrasound for Physical Medicine and Rehabilitation (PM&R) residents at the University of Manitoba (U of M), in collaboration with the University’s anatomy lab. The session aimed to provide residents with practical experience in identifying anatomic structures via ultrasound and in ultrasound-guided injections.Context:Ultrasound (US) is being used increasingly in physiatry clinical practice for diagnostic and therapeutic purposes. Traditionally, US training has not been a significant part of the Canadian PM&R curriculum. A resident-led musculoskeletal US curriculum has recently been implemented at the U of M.Methods:One designated PM&R resident lead provided pre-readings, gave a presentation outlining the session objectives, and performed a live demonstration for the PM&R resident audience. Six residents were divided into three junior-and-senior-resident pairs. Each pair shared a hand-held ultrasound device. Residents scanned structures on each other following a protocol created by the lead resident. The knee was divided into anterior, posterior, medial, and lateral compartments, with 30 minutes afforded to each compartment for sonographic identification. Anatomists with experience in ultrasound circulated to provide support throughout the session. The final 45 minutes of the session was devoted to US-guided knee injection. Following a demonstration by the lead resident, the group practiced injecting saline into the suprapatellar recess on a soft-embalmed cadaver. Pre- and post-session reflection questionnaires were completed by the resident lead. Post-session peer-feedback surveys were completed by the remaining five residents.Results:The resident lead expressed that preparing the session enhanced learning in anatomy and ultrasound. The soft-embalmed cadaver was an instrumental resource. Lack of prior clinical exposure was identified as the main challenge. Four peer-feedback surveys were submitted. All resident learners felt more confident about their anatomic knowledge and ultrasound scanning skills following the session. None expressed concerns about the resident lead’s expertise in the subject.Conclusion:The resident-led session established a model for PM&R US learning that incorporates anatomy, sonographic identification, and US-guided intervention. Interdisciplinary collaboration and use of soft-embalmed cadavers are valuable to achieving these goals. Given the novelty of these sessions in resident curriculum, formative feedback should be obtained following every teaching session. |
Courtney | Grotski | Physical Medicine and Rehabilitation, University of Manitoba | |
| 1 | Decreasing wait times and improving access to stroke rehabilitation outpatient occupational therapy using cost-effective organizational and structural changes: a quality improvement project | ["Occupational Therapists", "Outpatients", "Quality Improvement", "Stroke Rehabilitation", "Waiting Lists"] | Drew Rajaraman, Katherine B Knox, Sarah J Donkers, Jing Shi | Abstract |
Introduction:Decreased wait times to therapy services is a common goal amongst stroke rehabilitation facilities as it enhances patient outcomes. However, cost-effective solutions that utilize existing resources to address wait time issues may be overlooked in favour of more obvious, but costly, solutions such as hiring more staff. Due to provincial occupational therapy (OT) shortages, we were unable to increase OT full-time equivalents (FTEs) at our tertiary outpatient stroke rehabilitation center. The wait time for outpatient OT was 34-45 days between 2019-21, far from the Canadian Stroke Best Practice Recommendations target of within 48 hours following discharge from an acute care hospital. We aimed to determine cost-effective solutions, utilizing existing resources, to increase access and decrease wait times to outpatient stroke rehabilitation.Methods:We performed a quality improvement project using an on-going iterative approach, derived from the Model for Improvement Framework from May 2021 to December 2022. Retrospectively, patient baseline wait-time data was analyzed for the years 2019-2021. Contributing factors for delayed access were identified using a Fishbone diagram, and a Driver diagram organized these factors into key change categories with potential change items proposed. High-yield change items were identified and were tested starting in October 2021 with data collected on number of referrals, number of FTE OTs, wait-times for stroke patients referred from acute care, and patient satisfaction. Run charts were created to visualize the changes in wait-times and referrals over time.Results:Prioritized change items identified included engagement and coordination with acute care, referral triaging and prioritization, a direct-access interprofessional stroke rehabilitation clinic, and introducing group-based OT sessions. Total referrals to outpatient OT doubled in 2022 from 128 (2019), 114 (2020), 144 (2021) to 374 (2022). OT referrals for stroke patients direct from acute care increased from 15 (2019), 26 (2020), 9 (2021) to 48 (2022). OT wait times decreased from an average of 45 days (2019), 44 days (2020), 34 days (2021) to 11 days (2022) for stroke patients directly referred from acute care. Total FTE OTs slightly increased from 2.2 (2019-21) to 2.3 (January 2022), then decreased to 1.3 (Sept 2022-Dec 2022). 83% of patients felt the wait time for their first therapy appointment was “Not Too Long” in 2022.Conclusion:A low-cost structured approach using a formalized quality improvement framework can both improve access and decrease wait-times for outpatient stroke rehabilitation services with good patient satisfaction, despite a decrease in total therapy staffing and increased referral volumes. |
Jing | Shi | Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan | |
| 1 | Decreasing wait times and improving access to stroke rehabilitation outpatient occupational therapy using cost-effective organizational and structural changes: a quality improvement project | ["Occupational Therapists", "Outpatients", "Quality Improvement", "Stroke Rehabilitation", "Waiting Lists"] | Drew Rajaraman, Katherine B Knox, Sarah J Donkers, Jing Shi | Abstract |
