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1.
Front Public Health ; 9: 738253, 2021.
Article in English | MEDLINE | ID: covidwho-1775887

ABSTRACT

Physiatry is a medical specialty focused on improving functional outcomes in patients with a variety of medical conditions that affect the brain, spinal cord, peripheral nerves, muscles, bones, joints, ligaments, and tendons. Social determinants of health (SDH) play a key role in determining therapeutic process and patient functional outcomes. Big data and precision medicine have been used in other fields and to some extent in physiatry to predict patient outcomes, however many challenges remain. The interplay between SDH and physiatry outcomes is highly variable depending on different phases of care, and more favorable patient profiles in acute care may be less favorable in the outpatient setting. Furthermore, SDH influence which treatments or interventional procedures are accessible to the patient and thus determine outcomes. This opinion paper describes utility of existing datasets in combination with novel data such as movement, gait patterning and patient perceived outcomes could be analyzed with artificial intelligence methods to determine the best treatment plan for individual patients in order to achieve maximal functional capacity.


Subject(s)
Physical and Rehabilitation Medicine , Artificial Intelligence , Clinical Decision-Making , Humans , Social Determinants of Health
2.
Am J Phys Med Rehabil ; 100(11): 1100-1104, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1700322

ABSTRACT

ABSTRACT: Drastic and rapid changes to medical education are uncommon because of regulations and restrictions designed to ensure consistency among medical school curriculums and to safeguard student well-being. As a consequence of the COVID-19 pandemic, medical education had to break away from its conventions and transition from time-honored teaching methods to innovative solutions. This article explores the anticipated and actual efficacy of the swift conversion of a specialty elective from a traditional in-person format to a fully virtual clerkship. In addition, it includes a noninferiority study to determine where a virtual classroom may excel or fall short in comparison with conventional clinical rotations.


Subject(s)
Clinical Clerkship , Education, Distance/methods , Education, Medical, Undergraduate/methods , Models, Educational , Physical and Rehabilitation Medicine/education , Adult , COVID-19 , Curriculum , Educational Measurement , Female , Humans , Male , Minnesota , Organizational Innovation , Pandemics , SARS-CoV-2
3.
Am J Phys Med Rehabil ; 100(12): 1133-1139, 2021 12 01.
Article in English | MEDLINE | ID: covidwho-1522399

ABSTRACT

ABSTRACT: After surviving infection with the SARS-CoV-2 virus, individuals may have persistent symptoms and prolonged impairments that may last for weeks to months. The frequency and heterogeneity of persistent post-COVID conditions have created challenges in care. Specialty clinics are being established in response to an increasing need to care for patients with postacute sequelae of SARS-CoV-2 or long COVID syndrome. Although many post-COVID conditions can be bettered through a comprehensive rehabilitation plan, various clinical settings may benefit from differing models of coordinated care. We present five models of care in varying degrees of development and compare processes and adaptations to address the unique needs of each center and their unique patient populations. Forging a path to recovery will necessitate a multidisciplinary team with physiatry involvement to meet the distinctive needs of patients with postacute sequelae of SARS-CoV-2. Furthermore, it is imperative that there be equitable access to this care and commitment from healthcare institutions to provide resources for these programs.


Subject(s)
Ambulatory Care/methods , COVID-19/complications , COVID-19/rehabilitation , Physical and Rehabilitation Medicine/methods , Subacute Care/methods , Humans , SARS-CoV-2
4.
Am J Phys Med Rehabil ; 100(11): 1100-1104, 2021 11 01.
Article in English | MEDLINE | ID: covidwho-1483693

ABSTRACT

ABSTRACT: Drastic and rapid changes to medical education are uncommon because of regulations and restrictions designed to ensure consistency among medical school curriculums and to safeguard student well-being. As a consequence of the COVID-19 pandemic, medical education had to break away from its conventions and transition from time-honored teaching methods to innovative solutions. This article explores the anticipated and actual efficacy of the swift conversion of a specialty elective from a traditional in-person format to a fully virtual clerkship. In addition, it includes a noninferiority study to determine where a virtual classroom may excel or fall short in comparison with conventional clinical rotations.


