ABSTRACT
OBJECTIVES: To investigate the frequency of and reasons for readmissions to acute care (RTAC) during inpatient rehabilitation (IPR) after non-traumatic spinal cord injury (NT-SCI). To develop a predictive model for RTAC using identified risk factors. DESIGN: Retrospective case-control. SETTING: Academic IPR hospital. PARTICIPANTS: Individuals with NT-SCI admitted to an academic SCI rehabilitation unit from January 2014-December 2015. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: Readmissions to acute care services from IPR. RESULTS: Thirty-seven participants (20%) experienced a RTAC for a total of 39 episodes. Thirty-five experienced 1 RTAC, while two had 2. The most common medical reasons for RTAC were infection (27%), neurological (27%), and noninfectious respiratory (16%). Multivariable logistic regression was used to develop a model to predict RTAC. Paraplegia was associated with 3.2 times increase in the odds of RTAC (P = 0.03). For every unit increase in FIM-Motor, there was a 5% reduction in the odds of RTAC (P = 0.03) Body mass index less than 30 decreased odds of RTAC by 61% (P = 0.004). CONCLUSION: RTACs were associated with body mass index greater than 30, decreased FIM-Motor subscore on admission, and paraplegia. Physiatrists caring for the non-traumatic SCI patient need be more circumspect of individuals with these parameters to potentially prevent the problems necessitating acute care transfer.
Subject(s)
Neurological Rehabilitation/statistics & numerical data , Patient Readmission/statistics & numerical data , Spinal Cord Injuries/epidemiology , Adult , Body Mass Index , Emergency Medical Services/statistics & numerical data , Female , Humans , Inpatients/statistics & numerical data , Male , Middle Aged , Spinal Cord Injuries/rehabilitationABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of a female patient with osteoporosis and addresses the clinical presentation, assessment, medical management, and rehabilitation approaches to a patient with an acute vertebral fracture. It is part of the study guide on osteoporosis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes the differential diagnosis, clinical diagnostic considerations, current pharmacotherapy, invasive procedure options, and orthotic and exercise interventions for a patient with postmenopausal osteoporosis. OVERALL ARTICLE OBJECTIVE: To summarize the clinical evaluation, medical management, and rehabilitation strategies in women with postmenopausal osteoporosis and acute vertebral fracture presentation.
Subject(s)
Osteoporosis/diagnosis , Osteoporosis/therapy , Alendronate/therapeutic use , Analgesics, Opioid/therapeutic use , Cyclooxygenase Inhibitors/therapeutic use , Diagnosis, Differential , Humans , Osteoporosis/drug therapy , Osteoporosis/rehabilitation , Osteoporosis, Postmenopausal/diagnosis , Osteoporosis, Postmenopausal/drug therapy , Osteoporosis, Postmenopausal/rehabilitation , Osteoporosis, Postmenopausal/therapy , Pain/drug therapy , Risk Factors , Spinal Fractures/diagnosis , Spinal Fractures/therapy , Tramadol/therapeutic useABSTRACT
UNLABELLED: This self-directed learning module discusses a patient with knee osteoarthritis and addresses the clinical presentation, assessment, medical management, rehabilitation approaches, and surgical options. It is part of the chapter on osteoarthritis in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes the differential diagnosis, clinical diagnostic considerations, current pharmacology, orthotics, exercise interventions, and surgical procedure options for a patient with knee osteoarthritis. OVERALL ARTICLE OBJECTIVE: To summarize diagnostic considerations and management of knee osteoarthritis.
Subject(s)
Osteoarthritis, Knee/diagnosis , Osteoarthritis, Knee/therapy , Acute Kidney Injury/chemically induced , Aged , Anti-Inflammatory Agents, Non-Steroidal/adverse effects , Arthroplasty, Replacement, Knee/rehabilitation , Diagnosis, Differential , Disease Management , Exercise Therapy , Gastrointestinal Hemorrhage/chemically induced , Humans , Male , Orthotic Devices , Osteoarthritis, Knee/rehabilitation , Risk FactorsABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of a female patient who had a total hip arthroplasty. The module addresses the medical management and rehabilitation interventions necessary to direct the postacute care needs of this patient. It is part of the study guide on rehabilitation of the joint replacement patient in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This chapter emphasizes planning for discharge from the acute care hospital, postacute care medical complications, and rehabilitation program elements germane to the patient with hip joint replacement. OVERALL ARTICLE OBJECTIVE: To summarize the postacute care planning, medical complications, and rehabilitation needs of the patient with hip joint replacement.
Subject(s)
Arthroplasty, Replacement, Hip/rehabilitation , Aged , Bandages , Female , Humans , Length of Stay , Thromboembolism/prevention & control , Thrombolytic Therapy , Transportation of PatientsABSTRACT
UNLABELLED: This self-directed learning module highlights a clinical vignette of 2 patients: (1) a woman with bilateral, distal, upper-limb pain assessed by differential diagnosis, laboratory work-up, and treatment of rheumatologic disorders frequently seen in the physiatric practice setting and (2) a 57-year-old man with an acute recurring monoarthritis of the knee and addresses clinical presentation, assessment, medical management, and rehabilitation approaches. It is part of the chapter on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. This article specifically focuses on 2 aspects: (1) the differential diagnosis of polyarthralgia, distal upper-limb pain, criteria for classification of rheumatoid arthritis, synovial fluid analysis, and comprehensive treatment of rheumatoid arthritis, both pharmacologic and nonpharmacologic and (2) the differential diagnosis, clinical diagnostic considerations, current pharmacotherapy, invasive procedure options, and orthotic and exercise interventions for a patient with calcium pyrophosphate dehydrate-induced monoarthritis of the knee. OVERALL ARTICLE OBJECTIVES: (a) Clinical evaluation, diagnosis, management, and rehabilitation strategies in persons with initial presentations of inflammatory distal upper-limb pain and (b) clinical evaluation of an individual with crystal-induced monoarthritis and differentiation of the pathophysiology, assessment, and treatment of chondrocalcinosis.
Subject(s)
Arthritis, Rheumatoid/rehabilitation , Chondrocalcinosis/rehabilitation , Adult , Arthritis, Rheumatoid/diagnosis , Arthritis, Rheumatoid/drug therapy , Chondrocalcinosis/diagnosis , Diagnosis, Differential , Exercise Therapy , Female , Humans , Knee Joint/diagnostic imaging , Male , Middle Aged , Musculoskeletal Diseases/diagnosis , Radiography , Synovial Fluid/chemistry , Wrist Joint/diagnostic imagingABSTRACT
UNLABELLED: This self-directed learning module highlights the pathoanatomy and pathogenesis of lumbar spinal stenosis. The areas covered include assessment and therapeutic options in the rehabilitation of patients with degenerative lumbar spinal stenosis. It is part of the study guide on rehabilitation of orthopedic and rheumatologic disorders in the Self-Directed Physiatric Education Program for practitioners and trainees in physical medicine and rehabilitation. OVERALL ARTICLE OBJECTIVES: (a) To summarize the evaluation and management of lumbar spinal stenosis and (b) to review the pathoanatomy and pathogenesis of lumbar degenerative spinal stenosis.
