A Proposal for Expansion of the Medical Specialty of Rehabilitation Medicine.

The workforce of the medical specialty of Rehabilitation Medicine (RM) in the UK is 10 times less than the European average for the specialty of Physical and Rehabilitation Medicine (PRM). This can be explained partly by the difference in the scope of practice within the specialty between the UK and other European countries and USA. This opinion paper aims to compare the rehabilitation needs in chronic medical conditions and compare the scope of practice between countries within Europe and other regions of the world. The potential advantages of a broader remit specialty to improve rehabilitation care for patients by involving rehabilitation physicians in various medical conditions is explored. Recommendations have been put forward in the Rehabilitation Medicine Expansion Proposal (RMEP), which is likely to make the medical specialty of RM/ PRM more satisfying for the doctors working in the specialty and a more attractive career choice for those entering training in the specialty. There is a need for an international universal framework for the scope of the specialty to have a greater impact on improving the lives of those with chronic medical conditions.

Associations between nutrition risk status, body composition and physical performance among community-dwelling older adults.

OBJECTIVE: To investigate the associations between nutrition risk status, body composition and physical performance among community-dwelling older New Zealanders. METHODS: This cross-sectional study enrolled 257 community-dwelling older adults (median age 79 years). Assessments included the Mini Nutritional Assessment-Short Form (MNA®-SF) for nutrition risk; the Eating Assessment Tool-10 for dysphagia risk; bioimpedance analysis for body composition (free fat mass (FFM) and percentage body fat) and gait speed for physical performance. A multiple logistics regression analysis was conducted, to determine factors associated with lower odds [OR (95% CI)] for nutrition risk. RESULTS: Every yearly increase in age was associated with higher odds 1.09 (1.01-1.17) for nutrition risk. Additionally, nutrition risk was less likely to occur among participants of age <85 years 0.30 (0.11-0.79), with no dysphagia 0.29 (0.09-0.97) and those with a healthy gait speed 0.29 (0.09-0.97). Lower odds for nutrition risk were also found with increasing values of FFM index 0.51 (0.34-0.77), and percentage body fat 0.81 (0.72-0.90). Gait speed was positively correlated with FFM index (r=0.19 p<0.022), percentage body fat (r=0.23, p=0.006) and BMI (r=0.29, p<0.001). CONCLUSION: Among these participants, associations between nutrition risk, body composition and physical performance were found. Implications for public health: Routine screening of nutrition risk and/or physical performance among vulnerable older adults is key towards identifying those in need of assessment and dietary intervention. Alongside strategies to encourage physical activity, this may help to slow losses of FFM and protect physical performance.

Motorcyclists' self-reported riding mileage versus actual riding mileage in the following year.

INTRODUCTION: Accurate motorcyclist mileage estimates are important because self-evaluation of riding experience is related to riding behavior, the relationship of self-reported to actual or future mileage is necessary in targeting training and considering survey responses, and motorcycle crash statistics require accurate travel data. METHOD: This study collected real-world data from motorcyclists over the course of two months to two years per rider. This paper explores motorcyclists' self-reported annual riding mileage (obtained via pre-study surveys) and the actual amount of riding during the study (based upon odometer readings and GPS data). RESULTS: Of the 91 riders who had been riding for at least a year before the study, significantly more (73%) rode less the following year than reported for the previous year. The recorded annualized mileage averaged 89% of the reported mileage from the previous year. Analyses based on estimated average annual mileage were similar to those using the previous year estimation, and the pattern held regardless of age group, motorcycle type, or gender. The exception was novice or returning riders, who tended to either significantly underestimate or increase actual mileage as they began (or continued) to ride. CONCLUSIONS: Motorcyclists' estimation of riding experience expressed as mileage may not be indicative of current or future mileage. PRACTICAL APPLICATIONS: Reliance on self-reported mileage during training to categorize groups, for interpretation of studies, or to develop motorcycle travel data and safety statistics may be unrealistic. Certainly any use of self-reported mileage should incorporate the concept that mileage overestimation seems likely. Because questions about previous year and average annual mileage may elicit similar responses, motorcyclist surveys should be constructed to prompt the most thoughtful responses in terms of mileage estimations. In general, reported mileage should not be relied upon as an accurate predictor of future actual mileage.

Treatment of post-dural puncture headache using epidural injection of fibrin sealant as an alternative to autologous epidural blood patch (case report).

Background Post dural puncture headache (PDPH) is an iatrogenic cause of patient morbidity in pain management after spinal or epidural anaesthesia, as well as after diagnostic lumbar puncture. Most patients respond to conservative treatment or to epidural blood patch, yet limited options for effective treatment are available for patients who fail these treatments or present with theoretical contraindication. Case report We present a case of a patient with previously diagnosed human immunodeficiency virus and hepatitis C, who presented with signs of PDPH, which placed him at a theoretical risk of meningeal seeding of the virus during the blood patching procedure. Conclusion We successfully treated the post dural puncture headache and avoided the risk of viral seeding of the meninges by using a fibrin sealant.

Profile of the physiotherapy profession in New South Wales (1975-2002).

This was the first study known to the authors exploring workforce data from the New South Wales Physiotherapists Registration Board over several decades. Labour force statistics were examined from various data sources over the years 1975 to 2002. The results indicate that the demographics and working patterns of physiotherapists in New South Wales have remained remarkably stable over time. The workforce continues to grow, however the growth rate has decreased markedly with only a 2.3% increase from 2001 to 2002. The proportion of men within the profession is steadily increasing; in 1975 men accounted for 5.2% of physiotherapists, in 2000 23.5% of physiotherapists were male. While the male workforce increases, the female workforce is ageing. The modal age for female physiotherapists has steadily increased from 25-29 years in 1975 to 40-44 years in 2001. Importantly, in relation to attrition, the degree of workforce participation has not undergone significant change since 1987. Although labour force analysis has demonstrated that the workforce is in shortage, attrition does not appear to be the major contributor to this situation. The proportion of the profession who are inactive has remained relatively stable since 1987. More pertinent to the current shortage is the slowing of the growth rate of the profession while demand for physiotherapy services continues to rise.