AAPM&R consensus guidance on spasticity assessment and management.

BACKGROUND: The American Academy of Physical Medicine and Rehabilitation (AAPM&R) conducted a comprehensive review in 2021 to identify opportunities for enhancing the care of adult and pediatric patients with spasticity. A technical expert panel (TEP) was convened to develop consensus-based practice recommendations aimed at addressing gaps in spasticity care. OBJECTIVE: To develop consensus-based practice recommendations to identify and address gaps in spasticity care. METHODS: The Spasticity TEP engaged in a 16-month virtual meeting process, focusing on formulating search terms, refining research questions, and conducting a structured evidence review. Evidence quality was assessed by the AAPM&R Evidence, Quality and Performance Committee (EQPC), and a modified Delphi process was employed to achieve consensus on recommendation statements and evidence grading. The Strength of Recommendation Taxonomy (SORT) guided the rating of individual studies and the strength of recommendations. RESULTS: The TEP approved five recommendations for spasticity management and five best practices for assessment and management, with one recommendation unable to be graded due to evidence limitations. Best practices were defined as widely accepted components of care, while recommendations required structured evidence reviews and grading. The consensus guidance statement represents current best practices and evidence-based treatment options, intended for use by PM&R physicians caring for patients with spasticity. CONCLUSION: This consensus guidance provides clinicians with practical recommendations for spasticity assessment and management based on the best available evidence and expert opinion. Clinical judgment should be exercised, and recommendations tailored to individual patient needs, preferences, and risk profiles. The accompanying table summarizes the best practice recommendations for spasticity assessment and management, reflecting principles with little controversy in care delivery.

Ultrasound Lumbar Spine Clinical Training Phantom: Which is the Best Embedding Medium?

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Prevalence of human papilloma virus in Oman: Genotypes 82 and 68 are dominating.

BACKGROUND: Persistent infection with high-risk (HR) HPV genotypes has been associated with cervical cancer, the third cancer affecting women in Oman with a crude incidence rate of 4.7 and mortality rate of 2.5 respectively. Other types of lower-risk (LR) HPV are associated with warts in both genders worldwide. OBJECTIVES: To assess the prevalence and genotype distribution of HPV and the risk factors among women with normal and abnormal cytology. METHODS: A cross sectional study conducted between September 2014 and April 2015. 258 cervical samples were obtained from women aged 18-68 years attending the Gynaecology Out-patient Clinic. HPV genotyping was performed using a multiplex real time-polymerase chain reaction (RT-PCR) assay. RESULTS: 22 different HPV genotypes were detected in 46 women (17.8%) and included 15 HR and 7 LR genotypes. Human immunodeficiency virus (HIV) patients (P = 0.052) and oral contraceptives users (P = 0.016) showed significant association with HPV infection. CONCLUSION: The most frequently observed HPV types were HR HPV 82 and LR HPV 54. These findings show that the predominant HPV genotypes in Oman are different from those seen in worldwide studies. This finding is important to determine the potential impact of preventive measures especially new vaccines to reduce the burden of cervical cancer.

Getting a Manual Wheelchair Over a Threshold Using the Momentum Method: A Descriptive Study of Common Errors.

OBJECTIVES: To (1) document the success of learners' attempts to overcome a threshold in a manual wheelchair while using the momentum method; (2) describe the frequency and nature of any errors observed; and (3) compare the characteristics of participants who were or were not successful on their first attempts. DESIGN: Cross-sectional, observational study following Strengthening the Reporting of Observational Studies in Epidemiology guidelines. SETTING: Indoor obstacle course in a rehabilitation center. PARTICIPANTS: Able-bodied students (N=214) learning the threshold skill. INTERVENTION: Participants attempted to get over the Wheelchair Skills Test (WST) threshold (2cm high, 1.5m wide, and 10cm in the line of progression) in a manual wheelchair. MAIN OUTCOME MEASURES: From each participant's video recording of the first attempt, we assigned a WST score for the skill and described any errors noted. RESULTS: The WST scores for the first attempts were "pass" for 16 (7.5%), "pass with difficulty" for 100 (46.7%), and "fail" for 98 (45.8%). Eventually, requiring up to 6 attempts, 203 participants (94.9%) were successful (pass or pass with difficulty). Twenty-six different error types were identified. With the use of logistic regression analysis, the odds ratio of failing on the first attempt for women versus men was 2.71 (95% confidence interval, 1.23-6.00) (P=.0138). CONCLUSIONS: Only about half of able-bodied people learning the threshold skill using the momentum method are successful on their first attempts, although almost all are successful with further practice and feedback. During the first attempts, there are a wide variety of errors, primarily in the popping phase of the skill. Those who are successful on their first attempts are more likely to be men. These findings have implications for the assessment and training of the threshold skill.

Molecular characterization of rotavirus strains circulating in Oman in 2005.

Limited genotyping data are available for rotavirus strains in the Middle East. In this study, we investigated the molecular epidemiology of human rotavirus strains circulating in the Sultanate of Oman during 2005. Rotavirus was detected in 178 (57.4%) of 310 of the diarrheal stools of young children <5 years admitted to hospitals and outpatients clinics. Polyacrylamide gel electrophoresis demonstrated the cocirculation of 8 strains, although 2 strains predominated across the Sultanate. Genotyping revealed the presence of human rotavirus strains of types G1P[8], G2P[4], and G3P[8]. Several strains exhibited unusual combinations of G and P genotypes and RNA electropherotypes, indicating the likelihood of natural reassortment events occurring with a high frequency. In addition, the unusual P[10] genotype was identified among the rotavirus strains, in combination with the G1 type.