Rehabilitative Sciences

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    Arthroscopic vs. an Open Procedure for the first time success rate of a Torn Rotator Cuff
    (2022) Navid, Daniel; Dutta, Arpam; Campbell, Blake; Mohammad, Moath
    Arthroscopic vs. an Open Procedure for the first time success rate of a Torn Rotator Cuff This paper will explore three published articles, data from Houston Northwest, and opinions from doctors in order to examine the two procedure techniques, arthroscopic vs. open surgery on the first time success rate of a torn rotator cuff. The first article by Ghodadra, Provencher, and Verma (2009) suggest that patients that "undergo all arthroscopic rotator cuff repair should undergo an accelerated postoperative rehabilitation program." The second paper conducted by Godley and Funk (2009) examine an arthroscopic repair of a rotator cuff and analyze outcomes over an 18-month period. The final area of examination was done by the author looking at the patient data base in Houston Northwest hospital. In this hospital, there have been over 200 rotator cuff repairs in the past 5 years. Each patient's chart was examined at the date of the repair finding out if was done arthroscopically or open. The chart was then further examined to see if there was a reoccurring problem or found at a later date. Finally, preferred methods will be given from Dr. Shawn Mansour, Dr. Moran, and surgical assistance to give their opinions on the different methods over the years. All of these sources were combined to find the best surgical option for the repair of a torn rotator cuff.
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    Factors Associated with Pain Sensitivity and its Impact on Long-Term Outcomes in Patients with Chronic Pain: A Retrospective Cohort Study
    (2022) Beal, Jennifer; Fakes, Nicole; Herron, Breanna; Jacobs, Colleen; Vasudevan, Aditi; Licciardone, John C.
    Purpose Low back pain is estimated to affect 632 million people globally and treatment of back and neck pain in the United States costs upwards of $100 billion annually. Major clinical practice guidelines have been established for chronic pain in general, and for chronic low back pain (CLBP) in particular, with non-pharmacological and non-opioid therapies as first-line treatments. Nevertheless, these guidelines do not address how pain sensitivity may influence treatment. Pain sensitivity may be defined as the perception of pain in different situations, which varies from person to person. This study aims to determine if pain sensitivity is associated with long-term outcomes relating to low back pain intensity, back-related disability, and health-related quality of life in patients with CLBP. Methods Participants with CLBP were recruited from the Pain Registry for Epidemiological, Clinical, and Interventional Studies and Innovation (PRECISION Pain Research Registry) from April 2016 through December 2021. Pain sensitivity was measured for each participant using the Pain Sensitivity Questionnaire (PSQ), wherein scores range from 0 (least pain sensitivity) to 10 (greatest pain sensitivity). Participants were subsequently classified as having low (PSQ score ≤4) or high (PSQ score >4) pain sensitivity based on a median split. The primary outcomes were measured at quarterly encounters over 12 months, and included low back pain intensity measured with a numerical rating scale, back-related disability measured with the Roland-Morris Disability Questionnaire, and health-related quality of life measured with the SPADE cluster (sleep disturbance, pain interference, anxiety, depression, and low energy/fatigue) derived from the Patient-Reported Outcomes Measurement Information System. Multiple logistic regression was initially used to predict participant characteristics associated with high pain sensitivity. Longitudinal outcomes over 12 months were then compared according to pain sensitivity level using repeated measures analysis of variance, while simultaneously controlling for potential confounders using propensity scores. Results The strongest predictors of high pain sensitivity were being Black (OR, 6.43; 95% CI, 4.01-10.32; P< 0.001) and having high pain catastrophizing (OR, 3.11; 95% CI, 2.09-4.62; P< 0.001). High pain sensitivity was associated with greater overall levels of low back pain intensity (P< 0.001), back-related disability (P< 0.001), and health-related quality-of-life deficits (P< 0.001). However, after controlling for confounding variables, only the findings for pain intensity remained significant (P< 0.001). Conclusions High pain sensitivity is associated with greater low back pain intensity (but not with back-related disability or health-related quality of life) after controlling for confounding variables. Being Black and having high levels of pain catastrophizing were highly significant predictors of high pain sensitivity. The latter finding has important implications for rehabilitation of patients with chronic pain, as it highlights the importance of interventions that address patient pain catastrophizing, pain sensitivity, and ultimately adverse health outcomes. Physicians should be aware of how they can improve long-term chronic pain outcomes by addressing the patient's mental state relating to pain, as well as using other more conventional approaches to pain management.