Introduction:Decreased wait times to therapy services is a common goal amongst stroke rehabilitation facilities as it enhances patient outcomes. However, cost-effective solutions that utilize existing resources to address wait time issues may be overlooked in favour of more obvious, but costly, solutions such as hiring more staff. Due to provincial occupational therapy (OT) shortages, we were unable to increase OT full-time equivalents (FTEs) at our tertiary outpatient stroke rehabilitation center. The wait time for outpatient OT was 34-45 days between 2019-21, far from the Canadian Stroke Best Practice Recommendations target of within 48 hours following discharge from an acute care hospital. We aimed to determine cost-effective solutions, utilizing existing resources, to increase access and decrease wait times to outpatient stroke rehabilitation.Methods:We performed a quality improvement project using an on-going iterative approach, derived from the Model for Improvement Framework from May 2021 to December 2022. Retrospectively, patient baseline wait-time data was analyzed for the years 2019-2021. Contributing factors for delayed access were identified using a Fishbone diagram, and a Driver diagram organized these factors into key change categories with potential change items proposed. High-yield change items were identified and were tested starting in October 2021 with data collected on number of referrals, number of FTE OTs, wait-times for stroke patients referred from acute care, and patient satisfaction. Run charts were created to visualize the changes in wait-times and referrals over time.Results:Prioritized change items identified included engagement and coordination with acute care, referral triaging and prioritization, a direct-access interprofessional stroke rehabilitation clinic, and introducing group-based OT sessions. Total referrals to outpatient OT doubled in 2022 from 128 (2019), 114 (2020), 144 (2021) to 374 (2022). OT referrals for stroke patients direct from acute care increased from 15 (2019), 26 (2020), 9 (2021) to 48 (2022). OT wait times decreased from an average of 45 days (2019), 44 days (2020), 34 days (2021) to 11 days (2022) for stroke patients directly referred from acute care. Total FTE OTs slightly increased from 2.2 (2019-21) to 2.3 (January 2022), then decreased to 1.3 (Sept 2022-Dec 2022). 83% of patients felt the wait time for their first therapy appointment was “Not Too Long” in 2022.Conclusion:A low-cost structured approach using a formalized quality improvement framework can both improve access and decrease wait-times for outpatient stroke rehabilitation services with good patient satisfaction, despite a decrease in total therapy staffing and increased referral volumes. |
Drew | Rajaraman | Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan | |
| 1 | Decreasing wait times and improving access to stroke rehabilitation outpatient occupational therapy using cost-effective organizational and structural changes: a quality improvement project | ["Occupational Therapists", "Outpatients", "Quality Improvement", "Stroke Rehabilitation", "Waiting Lists"] | Drew Rajaraman, Katherine B Knox, Sarah J Donkers, Jing Shi | Abstract |
Introduction:Decreased wait times to therapy services is a common goal amongst stroke rehabilitation facilities as it enhances patient outcomes. However, cost-effective solutions that utilize existing resources to address wait time issues may be overlooked in favour of more obvious, but costly, solutions such as hiring more staff. Due to provincial occupational therapy (OT) shortages, we were unable to increase OT full-time equivalents (FTEs) at our tertiary outpatient stroke rehabilitation center. The wait time for outpatient OT was 34-45 days between 2019-21, far from the Canadian Stroke Best Practice Recommendations target of within 48 hours following discharge from an acute care hospital. We aimed to determine cost-effective solutions, utilizing existing resources, to increase access and decrease wait times to outpatient stroke rehabilitation.Methods:We performed a quality improvement project using an on-going iterative approach, derived from the Model for Improvement Framework from May 2021 to December 2022. Retrospectively, patient baseline wait-time data was analyzed for the years 2019-2021. Contributing factors for delayed access were identified using a Fishbone diagram, and a Driver diagram organized these factors into key change categories with potential change items proposed. High-yield change items were identified and were tested starting in October 2021 with data collected on number of referrals, number of FTE OTs, wait-times for stroke patients referred from acute care, and patient satisfaction. Run charts were created to visualize the changes in wait-times and referrals over time.Results:Prioritized change items identified included engagement and coordination with acute care, referral triaging and prioritization, a direct-access interprofessional stroke rehabilitation clinic, and introducing group-based OT sessions. Total referrals to outpatient OT doubled in 2022 from 128 (2019), 114 (2020), 144 (2021) to 374 (2022). OT referrals for stroke patients direct from acute care increased from 15 (2019), 26 (2020), 9 (2021) to 48 (2022). OT wait times decreased from an average of 45 days (2019), 44 days (2020), 34 days (2021) to 11 days (2022) for stroke patients directly referred from acute care. Total FTE OTs slightly increased from 2.2 (2019-21) to 2.3 (January 2022), then decreased to 1.3 (Sept 2022-Dec 2022). 83% of patients felt the wait time for their first therapy appointment was “Not Too Long” in 2022.Conclusion:A low-cost structured approach using a formalized quality improvement framework can both improve access and decrease wait-times for outpatient stroke rehabilitation services with good patient satisfaction, despite a decrease in total therapy staffing and increased referral volumes. |
Sarah J | Donkers | School of Rehabilitation Science, College of Medicine, University of Saskatchewan | |
| 1 | Decreasing wait times and improving access to stroke rehabilitation outpatient occupational therapy using cost-effective organizational and structural changes: a quality improvement project | ["Occupational Therapists", "Outpatients", "Quality Improvement", "Stroke Rehabilitation", "Waiting Lists"] | Drew Rajaraman, Katherine B Knox, Sarah J Donkers, Jing Shi | Abstract |
Introduction:Decreased wait times to therapy services is a common goal amongst stroke rehabilitation facilities as it enhances patient outcomes. However, cost-effective solutions that utilize existing resources to address wait time issues may be overlooked in favour of more obvious, but costly, solutions such as hiring more staff. Due to provincial occupational therapy (OT) shortages, we were unable to increase OT full-time equivalents (FTEs) at our tertiary outpatient stroke rehabilitation center. The wait time for outpatient OT was 34-45 days between 2019-21, far from the Canadian Stroke Best Practice Recommendations target of within 48 hours following discharge from an acute care hospital. We aimed to determine cost-effective solutions, utilizing existing resources, to increase access and decrease wait times to outpatient stroke rehabilitation.Methods:We performed a quality improvement project using an on-going iterative approach, derived from the Model for Improvement Framework from May 2021 to December 2022. Retrospectively, patient baseline wait-time data was analyzed for the years 2019-2021. Contributing factors for delayed access were identified using a Fishbone diagram, and a Driver diagram organized these factors into key change categories with potential change items proposed. High-yield change items were identified and were tested starting in October 2021 with data collected on number of referrals, number of FTE OTs, wait-times for stroke patients referred from acute care, and patient satisfaction. Run charts were created to visualize the changes in wait-times and referrals over time.Results:Prioritized change items identified included engagement and coordination with acute care, referral triaging and prioritization, a direct-access interprofessional stroke rehabilitation clinic, and introducing group-based OT sessions. Total referrals to outpatient OT doubled in 2022 from 128 (2019), 114 (2020), 144 (2021) to 374 (2022). OT referrals for stroke patients direct from acute care increased from 15 (2019), 26 (2020), 9 (2021) to 48 (2022). OT wait times decreased from an average of 45 days (2019), 44 days (2020), 34 days (2021) to 11 days (2022) for stroke patients directly referred from acute care. Total FTE OTs slightly increased from 2.2 (2019-21) to 2.3 (January 2022), then decreased to 1.3 (Sept 2022-Dec 2022). 