Aproximación a la práctica clínica del médico fisiatra y su desarrollo en Chile / Approach to clinical practice for Physiatrists or PM&R physicians and its development in Chile

Introducción: la actividad médica no acaba cuando la enfermedad remite. Así lo han demostrado las personas con COVID-19 grave, que no hablan de recuperación hasta meses después del egreso hospitalario. Bajo esta premisa amerita profundizar en el rol de la Medicina física y Rehabilitación. Materiales y Métodos: se realizó una revisión de la literatura en revistas de habla hispana e inglesa indexadas en bases de datos científicas. Los criterios de búsqueda fueron dirigidos a los objetivos: definir fisiatría y su posición dentro del modelo sanitario, conocer sus áreas de desempeño y la realidad nacional. Resultados: la fisiatría es la especialidad médica que se encarga de optimizar el funcionamiento de las personas mediante técnicas y estrategias de rehabilitación. Una vez establecido el diagnóstico trimodal, el fisiatra propone objetivos que involucren a todo el equipo rehabilitador, previo acuerdo con el paciente y su familia. Se encuadra bajo el modelo biopsicosocial y su espectro de acción comprende toda condición de salud o patología -congénita o adquirida- que genere una disfunción física, cognitiva o emocional, una limitación en la actividad o algún grado de restricción en la participación. A pesar del desarrollo de casi 60 años de la especialidad en Chile, existe desconocimiento en torno a ella y su alcance clínico. Discusión: parece importante contar en Chile con canales y agentes de difusión sobre el papel que juega la fisiatría como un recurso que eficientiza la restitución de las personas; deben promoverse líneas de investigación, desarrollo de subespecialidades y la descentralización de sus atenciones.

Introduction: Medical activity does not end when the disease remits. This has been demonstrated by patients with severe COVID-19, who do not speak of recovery until months after hospital discharge. Under this premise, the role of Physical medicine and rehabilitation deserves to be studied in depth. Materials and Methods: A literature review was conducted in Spanish and English language journals indexed in scientific databases. Search criteria were refined with the following objectives: to define Physiatry and its position within the health model, recognize its areas of performance, and describe the national context. Results: Physiatry is the medical specialty responsible for optimizing the functionality of people through rehabilitation techniques and strategies. Once the trimodal diagnosis is established, the physiatrist proposes objectives that involve the entire rehabilitation team and prior agreement with the patient and family. It is framed under the biopsychosocial model. Its range of action includes any health condition or pathology -congenital or acquired- that generates a physical, cognitive or emotional dysfunction, a limitation in activities, or any degree of restriction in participation. Despite 60 years of development in Chile, there is a lack of knowledge about this specialty and its potential clinical applicability. Discussion: It seems essential to create channels for dissemination of the role played by Physiatry in Chile as a resource that makes people's restitution more efficient, as well as promoting lines of research, development of subspecialties, and decentralization of care

Application of Workshop Mode in Practical Teaching of Physiatry in Rehabilitation Therapy Specialty / 中国康复理论与实践

In view of the problems existing in the physiatry teaching of rehabilitation therapy specialty, the characteristics of the work-shop mode, which is a kind of teaching mode popularized in domestic and international higher education, was analyzed. The workshop mode was introduced into the practical teaching of physiatry, and the main organization form of practical teaching was put forward and put into practice. The results showed that the workshop mode improved the students' abilities of practice, self learning, expression, interpersonal communication and innovative consciousness, etc.

Interventional Pain Management in Rheumatological Diseases: A Three Years Physiatric Experience in a Tertiary Medical College Hospital in Bangladesh

BACKGROUND: Interventional pain management (IPM) is a branch of medical science that deals with management of painful medical conditions using specially equipped X-ray machines and anatomical landmarks. Interventional physiatry is a branch of physical medicine and rehabilitation that treats painful conditions through intervention in peripheral joints, the spine, and soft tissues. METHODS: A cross-sectional study was conducted using three years of hospital records (2006 to 2008) from the Physical Medicine and Rehabilitation Department at Chittagong Medical College Hospital in Bangladesh, with a view toward highlighting current interventional pain practice in a tertiary medical college hospital. RESULTS: The maximum amount of intervention was done in degenerative peripheral joint disorders (600, 46.0%), followed by inflammatory joint diseases (300, 23.0%), soft tissue rheumatism (300, 23.0%), and radicular or referred lower back conditions (100, 8.0%). Of the peripheral joints, the knee was the most common site of intervention. Motor stimulation-guided intralesional injection of methylprednisolone into the piriformis muscle was given in 10 cases of piriformis syndrome refractory to both oral medications and therapeutic exercises. Soft tissue rheumatism of unknown etiology was most common in the form of adhesive capsulitis (90, 64.3%), and is discussed separately. Epidural steroid injection was practiced for various causes of lumbar radiculopathy, with the exception of infective discitis. CONCLUSIONS: All procedures were performed using anatomical landmarks, as there were no facilities for the C-arm/diagnostic ultrasound required for accurate and safe intervention. A dedicated IPM setup should be a requirement in all PMR departments, to provide better pain management and to reduce the burden on other specialties.

