Impacts of Ultrasonogram-Guided, Intra-fascial, Autologous, Activated Platelet-Rich Plasma Injection in Chronic Plantar Fasciitis: A Quasi-experimental Study.

Background Plantar fasciitis is the most common cause of foot pain. Patients with plantar fasciitis typically present with 'first step pain,' which tends to decrease with activity and worse with heavy use. This study determines the effect of ultrasound-guided, single-dose, platelet-rich plasma (PRP) injection in patients with chronic plantar fasciitis. Materials and methods It was a quasi-experimental trial carried out in the Department of Physical Medicine and Rehabilitation, Bangabandhu Sheikh Mujib Medical University (BSMMU), Dhaka, Bangladesh, from March 2019 to March 2022. A total of 148 patients diagnosed with chronic plantar fasciitis were selected as samples. A total of 75 patients were allocated to group A (intra-lesional injection of autologous PRP with conservative management) and 73 patients to Group B (only conservative management). Both groups of patients were allocated to conservative management with exercises, shoe modification, activities of daily living (ADLs) instruction, and oral paracetamol. Results This study shows that in group A, the mean visual analog scale (VAS) score significantly reduced to 1.47±0.51 after six months of single-dose PRP injection (p<0.001). In group B, the VAS score also decreased substantially after conservative treatment. Though in groups A and B, pain reduction was significant, in group A, the pain was decreased more compared to group B and statistically significant differences were found between the two groups at the 12th week and 24th week. The foot function index (FFI) scores decreased significantly in group A after a single dose PRP injection, compared with group B treated with conventional therapy. In group A, FFI scores decreased from 49.09±5.72 to 7.67±3.41. The study revealed a significant difference between study groups in the 12th week and 24th week regarding FFI scores. Conclusion Ultrasound-guided intra-lesional autologous PRP Injection is safe and effective and recommended in patients with chronic plantar fasciitis, especially in recalcitrant cases after the failure of conservative treatment and corticosteroid injection.

The Impact of COVID-19 and the Challenges of Post-COVID Rehabilitation in a Developing Country.

The coronavirus disease 2019 (COVID-19) and its impact on human functioning are gaining increased interest. Like many other lower-income countries, the Bangladesh health and rehabilitation sector was adversely affected by COVID-19. Multiple challenges were identified for preparedness and medical rehabilitation during COVID-19 surges. Appropriate supervision of multispecialty long COVID clinics and attention to rehabilitation teamwork are important. Rehabilitation plays a key role in the management of patients with COVID-19 and can reduce the length of hospital stay and improve health outcomes. While waiting for people to be fully vaccinated; ensuring equitable access to COVID-19 vaccination, health care, and rehabilitation services among people with disabilities should be a part of the core mission during the pandemic. All levels of care including, critical, post-acute, or long covid clinic scale-up of rehabilitation services are needed. A physiatrist-led rehabilitation team approach is vital for the adaptation of rehabilitation interventions to improve the functional outcomes of persons with impairment and disability affected by COVID-19.