83% of patients felt the wait time for their first therapy appointment was “Not Too Long” in 2022.Conclusion:A low-cost structured approach using a formalized quality improvement framework can both improve access and decrease wait-times for outpatient stroke rehabilitation services with good patient satisfaction, despite a decrease in total therapy staffing and increased referral volumes. |
Katherine B | Knox | Department of Physical Medicine and Rehabilitation, College of Medicine, University of Saskatchewan | |
| 1 | Effect of botulinum neurotoxin (BoNT) in muscle contracture (MC) presenting with electrical myotonia- A case study. | ["Butulinum Toxin", "channelopathy", "contracture", "myotonia", "muscle disease"] | Satyendra Sharma | Abstract |
Context:36 years old man presented with severe hip and knee flexor MC of lower extremities without a definite neurological diagnosis. He was born premature by 6 weeks Micrognathia, cleft palate, swallowing difficulties, ear infections and physical and intellectual delay were recorded in early infancy. Genetic studies were negative for 2P or 2Q deletion syndromes. As a teenager, he was ambulant for short distances with assistance, but lost the ability to walk after a fall. MRI of head was negative for new pathology and clinical findings for upper motor neuron syndrome or spasticity were negative. There was no record of clinical myotonia. Goal was set to increase the knee extension (KE) for comfortable seating in a chair. MTHOD: The hip fixed flexion was measured as 40 degrees on right and 30 degrees on left. Passive KE was 15 degrees from fully flexed position on both sides. OnabotulinumtoxinA (ONA) was injected in psoas major, semitendinosus, semimembranosus, biceps femoris and hip adductors at an interval varying from 3-4 months. KE was measured before each treatment. The dose of ONA was 600-700 units used in 9 sessions. The toxin was changed to AbobotulinumtoxinA for next 7 sessions and the dose used was 1800- 2000 units. EMG monitored injections were done which recorded waxing and wanning myotonic discharges in all muscles examined, consistent with muscle disease (MD) such as myotonic dystrophy (DM). RESULTS: Both toxins helped to relieve the muscle contracture. After 2 years of treatment the KE increased to an angle of 120 degrees (-60 degrees from full extension) on both sides with maximum stretch. Comfortable seating in a customized chair was achieved. Myotonia was decreased but did not disappear in the treated muscles.The genetic study for DMII was negative. DISCUSSION: There is no previous report of use or effectiveness of BoNT in contractures in MD presenting with myotonia or DM. Acetylcholine (Ach) plays an important role in Channelopathies (CHP) in maintaining hyper polarization (HP) of muscle membrane. Blocking of Ach likely reduces the HP of muscle membrane and sustained muscle contractility. CONCLUSION:** The role of BoNT in reducing myotonia, muscle spasms and sustained contractility in MD and CHP needs to be further explored. |
Satyendra | Sharma | Medicine- Neurology Clinics-PM&R, Baycrest Hospital; Medicine -PM&R, Sunnybrook Health Science Centre and Baycrest Health | |
| 1 | Effect of botulinum neurotxin (BoNT) in muscle contracture presenting with electrical myotonia- A case study. | ["Butulinum Toxin", "channelopathy", "contracture", "myotonia", "muscle disease"] | Satyendra Sharma | Abstract |
36 years old man presented with severe hip and knee flexor muscle contractures of lower extremities with seating, bed positioning and transportation problems. Mother’s Pregnancy with patient was terminated 6 weeks earlier because of high fever. Micrognathia, cleft palate, swallowing difficulties, ear infections and physical and intellectual delay were recorded in early infency. Genetic studies were negative for 2P or 2Q deletion syndromes. As a teenager, he was ambulant for short distances with assistance, but lost the ability to walk after a fall. MRI of head was negative for new pathology and clinical findings for upper motor neurone syndrome were negative. MTHOD: The hip fixed flexion was measured as 40 degrees on right and 30 degrees on left. Knee passive extension was 15 degrees from fully contracted position on both sides. Onabotulinum Toxin A (ONA) was injected in psoas major, semitendinosus, semimembranosus, biceps femoris and hip adductors at an interval varying from 3-4 months. Knee extension was measured before each treatment. The dose of ONA was 600-700 units used in 9 sessions. The toxin was changed to Abobotulinum toxin A for next 7 sessions and the dose used was 1800- 2000 units. EMG monitored injections were done which recorded vaxing and vaning myotonic discharges in all muscles, consistent with muscle disease (MD) such as myotonic dystrophy (DM). RESULTS: Both toxins helped to relieve the muscle tightness. After 2 years of treatment the knee extension up to 120 degrees and seating in a customized chair were achieved. Myotonia was decreased but did not disappear in the treated muscles.The genetic study for DMII was negative. DISCUSSION: There is no previous report of use or effectiveness of BoNT in contractures in MD presenting with myotonia or DM. Acetylcholine (Ach) plays an important role in Channelopathies (CHP) in maintaining hyper polarization (HP) of muscle membrane. Blocking of Ach likely reduces the HP of muscle membrane and sustained muscle contractility. CONCLUSION:The role of BoNT in reducing myotonia, muscle spasms and sustained contractility in MD and CHP needs to be further explored. |
Satyendra | Sharma | Medicine -Neurophysiology, Toronto Western Hospital, UHN; Medicine- PM&R, Sunnybrook Health Science Centre | |
| 1 | Electrodiagnostic Reporting Preferences of Referring Physicians: An Exploratory Survey | ["Communication", "Electrodiagnosis", "Electromyography", "Nerve Conduction Studies"] | Kyung Joon Mun, Jordan Farag, Lawrence R. Robinson | Abstract |