Subject(s)
Clinical Clerkship , Education, Distance/methods , Education, Medical, Undergraduate/methods , Models, Educational , Physical and Rehabilitation Medicine/education , Adult , COVID-19 , Curriculum , Educational Measurement , Female , Humans , Male , Minnesota , Organizational Innovation , Pandemics , SARS-CoV-2
5.
J Rehabil Med ; 53(9): jrm00228, 2021 Sep 16.
Article in English | MEDLINE | ID: covidwho-1470733

ABSTRACT

OBJECTIVE: To describe adaptations in the provision of rehabilitation services proposed by scientific and professional rehabilitation organizations to avoid interruptions to patients rehabilitation process and delays in starting rehabilitation in patients with COVID-19. METHODS: A narrative review approach was used to identify the recommendations of scientific and professional organizations in the area of rehabilitation. A systematic search was performed in the main data-bases in 78 international and regional web portals of rehabilitation organizations. A total of 21 publications from these organizations were identified and selected. RESULTS: The results are presented in 4 categories: adequacy of inpatient services, including acute care services and intensive care unit for patients with and without COVID-19; adequacy of outpatient services, including home-based rehabilitation and tele-rehabilitation; recommendations to prevent the spread of COVID-19; and regulatory standards and positions during the COVID-19 pandemic expressed by organizations for protecting the rights of health workers and patients. CONCLUSION: Health systems around the world are rapidly learning from actions aimed at the reorganization of rehabilitation services for patients who are in the process of recovery from acute or chronic conditions, and the rapid response to the rehabilitation of survivors of COVID-19, as well as from efforts in the prevention of contagion of those providing the services.


Subject(s)
Health Personnel/psychology , Pandemics , Physical and Rehabilitation Medicine/methods , Rehabilitation , COVID-19/epidemiology , COVID-19/psychology , Humans , Patient Care Team , SARS-CoV-2 , Survivors
6.
Am J Phys Med Rehabil ; 100(9): 831-836, 2021 09 01.
Article in English | MEDLINE | ID: covidwho-1447682

ABSTRACT

ABSTRACT: The novel coronavirus 2019 pandemic has led to new dilemmas in medical education because of an initial shortage of personal protective equipment, uncertainty regarding disease transmission and treatments, travel restrictions, and social distancing guidelines. These new problems further compound the already existing problem of limited medical student exposure to the field of physical medicine and rehabilitation, particularly for students in medical schools lacking a department of physical medicine and rehabilitation, approximately 50% of medical schools. A virtual medical student physical medicine and rehabilitation rotation was created to mitigate coronavirus 2019-related limitations and impact on medical education. Using audiovisual technology, students had the opportunity to participate in clinical inpatient and outpatient care, live-streamed procedures, and virtual didactics, develop and showcase their clinical knowledge and reasoning skills, and become familiar with the culture of the physical medicine and rehabilitation residency program. Adaptive educational approaches, including integration of the flipped classroom model, success, pitfalls, and areas for improvement will be described and discussed. Providing nontraditional methods for physical medicine and rehabilitation education and exposure to medical students is crucial to maintain and promote growth of the field in this unprecedented and increasingly virtual era.


Subject(s)
COVID-19 , Education, Distance/methods , Education, Medical/methods , Internship and Residency/methods , Physical and Rehabilitation Medicine/education , Humans , SARS-CoV-2
7.
Eur J Phys Rehabil Med ; 57(3): 451-457, 2021 Jun.
Article in English | MEDLINE | ID: covidwho-1318501

ABSTRACT

BACKGROUND: The COVID-19 pandemic was the reason for closing down all non-urgent outpatient services in hospitals treating COVID-19 patients. The lockdown and reorganization of medical units also altered the accessibility to outpatient rehabilitation services. AIM: The focus of interest in our report lies in the evaluation of the outpatient rehabilitation treatment accessibility at our center in the time of the COVID-19 pandemic. DESIGN: Cross-sectional observational study. SETTING: Outpatients Rehabilitation Unit at University Medical Centre Maribor (UMC Maribor), Slovenia. POPULATION: Patients with diverse pathologies referred to outpatient rehabilitation. METHODS: The data were gathered retrospectively at the Institute of Physical and Rehabilitation Medicine (IPRM) at the UMC Maribor. The search included all the patients treated at IPRM in the pre-COVID and COVID period from March 16 to August 31 in 2019 and 2020. The data for the period including the lockdown (March 16 to August 31, 2020) and the period after the lockdown (June 1 to August 31, 2020) was analyzed and compared to the same timeframes in 2019. We were interested in the magnitude of decline in the total number of patients, the number of the first and follow-up visits, the number of sessions and in the profile and pathologies of patients comparing pre-COVID and COVID period. The χ2 and Fisher's Exact test were used in the analysis. RESULTS: With the lockdown period included there was a 44% decline in the total number of patients, a 71.1% decline in the number of sessions, a 42% decline of the first visits and a 60.9% decline of follow-up visits. When comparing the pre-COVID and COVID period after the lockdown, a 28.5% decline in the number of patients treated in 2020 compared to 2019 was observed. By analyzing the number of sessions in the pre-COVID and COVID period after the lockdown there was a 46.6% decline. No statistically significant difference was found in the age groups between the two periods (X2=9.466; P=0.05). The difference for the first and follow-up visits in 2019 and 2020 proved to be statistically significant (P<0.001), as well as the difference in percentage of patients in the acute and chronic group (P=0.037). CONCLUSIONS: Our findings showed how COVID-19 outbreak hindered the accessibility to outpatient rehabilitation service. Not only has the number of patients substantially reduced in the year 2020 compared to 2019, but also the number of sessions and number of first and follow-up visits declined. The demographic structure of the patients remained the same. CLINICAL REHABILITATION IMPACT: This study adds evidence at the level of health services about lower standard of care in the physical and rehabilitation medicine field for patients experiencing disabling conditions in the time of COVID-19.