Defining Physiatry and Future Scope of Rehabilitation Medicine

To identify the 'physiatry' in a single word is difficult. This may be due that physiatry originated from two different fields, physical medicine and rehabilitation and focuses on assisting the general improvement of functional recovery in disabled patients. In addition, physiatry has new markets to develop; health and welfare. Therefore, the identity of physiatry will change depending on how physiatrists act in these fields. We attempt to define the physiatry from several aspects.

A survey of the perceptions, knowledge, attitudes and practice of evidence-based medicine among rehabilitation medicine trainees and consultants in a university-based tertiary hospital

OBJECTIVES:The study aimed to determine the perceptions, attitudes, knowledge and practice of Evidence-Based Medicine (EBM) among Rehabilitation Medicine trainees and faculty. It aimed to compare trainees and faculty in terms of perceptions, attitudes, knowledge and practice. The study also intended to identify the barriers in the practice of EBM.METHODS: The study utilized a cross-sectional design. The study included residents or trainees and consultants at the Department of Rehabilitation Medicine-Philippine General Hospital. A questionnaire exploring the perceptions, knowledge, attitudes and practice of EBM and the barriers in its practice was developed based on review of previous studies. Focus group discussions were conducted with the residents and consultants separately to probe the responses in the questionnaire.RESULTS: Thirty-four trainees and consultants participated in the study. Trainees considered themselves having received more training in literature search (p=0.005) and critical appraisal (p=0.01) than consultants. Majority had fairly accurate conceptions of EBM. Thirty-eight percent of participants considered themselves competent in developing a clinical question and in doing a literature search. About 18% considered themselves competent in appraising literature. There were no significant differences between trainees and consultants in terms of their perceived knowledge and skills in EBM techniques. Consultants and trainees expressed positive attitudes towards EBM. In a week, some 50% search the literature at least twice and appraised an article. Eighty percent of Rehabilitation Medicine physicians (physiatrists) spent at least 2 hours per week reading related literature. In terms of practice of EBM, the trainees rated themselves higher in searching and appraising literature than the consultants but the differences were not significant. More than 90% indicated interest in further training in EBM. Majority cited lack of time, lack of understanding of statistics and inadequate information sources as barriers to EBM.CONCLUSION: Physiatrists have fairly accurate perceptions; positive attitudes; some knowledge / skills; and a high level of interest in EBM. There were no significant differences between consultants and trainees except in the aspect of training in literature search and appraisal. The lack of personal time, lack of understanding of statistical analyses and inadequate information sources were the most common perceived barriers in the practice of EBM in Physiatry.

The Practice of Physical Medicine and Rehabilitation in subSaharan Africa and Antarctica:A White Paper or a Black Mark? / 中国康复医学杂志

Objective: To explore the practice of PM&R in subSabaran Africa and Antarctica. Method: Medline searches, membership data searches, fax survey of medical schools, Internet searches, and interviews with experts. Result:The continents are dissimilar in terms of climate and govemment. However both Antarctica and subSaharan Africa have no PM&R training programs, no professional organizations, no specialty board requirements, and no practicing physicians in the field. Since there is no known disabled child on Antarctica and adults are airlifted to world-class health care, the consequences of this deficit are minimal there. However the 788,000,000 permanent residents of subSabaran Africa including approximately 78 million persons with disability are left unserved. Conclusion:Antarctica is doing fine. Africa is in a crisis. Local medical schools, hospitals doctors, and persons with disability; along with foreign volunteers, aid groups, and policymakers can impact the crisis. However govemment-specifically national ministries of health-is ultimately responsible for the health and wellbeing of citizens.