Context:Electrodiagnostic (EDX) studies, consisting of nerve conduction studies (NCS) and needle electromyography (EMG), play a crucial role in the evaluation of patients with neuromuscular and peripheral nerve disorders. Electromyographers work in close collaboration with referring physicians, oftentimes through referral and consultation letters. However, there is variation in the format and content of EDX reports to referring physicians, which might complicate communication and clinical decision-making for physicians and patients. Accurate and succinct communication of test results is critical to patient safety, so that important results are neither lost nor miscommunicated.Objective:To explore EDX reporting preferences of referring physicians in order to improve the quality of communication and subsequent patient care.Methods:An online survey was developed, exploring specialty type and preferences for data reporting, data summary/interpretation, and diagnostic impression. A purposive sampling strategy was used to recruit physicians in the authors’ professional networks who had previously referred patients for EDX studies. Quantitative and qualitative survey data underwent descriptive statistical analysis and thematic analysis, respectively.Results:There was a total of 40 respondents, consisting of non-surgical specialists (_n_ = 22), surgical specialists (_n_ = 12), and family physicians (_n_ = 6). The majority of respondents indicated that the data summary/interpretation and diagnostic impression sections of an EDX report were most critical to their needs; important elements included differential diagnosis, prognosis, and management recommendations. A considerably smaller proportion of respondents comprised of primarily non-surgical and surgical specialists indicated numeric data as critical to their needs, preferring this data to be formatted as bullet points or tables without NCS waveforms. Regarding the format of EDX reports, the majority of respondents preferred bullet point rather than paragraph formatting of the data summary/interpretation and diagnostic impression sections. These preferences were corroborated in the thematic analysis of text responses, which also highlighted the importance of the clarity and consistency of EDX reports.Conclusion:The results of this exploratory survey suggest that physicians who refer patients for EDX studies prefer reports that emphasize the interpretation of EDX data and a clear diagnostic impression, particularly in bullet point format. This project highlights the importance of optimizing communication between electromyographers and referring physicians to ultimately improve patient care. Future research should explore larger sample sizes to ascertain any subgroup differences and investigate the impact of different reporting styles using relevant outcome measures (i.e. clinical utility, physician satisfaction). |
Jordan | Farag | Toronto Rehabilitation Institute, Toronto, ON, Canada; Department of Medicine, Division of Physical Medicine and Rehabilitation, University of Toronto, Toronto, ON, Canada | |
| 1 | Electrodiagnostic Reporting Preferences of Referring Physicians: An Exploratory Survey | ["Communication", "Electrodiagnosis", "Electromyography", "Nerve Conduction Studies"] | Kyung Joon Mun, Jordan Farag, Lawrence R. Robinson | Abstract |
Context:Electrodiagnostic (EDX) studies, consisting of nerve conduction studies (NCS) and needle electromyography (EMG), play a crucial role in the evaluation of patients with neuromuscular and peripheral nerve disorders. Electromyographers work in close collaboration with referring physicians, oftentimes through referral and consultation letters. However, there is variation in the format and content of EDX reports to referring physicians, which might complicate communication and clinical decision-making for physicians and patients. Accurate and succinct communication of test results is critical to patient safety, so that important results are neither lost nor miscommunicated.Objective:To explore EDX reporting preferences of referring physicians in order to improve the quality of communication and subsequent patient care.Methods:An online survey was developed, exploring specialty type and preferences for data reporting, data summary/interpretation, and diagnostic impression. A purposive sampling strategy was used to recruit physicians in the authors’ professional networks who had previously referred patients for EDX studies. Quantitative and qualitative survey data underwent descriptive statistical analysis and thematic analysis, respectively.Results:There was a total of 40 respondents, consisting of non-surgical specialists (_n_ = 22), surgical specialists (_n_ = 12), and family physicians (_n_ = 6). The majority of respondents indicated that the data summary/interpretation and diagnostic impression sections of an EDX report were most critical to their needs; important elements included differential diagnosis, prognosis, and management recommendations. A considerably smaller proportion of respondents comprised of primarily non-surgical and surgical specialists indicated numeric data as critical to their needs, preferring this data to be formatted as bullet points or tables without NCS waveforms. Regarding the format of EDX reports, the majority of respondents preferred bullet point rather than paragraph formatting of the data summary/interpretation and diagnostic impression sections. These preferences were corroborated in the thematic analysis of text responses, which also highlighted the importance of the clarity and consistency of EDX reports.Conclusion:The results of this exploratory survey suggest that physicians who refer patients for EDX studies prefer reports that emphasize the interpretation of EDX data and a clear diagnostic impression, particularly in bullet point format. This project highlights the importance of optimizing communication between electromyographers and referring physicians to ultimately improve patient care. Future research should explore larger sample sizes to ascertain any subgroup differences and investigate the impact of different reporting styles using relevant outcome measures (i.e. clinical utility, physician satisfaction). |
Kyung Joon | Mun | Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, ON, Canada | |
| 1 | Electrodiagnostic Reporting Preferences of Referring Physicians: An Exploratory Survey | ["Communication", "Electrodiagnosis", "Electromyography", "Nerve Conduction Studies"] | Kyung Joon Mun, Jordan Farag, Lawrence R. Robinson | Abstract |