Subject(s)
Ambulatory Care , COVID-19/epidemiology , Health Services Accessibility , Physical and Rehabilitation Medicine , Adolescent , Adult , Aged , Child , Child, Preschool , Cross-Sectional Studies , Female , Humans , Infant , Infant, Newborn , Male , Middle Aged , Pandemics , SARS-CoV-2 , Slovenia/epidemiology , Young Adult
8.
Clinics ; 76: e2804, 2021. tab, graf
Article in English | WHO COVID, LILACS (Americas) | ID: covidwho-1271046

ABSTRACT

OBJECTIVES: As patients recovering from the novel coronavirus disease 2019 (COVID-19) present with physical, respiratory, cognitive, nutritional, and swallowing-related impairments and mental health complications, their rehabilitation needs are complex. This study aimed to describe the demographic, clinical, and functional status after the discharge of COVID-19 survivors who underwent intensive multidisciplinary inpatient rehabilitation at the Physical and Rehabilitation Medicine Institute of the University of Sao Paulo Medical School General Hospital and Lucy Montoro Rehabilitation Institute. We determined the most important factors related to the length of inpatient rehabilitation treatment and present the functional outcomes. METHODS: This was a retrospective study based on electronic medical records. In addition to the severity of COVID-19 and length of hospital stay for the management of COVID-19 and comorbidities, we collected sociodemographic data including age, sex, height, and weight. Functional assessments were performed using the Functional Independence Measure (FIM); Short Physical Performance Battery; Montreal Cognitive Assessment; Depression, Anxiety and Stress Scale; Revised Impact of Events Scale; bioelectrical impedance; Functional Oral Intake Scale; oropharyngeal dysphagia classification; and nutritional assessment. RESULTS: There was a significant improvement in FIM before and after inpatient rehabilitation treatment (p<0.0001). Muscle strength and walking capacity were significantly improved (p<0.01). The most important factors related to the length of inpatient rehabilitation treatment were improvement in FIM scores (Spearman's r=0.71) and gain in lean mass (Spearman's r=0.79). CONCLUSIONS: Rehabilitation of patients after COVID-19 recovery improves their functional status and should be considered in the post-acute phase for selected patients with COVID-19.


Subject(s)
Humans , Physical and Rehabilitation Medicine , COVID-19 , Retrospective Studies , Treatment Outcome , Recovery of Function , SARS-CoV-2 , Length of Stay
10.
Am J Phys Med Rehabil ; 100(7): 712-717, 2021 07 01.
Article in English | MEDLINE | ID: covidwho-1270769

ABSTRACT

ABSTRACT: The field of physical medicine and rehabilitation should strive for a physician workforce that is ethnically/racially, sex, and ability diverse. Considering the recent realities of disparities in health outcomes related to COVID-19 and in racial injustice in the United States, we are called to be champions for antiracism and equity. The specialty of physical medicine and rehabilitation should be the leaders in fostering a culture of inclusion and pay special attention to the population of applicants who are underrepresented in medicine. The specialty needs tools to start addressing these disparities. This article aims to provide strategic and intentional evidence-based recommendations for programs to follow. Holistic review, implicit bias training, structured interviews, and targeted outreach for those underrepresented in medicine are some of the tools that will help students enter and become successful in our specialty. Furthermore, this article provides novel guidance and considerations for virtual interviews during the COVID-19 pandemic.


