A Comparison of Self-Reported Unmet Healthcare Needs among Adaptive and Able-Bodied Athletes.

BACKGROUND: Studies have revealed a higher incidence of injury and illness among elite adaptive athletes when compared to able-bodied athletes in competition. However, individuals with disabilities report poorer access to health care. OBJECTIVE: The purpose of this study is to identify differences in healthcare access, satisfaction, and unmet needs between recreational adaptive and able-bodied athletes in all sports and within a single sport (hockey). DESIGN: Cross-sectional, survey-based study. SETTING: Recreation sports programs in Boston, MA and Chicago, IL. PARTICIPANTS: Adult, recreational, competitive adaptive, and able-bodied athletes. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURE(S): The Short-Form Patient Satisfaction Questionnaire (PSQ-18) for healthcare access and satisfaction; percentage of athletes reporting unmet sports-related healthcare needs in the prior year. RESULTS: Sixty adaptive athletes (78% male, age 35.7 ± 12.4 years) and 65 able-bodied athletes (40% male, age 34.9 ± 11.9 years) participated. Mean access and satisfaction scores were not significantly different between groups in all sports (P = .53 and P = .19, respectively) or hockey (P = .28 and P = .55, respectively). Unmet needs were more commonly reported among adaptive athletes (18.3% all sports, 20.0% hockey) as compared to able-bodied athletes (9.2% all sports, 4.0% hockey). This reached statistical significance in the hockey group (P = .03), but not all sports (P = .12). CONCLUSIONS: No differences were seen between groups in healthcare access or satisfaction scores. Adaptive athletes of the same sport reported a higher rate of unmet sports-related healthcare needs but with few doctor's visits in the preceding year, suggesting discrepancies in expectations and healthcare-seeking behavior. LEVEL OF EVIDENCE: III.

Use of Platelet-Rich Plasma for the Treatment of Acetabular Labral Tear of the Hip: A Pilot Study.

OBJECTIVE: This study aims to assess whether ultrasound-guided injection of platelet-rich plasma can safely and effectively treat symptoms associated with acetabular hip labral tears. DESIGN: Institutional review board approval was gained for a prospective study of eight patients (N = 8), who have previously failed conservative management, to receive ultrasound-guided injection of platelet-rich plasma at the site of hip labrum tear. We assessed pain reduction and functional ability at baseline and then 2, 6, and 8 wks after injection, using the visual analog scale and Harris Hip Score, respectively. RESULTS: Statistically significant differences in Harris Hip Score were seen 2 wks (86.5 ± 10.8, P < 0.01), 6 wks (88.0 ± 10.7) P < 0.01), and 8 wks (92.1 ± 11.6, P < 0.01) after injection as compared with baseline (76.0 ± 13.4). Corresponding improvements were seen in visual analog scale 2 wks (1.0, P < 0.01 at rest, 2.5, P < 0.01 with activity), 6 (0.9, P < 0.01 at rest, 2.3, P < 0.01 with activity), and 8 wks (0.5, P < 0.01 at rest, 1.3, P < 0.01 with activity) compared with baseline (3.8 at rest, 5.4 with activity). CONCLUSIONS: Ultrasound-guided injection of platelet-rich plasma holds promise as an emerging, minimally invasive technique toward symptom relief, reducing pain, and improving function in patients with hip labral tears.

Cervical spine trauma evaluation.

Cervical spine trauma is a relatively rare but catastrophic event in sports. These critical situations depend on sports medicine personnel understanding every aspect of sideline care to ensure a safe and successful evaluation. This involves thorough preparation, vigilant observation of the sporting event to detect the possible mechanism of injury, and initiation of the appropriate action plan when a potentially catastrophic injury is suspected. Sideline management of cervical spine trauma requires the appropriate primary survey, with spine stabilization if necessary, secondary survey for concomitant injury, and, potentially, initiation of full spine stabilization with a spine board. In this chapter, our primary focus is discussion of the sideline evaluation of cervical spine trauma, and sideline practices designed to stabilize the athlete and minimize risk for further injury.

Assessing patient expectations and concerns in a physical medicine and rehabilitation unit: a real-time snapshot.

INTRODUCTION: To evaluate patient expectations, concerns, and satisfaction during physical medicine and rehabilitation (PM&R) inpatient hospitalization. Patients were also asked to comment on what resources might benefit them during their stay. DESIGN: More than 150 PM&R patients were asked to fill out a self-administered survey in a cross-sectional design. Patients receiving care under 5 other specialties (general medicine, obstetrics and gynecology, general surgery, orthopedics, and neurology) also were surveyed to determine whether qualitative differences existed between PM&R and other departments. In all, more than 1100 patients were given surveys to complete. Patients rated how concerned they were with more than 20 elements of their hospitalization, ranging from quality of food to pain management. Questions were divided into 2 sections: retrospectively before hospitalization and during current admission. SETTING: This study was completed in a large tertiary care PM&R facility with an adjoining medical center in an urban area. PARTICIPANTS: Patients were given the option to complete this survey in an anonymous fashion during their hospital stay. All those who did so were included in this analysis. Six different specialties were represented in the final tally, but the emphasis was on the PM&R department. MAIN OUTCOME MEASUREMENTS: The survey itself included more than 20 questions regarding the details of patients' hospital stays and how concerned they were with them. These categories included plans after discharge, duration of hospitalization, pain management, follow-up of medical issues, cost, insurance, and familiarity with diagnosis, physician, and medications. Other outcomes included patient input into what interventions they thought would most benefit them as well as a global satisfaction rating. RESULTS: Data analysis was performed with SPSS. Tukey tests provided comparison information across specialties. The response rate within PM&R was 68% (n = 128), whereas for all specialties combined it was 54% (n = 606). Multiple factors were found to be significant when examining expectations versus actual admission concerns. Most prominently within PM&R, patients indicated that they were less concerned during their admission than they thought they would be about potential duration of hospitalization (P < .001), understanding of diagnosis (P < .04), follow-up of medical issues (P < .01), and plan of care (P < .001), among others. However, patient expectations in other areas did not change or were negatively affected, such as help at home (P < .05), plans for discharge (P < .001), family involvement at home (P < .01), and future pain management at home (P < .05). Furthermore, qualitative comparisons among other specialties demonstrated differences in many areas. CONCLUSION: Results support the idea that the multidisciplinary approach inherent in PM&R positively alters many patient expectations related to outcomes. This has direct relevance to patient satisfaction and outcomes and warrants further investigation. The authors offer some potential interventions for future improvement in this area.