Context:Electrodiagnostic (EDX) studies, consisting of nerve conduction studies (NCS) and needle electromyography (EMG), play a crucial role in the evaluation of patients with neuromuscular and peripheral nerve disorders. Electromyographers work in close collaboration with referring physicians, oftentimes through referral and consultation letters. However, there is variation in the format and content of EDX reports to referring physicians, which might complicate communication and clinical decision-making for physicians and patients. Accurate and succinct communication of test results is critical to patient safety, so that important results are neither lost nor miscommunicated.Objective:To explore EDX reporting preferences of referring physicians in order to improve the quality of communication and subsequent patient care.Methods:An online survey was developed, exploring specialty type and preferences for data reporting, data summary/interpretation, and diagnostic impression. A purposive sampling strategy was used to recruit physicians in the authors’ professional networks who had previously referred patients for EDX studies. Quantitative and qualitative survey data underwent descriptive statistical analysis and thematic analysis, respectively.Results:There was a total of 40 respondents, consisting of non-surgical specialists (_n_ = 22), surgical specialists (_n_ = 12), and family physicians (_n_ = 6). The majority of respondents indicated that the data summary/interpretation and diagnostic impression sections of an EDX report were most critical to their needs; important elements included differential diagnosis, prognosis, and management recommendations. A considerably smaller proportion of respondents comprised of primarily non-surgical and surgical specialists indicated numeric data as critical to their needs, preferring this data to be formatted as bullet points or tables without NCS waveforms. Regarding the format of EDX reports, the majority of respondents preferred bullet point rather than paragraph formatting of the data summary/interpretation and diagnostic impression sections. These preferences were corroborated in the thematic analysis of text responses, which also highlighted the importance of the clarity and consistency of EDX reports.Conclusion:The results of this exploratory survey suggest that physicians who refer patients for EDX studies prefer reports that emphasize the interpretation of EDX data and a clear diagnostic impression, particularly in bullet point format. This project highlights the importance of optimizing communication between electromyographers and referring physicians to ultimately improve patient care. Future research should explore larger sample sizes to ascertain any subgroup differences and investigate the impact of different reporting styles using relevant outcome measures (i.e. clinical utility, physician satisfaction). |
Lawrence R. | Robinson | Sunnybrook Health Sciences Centre, Toronto, ON, Canada; Department of Medicine, Division of Physical Medicine & Rehabilitation, University of Toronto, Toronto, ON, Canada | |
| 1 | Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps tendonitis – a prospective study | ["Biceps tendonitis", "Shoulder examination", "Shoulder arthroscopy", "Shoulder ultrasound", "Ultrasound"] | Cyril Boulila, Benjamin Green, Vincent Roy, Rémi Lacroix, Valérie Bélanger, Samuel Côté, Jean-Sébanstie Roy, Sebastien Lambert, Stéphane Pelet, Martin Lesieur, Marie-Eve Roger, Emmanuelle Villemaire-Côté | Abstract |
Running title:Evaluation of ultrasound diagnosis in long head of biceps tendonitis : a prospective study Anterior shoulder pain could lead to functional limitation and represent a high cost for the society. However, the diagnosis of the etiology of the pain remained challenging for clinicians. As a result of the improvement in the quality in the imaging of ultrasound (US) technology, its use in the diagnosis of the long head of biceps (LHB) tendinopathy needs to be assessed. **OBJECTIVE** To compare the clinical and ultrasound (US) accuracy in the diagnosis of LHB tendonitis to the gold standard shoulder surgery. **DESIGN** An experimental, prospective, double-blind multicenter study was conducted to assess clinical, US and arthroscopic evaluations of patients with LHB-suggestive anterior shoulder pain. Function was reported using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical exam included range of motion (ROM) and shoulder specific tests (Speed, Yergason, O'Brien, Upper Cut, and palpation of the bicipital groove). Then, an US-certified physiatrist performed the quantitative and qualitative US measurements of the LHB tendon. Finally, a direct visualization of the LHB was performed through an open or arthroscopic shoulder surgery. **PARTICIPANTS** Adults with LHB tendonitis-suggestive anterior shoulder pain exempt from major shoulder ROM limitations, rheumatologic disease, recent joint infiltration, upper limb fracture, shoulder neoplasia, shoulder prosthesis, and complete rupture of the (LHB). **RESULTS** Preliminary results of 45/100 patients awaiting shoulder surgery (64% men), with a mean age of 55±15 years-old, were included in the study. Dedicated provocative tests were compared to gold-standard shoulder arthroscopy and showed Sensitivity (Sn), Specificity (Sp), positive (LR+) and negative (LR-) likelihood ratio as follows; Clinical specific tests showed a range of Sn: 35-58%, Sp: 36-57%, LR+:0.52-1.05, LR-:0.96-1.48. Moreover, qualitative LHB tendonitis diagnosis on shoulder US revealed Sn: 60% Sp: 36% LR+: 0.93 and LR-: 1.12 while combining both dedicated tests (Speed and Uppercut tests) and US showed Sn: 47% Sp: 38% LR+: 0.75 and LR-: 1.42. Finally, quantitative shoulder US analysis of LHB diameter at the rotator interval demonstrated Sn: 4%, Sp: 100%, LR+: 0 LR-: 0.96, LHB maximal diameter showed Sn: 8% Sp: 100% LR+: 0 LR-: 0.92, LHB thickness (>23mm) showed Sn: 74% Sp: 15% LR+: 0.87 and LR-: 1.70, while LHB maximal surface at rotator interval (>10mm) showed Sn: 83% Sp: 15% LR+: 0.98 and LR: 1.13 and LHB maximal surface (>10mm) was Sn: 72% Sp: 15% LR+: 0.85 LR-: 1.13. **CONCLUSION** In agreement with previous studies, clinical examination alone yielded poor diagnostic accuracy in LHB tendonitis. Up to now, taken separately, US qualitative and quantitative measures were not predictive of the LHB tendonitis diagnosis. Nonetheless, the LHB diameter at the rotator interval and the maximal diameter were 100% specific to LHB tendonitis. More research is needed to integrate the information brought by every test altogether to reproduce the clinician analysis process. |
Benjamin | Green | Medecine physique et réadaptation , Université laval | |
| 1 | Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps tendonitis – a prospective study | ["Biceps tendonitis", "Shoulder examination", "Shoulder arthroscopy", "Shoulder ultrasound", "Ultrasound"] | Cyril Boulila, Benjamin Green, Vincent Roy, Rémi Lacroix, Valérie Bélanger, Samuel Côté, Jean-Sébanstie Roy, Sebastien Lambert, Stéphane Pelet, Martin Lesieur, Marie-Eve Roger, Emmanuelle Villemaire-Côté | Abstract |