Subject(s)
Cultural Diversity , Disabled Persons , Education, Medical, Graduate/standards , Physical and Rehabilitation Medicine , Prejudice/prevention & control , Workforce , Humans , Physical and Rehabilitation Medicine/education , Physical and Rehabilitation Medicine/organization & administration , Physical and Rehabilitation Medicine/standards , Prejudice/ethnology , Socioeconomic Factors , United States , Workforce/organization & administration , Workforce/standards
19.
Am J Phys Med Rehabil ; 100(6): 526-532, 2021 06 01.
Article in English | MEDLINE | ID: covidwho-1231050

ABSTRACT

ABSTRACT: This article describes the impact of the pandemic on physical medicine and rehabilitation in a COVID-19 referral center of a developing country. It describes how telerehabilitation can be leveraged to fill in the gaps in service, training, and research arms of the physical medicine and rehabilitation specialty. The ITAWAG ("to call") telerehabilitation program is the response of the Department of Rehabilitation Medicine at Philippine General Hospital, which is the country's national university hospital, to the ongoing COVID-19 crisis that continues to limit face-to-face access to physical medicine and rehabilitation services throughout the country. With the significant decline in the number of patients served since the start of the pandemic, the ITAWAG program aimed to bridge the physical distance between patients and clinicians after a set of eligibility criteria for teleconsultation or teletherapy and a step-by-step process used before, during, and after each virtual encounter. However, because many physical medicine and rehabilitation consultants, residents, and therapists were not trained for the virtual approach to patient care, a telerehabilitation curriculum was developed to help in providing quality and competent services. Finally, despite the growing awareness of telerehabilitation throughout the country, several research gaps about this emerging technology are identified to determine its acceptance, applicability, and cost-effectiveness among others.


Subject(s)
COVID-19 , Physical and Rehabilitation Medicine/education , Telerehabilitation/methods , Curriculum , Humans , Patient Acceptance of Health Care , Philippines , Program Evaluation , Referral and Consultation , SARS-CoV-2
20.
Eur J Phys Rehabil Med ; 57(2): 189-198, 2021 Apr.
Article in English | MEDLINE | ID: covidwho-1224407

ABSTRACT

BACKGROUND: The Coronavirus Disease 2019 (COVID-19) pandemic increases the demand for postacute care in patients after a severe disease course. Various long-term sequelae are expected and rehabilitation medicine is challenged to support physical and cognitive recovery. AIM: We aimed to explore the dysfunctions and outcome of COVID-19 survivors after early postacute rehabilitation. DESIGN: Observational cohort study. METHODS: This study evaluated the postacute sequelae of patients hospitalized for SARS-CoV-2 infection and analyzed rehabilitative outcomes of a subgroup of patients included in the prospective observational multicenter CovILD study. RESULTS: A total of 23 subjects discharged after severe to critical COVID-19 infection underwent an individualized, multiprofessional rehabilitation. At the start of postacute rehabilitation, impairment of pulmonary function (87%), symptoms related to postintensive care syndrome, and neuropsychological dysfunction (85%) were frequently found, whereas cardiac function appeared to be largely unaffected. Of interest, multi-disciplinary rehabilitation resulted in a significant improvement in lung function, as reflected by an increase of forced vital capacity (P=0.007) and forced expiratory volume in one second (P=0.014), total lung capacity (P=0.003), and diffusion capacity for carbon monoxide (P=0.002). Accordingly, physical performance status significantly improved as reflected by a mean increase of six-minute walking distance by 176 (SD±137) meters. Contrarily, a considerable proportion of patients still had limited diffusion capacity (83%) or neurological symptoms including peripheral neuropathy at the end of rehabilitation. CONCLUSIONS: Individuals discharged after a severe course of COVID-19 frequently present with persisting physical and cognitive dysfunctions after hospital discharge. Those patients significantly benefit from multi-disciplinary inpatient rehabilitation. CLINICAL REHABILITATION IMPACT: Our data demonstrated the highly promising effects of early postacute rehabilitation in survivors of severe or critical COVID-19. This findings urge further prospective evaluations and may impact future treatment and rehabilitation strategies.


Subject(s)
COVID-19/rehabilitation , Intensive Care Units , Pandemics , Physical and Rehabilitation Medicine/methods , SARS-CoV-2 , Subacute Care/methods , Austria/epidemiology , COVID-19/epidemiology , Female , Follow-Up Studies , Humans , Male , Middle Aged , Treatment Outcome
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