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    Physical Therapy Telerehabilitation on COVID-19 Patients - A Literature Review
    (2022) Galvan, Valeria; Vasquez, Melissa; Rodriguez, Yuzek; Valencia, Karyna
    Introduction: The impact of Covid-19 has revolutionized how Physical Therapists provide treatment to patients to reduce the risk of infection, since most rehabilitation is done in close proximity, social distancing has been the main challenge when providing treatment. For physical therapy rehabilitation, it is imperative to provide treatment that still focuses on the recovery of function, strength, and movement of the patient. It is necessary to explore what are the best ways of implementation to maximize the patients' benefit. The purpose of this literature review is to analyze studies that focused on physical therapy through telehealth and the overall outcome of these visits. Methods: This review utilized randomized control trials and systematic reviews of various populations and settings using the following search terms: Telemedicine, Telehealth, Telerehabilitation, Covid-19, Physical therapy. All articles are dated within the past 2 years from PubMed, Scopus, and Google scholar. This literature review examines the effectiveness of telehealth in the era of Covid-19. Results: The population analyzed in these studies varied from infants to older adults. Results varied on each study, but all concluded with advantages and disadvantages of Physical Therapy Telerehabilitation. The main advantages were reducing travel fatigue, the general strain on the body, and minimizing travel cost. Some of the disadvantages found were the adaptability of both patient and therapist to limited treatment options, technological barriers, and reduction in equipment accessibility. Out of all the therapy sessions provided, 85% were telerehabilitation sessions, of which 94% out of those had to follow ups and patients expressed being at least satisfied with the service. Women participated more frequently and reported a higher level of satisfaction than male participants. A consensus was made and reported that 92% of the patients that participated in the telerehabilitation sessions were willing to continue with this practice. Overall physical therapy increases clinical effectiveness, functionality, quality of life, and user satisfaction. For patients recovering from COVID-19, telerehabilitation improves their vital respiratory capacity, increases respiratory muscle efficiency, and decreases fatigability levels. Conclusions: Physical Therapists recognize the value in training for virtual treatment delivery and continue to provide specialized rehabilitation services with new technical and clinical skills. Telehealth systems are the solution for the shortage of hospital beds and their home-based style can provide clinical benefits, cost-effectiveness, and simplicity. The implementation of telehealth services has been feasible and acceptable with the support of policy in favor of the expansion of telehealth physical therapy. The telehealth models now available globally are proving that telerehab is not inferior to standard rehabilitation. Clinical Relevance: Telemedicine services provide essential care for patients without increasing the risk of Covid-19 spread. Although it has some challenges, it is most accessible throughout all health care practices and has the potential to shape the future of the patient provider relationship, especially for physical therapy.
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    Branched-chain amino acids are neuroprotective against traumatic brain injury and enhance rate of recovery: prophylactic role for contact sports and emergent use
    (2022) Mathew, Ezek; Williamson, Julie; Mahama-Rodriguez, Alia; Mamo, Lois; Dickerman, Rob
    Background: Branched-chain amino acids (BCAA) are known to be neurorestorative after traumatic brain injury (TBI). Despite clinically significant improvements in severe TBI patients given BCAA, the approach is largely an unrecognized option. Furthermore, TBI continues to be the most common cause of morbidity and mortality in adolescents and adults. In this study, we sought to demonstrate the neuroprotective and restorative effects of BCAA on the sequelae of TBI. No study has evaluated whether BCAA can be preventive or neuroprotective if taken before a TBI. We hypothesized that if BCAA were elevated in the circulation prior to TBI, the brain would readily access the BCAA and the severity of injury could be reduced. Methods: A standard weight-drop method was used on 50 adult mice to model a closed-head TBI in humans. The mice were randomized into groups that were shams, untreated, and pre-treated with BCAA, post-treated with BCAA, or pre-treated + post-treated with BCAA. Pretreated mice received BCAA through supplemented water and were dosed via oral gavage 45 mins prior to TBI induction. All mice underwent beam walking to assess motor recovery and Morris water maze assessed cognitive function post-injury. Results: Pre-treated and pre-treated + post-treated mice exhibited significantly better motor recovery and cognitive function than the other groups. The pre-treated + post-treated group performed the best overall while the post-treated group only improved in memory after day 7 of the study. Conclusion: This is the first study, animal or human, to demonstrate BCAA are neuroprotective and neurorestorative after TBI, most likely through the important roles of BCAA to glutamate homeostasis.