Running title:Evaluation of ultrasound diagnosis in long head of biceps tendonitis : a prospective study Anterior shoulder pain could lead to functional limitation and represent a high cost for the society. However, the diagnosis of the etiology of the pain remained challenging for clinicians. As a result of the improvement in the quality in the imaging of ultrasound (US) technology, its use in the diagnosis of the long head of biceps (LHB) tendinopathy needs to be assessed. **OBJECTIVE** To compare the clinical and ultrasound (US) accuracy in the diagnosis of LHB tendonitis to the gold standard shoulder surgery. **DESIGN** An experimental, prospective, double-blind multicenter study was conducted to assess clinical, US and arthroscopic evaluations of patients with LHB-suggestive anterior shoulder pain. Function was reported using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical exam included range of motion (ROM) and shoulder specific tests (Speed, Yergason, O'Brien, Upper Cut, and palpation of the bicipital groove). Then, an US-certified physiatrist performed the quantitative and qualitative US measurements of the LHB tendon. Finally, a direct visualization of the LHB was performed through an open or arthroscopic shoulder surgery. **PARTICIPANTS** Adults with LHB tendonitis-suggestive anterior shoulder pain exempt from major shoulder ROM limitations, rheumatologic disease, recent joint infiltration, upper limb fracture, shoulder neoplasia, shoulder prosthesis, and complete rupture of the (LHB). **RESULTS** Preliminary results of 45/100 patients awaiting shoulder surgery (64% men), with a mean age of 55±15 years-old, were included in the study. Dedicated provocative tests were compared to gold-standard shoulder arthroscopy and showed Sensitivity (Sn), Specificity (Sp), positive (LR+) and negative (LR-) likelihood ratio as follows; Clinical specific tests showed a range of Sn: 35-58%, Sp: 36-57%, LR+:0.52-1.05, LR-:0.96-1.48. Moreover, qualitative LHB tendonitis diagnosis on shoulder US revealed Sn: 60% Sp: 36% LR+: 0.93 and LR-: 1.12 while combining both dedicated tests (Speed and Uppercut tests) and US showed Sn: 47% Sp: 38% LR+: 0.75 and LR-: 1.42. Finally, quantitative shoulder US analysis of LHB diameter at the rotator interval demonstrated Sn: 4%, Sp: 100%, LR+: 0 LR-: 0.96, LHB maximal diameter showed Sn: 8% Sp: 100% LR+: 0 LR-: 0.92, LHB thickness (>23mm) showed Sn: 74% Sp: 15% LR+: 0.87 and LR-: 1.70, while LHB maximal surface at rotator interval (>10mm) showed Sn: 83% Sp: 15% LR+: 0.98 and LR: 1.13 and LHB maximal surface (>10mm) was Sn: 72% Sp: 15% LR+: 0.85 LR-: 1.13. **CONCLUSION** In agreement with previous studies, clinical examination alone yielded poor diagnostic accuracy in LHB tendonitis. Up to now, taken separately, US qualitative and quantitative measures were not predictive of the LHB tendonitis diagnosis. Nonetheless, the LHB diameter at the rotator interval and the maximal diameter were 100% specific to LHB tendonitis. More research is needed to integrate the information brought by every test altogether to reproduce the clinician analysis process. |
Vincent | Roy | Faculty of medicine, Université Laval | |
| 1 | Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps tendonitis – a prospective study | ["Biceps tendonitis", "Shoulder examination", "Shoulder arthroscopy", "Shoulder ultrasound", "Ultrasound"] | Cyril Boulila, Benjamin Green, Vincent Roy, Rémi Lacroix, Valérie Bélanger, Samuel Côté, Jean-Sébanstie Roy, Sebastien Lambert, Stéphane Pelet, Martin Lesieur, Marie-Eve Roger, Emmanuelle Villemaire-Côté | Abstract |
Running title:Evaluation of ultrasound diagnosis in long head of biceps tendonitis : a prospective study Anterior shoulder pain could lead to functional limitation and represent a high cost for the society. However, the diagnosis of the etiology of the pain remained challenging for clinicians. As a result of the improvement in the quality in the imaging of ultrasound (US) technology, its use in the diagnosis of the long head of biceps (LHB) tendinopathy needs to be assessed. **OBJECTIVE** To compare the clinical and ultrasound (US) accuracy in the diagnosis of LHB tendonitis to the gold standard shoulder surgery. **DESIGN** An experimental, prospective, double-blind multicenter study was conducted to assess clinical, US and arthroscopic evaluations of patients with LHB-suggestive anterior shoulder pain. Function was reported using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical exam included range of motion (ROM) and shoulder specific tests (Speed, Yergason, O'Brien, Upper Cut, and palpation of the bicipital groove). Then, an US-certified physiatrist performed the quantitative and qualitative US measurements of the LHB tendon. Finally, a direct visualization of the LHB was performed through an open or arthroscopic shoulder surgery. **PARTICIPANTS** Adults with LHB tendonitis-suggestive anterior shoulder pain exempt from major shoulder ROM limitations, rheumatologic disease, recent joint infiltration, upper limb fracture, shoulder neoplasia, shoulder prosthesis, and complete rupture of the (LHB). **RESULTS** Preliminary results of 45/100 patients awaiting shoulder surgery (64% men), with a mean age of 55±15 years-old, were included in the study. Dedicated provocative tests were compared to gold-standard shoulder arthroscopy and showed Sensitivity (Sn), Specificity (Sp), positive (LR+) and negative (LR-) likelihood ratio as follows; Clinical specific tests showed a range of Sn: 35-58%, Sp: 36-57%, LR+:0.52-1.05, LR-:0.96-1.48. Moreover, qualitative LHB tendonitis diagnosis on shoulder US revealed Sn: 60% Sp: 36% LR+: 0.93 and LR-: 1.12 while combining both dedicated tests (Speed and Uppercut tests) and US showed Sn: 47% Sp: 38% LR+: 0.75 and LR-: 1.42. Finally, quantitative shoulder US analysis of LHB diameter at the rotator interval demonstrated Sn: 4%, Sp: 100%, LR+: 0 LR-: 0.96, LHB maximal diameter showed Sn: 8% Sp: 100% LR+: 0 LR-: 0.92, LHB thickness (>23mm) showed Sn: 74% Sp: 15% LR+: 0.87 and LR-: 1.70, while LHB maximal surface at rotator interval (>10mm) showed Sn: 83% Sp: 15% LR+: 0.98 and LR: 1.13 and LHB maximal surface (>10mm) was Sn: 72% Sp: 15% LR+: 0.85 LR-: 1.13. **CONCLUSION** In agreement with previous studies, clinical examination alone yielded poor diagnostic accuracy in LHB tendonitis. Up to now, taken separately, US qualitative and quantitative measures were not predictive of the LHB tendonitis diagnosis. Nonetheless, the LHB diameter at the rotator interval and the maximal diameter were 100% specific to LHB tendonitis. More research is needed to integrate the information brought by every test altogether to reproduce the clinician analysis process. |
Emmanuelle | Villemaire-Côté | Orthopedic Surgery, Université Laval | |
| 1 | Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps tendonitis – a prospective study | ["Biceps tendonitis", "Shoulder examination", "Shoulder arthroscopy", "Shoulder ultrasound", "Ultrasound"] | Cyril Boulila, Benjamin Green, Vincent Roy, Rémi Lacroix, Valérie Bélanger, Samuel Côté, Jean-Sébanstie Roy, Sebastien Lambert, Stéphane Pelet, Martin Lesieur, Marie-Eve Roger, Emmanuelle Villemaire-Côté | Abstract |
Running title:Evaluation of ultrasound diagnosis in long head of biceps tendonitis : a prospective study Anterior shoulder pain could lead to functional limitation and represent a high cost for the society. However, the diagnosis of the etiology of the pain remained challenging for clinicians. As a result of the improvement in the quality in the imaging of ultrasound (US) technology, its use in the diagnosis of the long head of biceps (LHB) tendinopathy needs to be assessed. **OBJECTIVE** To compare the clinical and ultrasound (US) accuracy in the diagnosis of LHB tendonitis to the gold standard shoulder surgery. **DESIGN** An experimental, prospective, double-blind multicenter study was conducted to assess clinical, US and arthroscopic evaluations of patients with LHB-suggestive anterior shoulder pain. Function was reported using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical exam included range of motion (ROM) and shoulder specific tests (Speed, Yergason, O'Brien, Upper Cut, and palpation of the bicipital groove). Then, an US-certified physiatrist performed the quantitative and qualitative US measurements of the LHB tendon. Finally, a direct visualization of the LHB was performed through an open or arthroscopic shoulder surgery. **PARTICIPANTS** Adults with LHB tendonitis-suggestive anterior shoulder pain exempt from major shoulder ROM limitations, rheumatologic disease, recent joint infiltration, upper limb fracture, shoulder neoplasia, shoulder prosthesis, and complete rupture of the (LHB). **RESULTS** Preliminary results of 45/100 patients awaiting shoulder surgery (64% men), with a mean age of 55±15 years-old, were included in the study. Dedicated provocative tests were compared to gold-standard shoulder arthroscopy and showed Sensitivity (Sn), Specificity (Sp), positive (LR+) and negative (LR-) likelihood ratio as follows; Clinical specific tests showed a range of Sn: 35-58%, Sp: 36-57%, LR+:0.52-1.05, LR-:0.96-1.48. Moreover, qualitative LHB tendonitis diagnosis on shoulder US revealed Sn: 60% Sp: 36% LR+: 0.93 and LR-: 1.12 while combining both dedicated tests (Speed and Uppercut tests) and US showed Sn: 47% Sp: 38% LR+: 0.75 and LR-: 1.42. Finally, quantitative shoulder US analysis of LHB diameter at the rotator interval demonstrated Sn: 4%, Sp: 100%, LR+: 0 LR-: 0.96, LHB maximal diameter showed Sn: 8% Sp: 100% LR+: 0 LR-: 0.92, LHB thickness (>23mm) showed Sn: 74% Sp: 15% LR+: 0.87 and LR-: 1.70, while LHB maximal surface at rotator interval (>10mm) showed Sn: 83% Sp: 15% LR+: 0.98 and LR: 1.13 and LHB maximal surface (>10mm) was Sn: 72% Sp: 15% LR+: 0.85 LR-: 1.13. **CONCLUSION** In agreement with previous studies, clinical examination alone yielded poor diagnostic accuracy in LHB tendonitis. Up to now, taken separately, US qualitative and quantitative measures were not predictive of the LHB tendonitis diagnosis. Nonetheless, the LHB diameter at the rotator interval and the maximal diameter were 100% specific to LHB tendonitis. More research is needed to integrate the information brought by every test altogether to reproduce the clinician analysis process. |
Cyril | Boulila | Physical Medicine and rehab, Université Laval | |
| 1 | Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps tendonitis – a prospective study | ["Biceps tendonitis", "Shoulder examination", "Shoulder arthroscopy", "Shoulder ultrasound", "Ultrasound"] | Cyril Boulila, Benjamin Green, Vincent Roy, Rémi Lacroix, Valérie Bélanger, Samuel Côté, Jean-Sébanstie Roy, Sebastien Lambert, Stéphane Pelet, Martin Lesieur, Marie-Eve Roger, Emmanuelle Villemaire-Côté | Abstract |
Running title:Evaluation of ultrasound diagnosis in long head of biceps tendonitis : a prospective study Anterior shoulder pain could lead to functional limitation and represent a high cost for the society. However, the diagnosis of the etiology of the pain remained challenging for clinicians. As a result of the improvement in the quality in the imaging of ultrasound (US) technology, its use in the diagnosis of the long head of biceps (LHB) tendinopathy needs to be assessed. **OBJECTIVE** To compare the clinical and ultrasound (US) accuracy in the diagnosis of LHB tendonitis to the gold standard shoulder surgery. **DESIGN** An experimental, prospective, double-blind multicenter study was conducted to assess clinical, US and arthroscopic evaluations of patients with LHB-suggestive anterior shoulder pain. Function was reported using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical exam included range of motion (ROM) and shoulder specific tests (Speed, Yergason, O'Brien, Upper Cut, and palpation of the bicipital groove). Then, an US-certified physiatrist performed the quantitative and qualitative US measurements of the LHB tendon. Finally, a direct visualization of the LHB was performed through an open or arthroscopic shoulder surgery. **PARTICIPANTS** Adults with LHB tendonitis-suggestive anterior shoulder pain exempt from major shoulder ROM limitations, rheumatologic disease, recent joint infiltration, upper limb fracture, shoulder neoplasia, shoulder prosthesis, and complete rupture of the (LHB). **RESULTS** Preliminary results of 45/100 patients awaiting shoulder surgery (64% men), with a mean age of 55±15 years-old, were included in the study. Dedicated provocative tests were compared to gold-standard shoulder arthroscopy and showed Sensitivity (Sn), Specificity (Sp), positive (LR+) and negative (LR-) likelihood ratio as follows; Clinical specific tests showed a range of Sn: 35-58%, Sp: 36-57%, LR+:0.52-1.05, LR-:0.96-1.48. Moreover, qualitative LHB tendonitis diagnosis on shoulder US revealed Sn: 60% Sp: 36% LR+: 0.93 and LR-: 1.12 while combining both dedicated tests (Speed and Uppercut tests) and US showed Sn: 47% Sp: 38% LR+: 0.75 and LR-: 1.42. Finally, quantitative shoulder US analysis of LHB diameter at the rotator interval demonstrated Sn: 4%, Sp: 100%, LR+: 0 LR-: 0.96, LHB maximal diameter showed Sn: 8% Sp: 100% LR+: 0 LR-: 0.92, LHB thickness (>23mm) showed Sn: 74% Sp: 15% LR+: 0.87 and LR-: 1.70, while LHB maximal surface at rotator interval (>10mm) showed Sn: 83% Sp: 15% LR+: 0.98 and LR: 1.13 and LHB maximal surface (>10mm) was Sn: 72% Sp: 15% LR+: 0.85 LR-: 1.13. **CONCLUSION** In agreement with previous studies, clinical examination alone yielded poor diagnostic accuracy in LHB tendonitis. Up to now, taken separately, US qualitative and quantitative measures were not predictive of the LHB tendonitis diagnosis. Nonetheless, the LHB diameter at the rotator interval and the maximal diameter were 100% specific to LHB tendonitis. More research is needed to integrate the information brought by every test altogether to reproduce the clinician analysis process. |
Rémi | Lacroix | Physical Medicine and rehabilitation, Université laval | |
| 1 | Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps tendonitis – a prospective study | ["Biceps tendonitis", "Shoulder examination", "Shoulder arthroscopy", "Shoulder ultrasound", "Ultrasound"] | Cyril Boulila, Benjamin Green, Vincent Roy, Rémi Lacroix, Valérie Bélanger, Samuel Côté, Jean-Sébanstie Roy, Sebastien Lambert, Stéphane Pelet, Martin Lesieur, Marie-Eve Roger, Emmanuelle Villemaire-Côté | Abstract |
Running title:Evaluation of ultrasound diagnosis in long head of biceps tendonitis : a prospective study Anterior shoulder pain could lead to functional limitation and represent a high cost for the society. However, the diagnosis of the etiology of the pain remained challenging for clinicians. As a result of the improvement in the quality in the imaging of ultrasound (US) technology, its use in the diagnosis of the long head of biceps (LHB) tendinopathy needs to be assessed. **OBJECTIVE** To compare the clinical and ultrasound (US) accuracy in the diagnosis of LHB tendonitis to the gold standard shoulder surgery. **DESIGN** An experimental, prospective, double-blind multicenter study was conducted to assess clinical, US and arthroscopic evaluations of patients with LHB-suggestive anterior shoulder pain. Function was reported using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical exam included range of motion (ROM) and shoulder specific tests (Speed, Yergason, O'Brien, Upper Cut, and palpation of the bicipital groove). Then, an US-certified physiatrist performed the quantitative and qualitative US measurements of the LHB tendon. Finally, a direct visualization of the LHB was performed through an open or arthroscopic shoulder surgery. **PARTICIPANTS** Adults with LHB tendonitis-suggestive anterior shoulder pain exempt from major shoulder ROM limitations, rheumatologic disease, recent joint infiltration, upper limb fracture, shoulder neoplasia, shoulder prosthesis, and complete rupture of the (LHB). **RESULTS** Preliminary results of 45/100 patients awaiting shoulder surgery (64% men), with a mean age of 55±15 years-old, were included in the study. Dedicated provocative tests were compared to gold-standard shoulder arthroscopy and showed Sensitivity (Sn), Specificity (Sp), positive (LR+) and negative (LR-) likelihood ratio as follows; Clinical specific tests showed a range of Sn: 35-58%, Sp: 36-57%, LR+:0.52-1.05, LR-:0.96-1.48. Moreover, qualitative LHB tendonitis diagnosis on shoulder US revealed Sn: 60% Sp: 36% LR+: 0.93 and LR-: 1.12 while combining both dedicated tests (Speed and Uppercut tests) and US showed Sn: 47% Sp: 38% LR+: 0.75 and LR-: 1.42. Finally, quantitative shoulder US analysis of LHB diameter at the rotator interval demonstrated Sn: 4%, Sp: 100%, LR+: 0 LR-: 0.96, LHB maximal diameter showed Sn: 8% Sp: 100% LR+: 0 LR-: 0.92, LHB thickness (>23mm) showed Sn: 74% Sp: 15% LR+: 0.87 and LR-: 1.70, while LHB maximal surface at rotator interval (>10mm) showed Sn: 83% Sp: 15% LR+: 0.98 and LR: 1.13 and LHB maximal surface (>10mm) was Sn: 72% Sp: 15% LR+: 0.85 LR-: 1.13. **CONCLUSION** In agreement with previous studies, clinical examination alone yielded poor diagnostic accuracy in LHB tendonitis. Up to now, taken separately, US qualitative and quantitative measures were not predictive of the LHB tendonitis diagnosis. Nonetheless, the LHB diameter at the rotator interval and the maximal diameter were 100% specific to LHB tendonitis. More research is needed to integrate the information brought by every test altogether to reproduce the clinician analysis process. |
Stéphane | Pelet | Orthopedic surgery, Université Laval | |
| 1 | Evaluation of clinical and ultrasound-based diagnosis of the long head of the biceps tendonitis – a prospective study | ["Biceps tendonitis", "Shoulder examination", "Shoulder arthroscopy", "Shoulder ultrasound", "Ultrasound"] | Cyril Boulila, Benjamin Green, Vincent Roy, Rémi Lacroix, Valérie Bélanger, Samuel Côté, Jean-Sébanstie Roy, Sebastien Lambert, Stéphane Pelet, Martin Lesieur, Marie-Eve Roger, Emmanuelle Villemaire-Côté | Abstract |
Running title:Evaluation of ultrasound diagnosis in long head of biceps tendonitis : a prospective study Anterior shoulder pain could lead to functional limitation and represent a high cost for the society. However, the diagnosis of the etiology of the pain remained challenging for clinicians. As a result of the improvement in the quality in the imaging of ultrasound (US) technology, its use in the diagnosis of the long head of biceps (LHB) tendinopathy needs to be assessed. **OBJECTIVE** To compare the clinical and ultrasound (US) accuracy in the diagnosis of LHB tendonitis to the gold standard shoulder surgery. **DESIGN** An experimental, prospective, double-blind multicenter study was conducted to assess clinical, US and arthroscopic evaluations of patients with LHB-suggestive anterior shoulder pain. Function was reported using the self-administered Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire. The clinical exam included range of motion (ROM) and shoulder specific tests (Speed, Yergason, O'Brien, Upper Cut, and palpation of the bicipital groove). Then, an US-certified physiatrist performed the quantitative and qualitative US measurements of the LHB tendon. Finally, a direct visualization of the LHB was performed through an open or arthroscopic shoulder surgery. **PARTICIPANTS** Adults with LHB tendonitis-suggestive anterior shoulder pain exempt from major shoulder ROM limitations, rheumatologic disease, recent joint infiltration, upper limb fracture, shoulder neoplasia, shoulder prosthesis, and complete rupture of the (LHB). **RESULTS** Preliminary results of 45/100 patients awaiting shoulder surgery (64% men), with a mean age of 55±15 years-old, were included in the study. Dedicated provocative tests were compared to gold-standard shoulder arthroscopy and showed Sensitivity (Sn), Specificity (Sp), positive (LR+) and negative (LR-) likelihood ratio as follows; Clinical specific tests showed a range of Sn: 35-58%, Sp: 36-57%, LR+:0.52-1.05, LR-:0.96-1.48. Moreover, qualitative LHB tendonitis diagnosis on shoulder US revealed Sn: 60% Sp: 36% LR+: 0.93 and LR-: 1.12 while combining both dedicated tests (Speed and Uppercut tests) and US showed Sn: 47% Sp: 38% LR+: 0.75 and LR-: 1.42. Finally, quantitative shoulder US analysis of LHB diameter at the rotator interval demonstrated Sn: 4%, Sp: 100%, LR+: 0 LR-: 0.96, LHB maximal diameter showed Sn: 8% Sp: 100% LR+: 0 LR-: 0.92, LHB thickness (>23mm) showed Sn: 74% Sp: 15% LR+: 0.87 and LR-: 1.70, while LHB maximal surface at rotator interval (>10mm) showed Sn: 83% Sp: 15% LR+: 0.98 and LR: 1.13 and LHB maximal surface (>10mm) was Sn: 72% Sp: 15% LR+: 0.85 LR-: 1.13. **CONCLUSION** In agreement with previous studies, clinical examination alone yielded poor diagnostic accuracy in LHB tendonitis. Up to now, taken separately, US qualitative and quantitative measures were not predictive of the LHB tendonitis diagnosis. Nonetheless, the LHB diameter at the rotator interval and the maximal diameter were 100% specific to LHB tendonitis. More research is needed to integrate the information brought by every test altogether to reproduce the clinician analysis process. |
Martin | Lesieur | Orthopedic Surgery, Université Laval | |
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