Archives of physical medicine and rehabilitation
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Arch Phys Med Rehabil · Jul 2009
Randomized Controlled Trial Multicenter StudyPulsed electromagnetic fields to reduce diabetic neuropathic pain and stimulate neuronal repair: a randomized controlled trial.
To determine whether repetitive and cumulative exposure to low-frequency pulsed electromagnetic fields (PEMF) targeting painful feet can reduce neuropathic pain (NP), influence sleep in symptomatic diabetic peripheral neuropathy (DPN), and influence nerve regeneration. ⋯ PEMF at this dosimetry was noneffective in reducing NP. However neurobiological effects on ENFD, PGIC and reduced itching scores suggest future studies are indicated with higher dosimetry (3000-5000 G), longer duration of exposure, and larger biopsy cohort.
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Arch Phys Med Rehabil · Jul 2009
What's so great about rehabilitation teams? An ethnographic study of interprofessional collaboration in a rehabilitation unit.
To explore team structures, team relationships, and organizational culture constituting interprofessional collaboration (IPC) in a particular rehabilitation setting; to develop a description of IPC practice that may be translated, adapted, and operationalized in other clinical environments. ⋯ IPC practice in rehabilitation care is supported by clinical, cultural, and organizational factors. This understanding of daily IPC work may guide initiatives to promote IPC in other clinical team settings.
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Arch Phys Med Rehabil · Jul 2009
Analgesic prescribing for musculoskeletal complaints in the ambulatory care setting after the introduction and withdrawal of cyclooxygenase-2 inhibitors.
To evaluate the analgesic prescribing patterns for musculoskeletal complaints in a nationally representative sample of ambulatory care visits over a dynamic period of pharmaceutical treatments. ⋯ COX-2 inhibitors may have been prescribed as substitutes for nsNSAIDs initially, but nsNSAID prescriptions returned to prior levels by 2005 as COX-2 inhibitor prescriptions declined. An increase in nonnarcotic analgesic prescribing in 2005 may have been caused by a class effect concern for NSAIDs. Prescribing of opiate analgesics and adjuvant analgesics increased over the study period, although apparently not in substitution for NSAIDs.
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Arch Phys Med Rehabil · Jul 2009
Handling stairs in the seated position for people with unilateral lower-limb amputations.
Handling stairs in the seated position for people with unilateral lower-limb amputations. The objective of this uncontrolled pilot study was to test the hypotheses that the seated stair-handling method enables people with unilateral lower-limb amputations to ascend and descend stairs effectively and safely, and with an acceptable level of perceived exertion. Eight people with unilateral lower-limb amputations each received a single 20-minute education session on climbing stairs in the seated position. ⋯ There were no adverse events. Ratings of perceived exertion for the seated method (n=7) ranged from 3 to 7.5 for stair ascent and 1 to 5.5 for descent. The seated stair-handling method is a generally effective, safe, and well-tolerated method for people with unilateral lower-limb amputations to ascend and descend stairs.
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Arch Phys Med Rehabil · Jul 2009
Intrathecal baclofen in patients with persistent vegetative state: 2 hypotheses.
Sporadic cases of recovery from persistent vegetative state (PVS) after administration of intrathecal baclofen (ITB) have been reported without giving any possible explanation for its paradoxical effect. We summarize our recent findings on 5 patients with PVS treated with ITB and make some speculations on the mechanisms responsible for the observed clinical improvement. The patients developed spasticity and were judged eligible for ITB therapy. ⋯ We hypothesize 2 possible mechanisms: first, a modulation confined to spinal cord segmental activities and to neuronal centripetal outputs reaching the cortex; and second, a modulation of sleep-wake cycles that, although present, may be dysregulated and interfere with alertness and awareness. Although our research is confined to a few subjects, it provides follow-up information by means of the CRS-R that is a validated standardized neurobehavioral instrument expressly designed for use in patients with PVS. Our observations indicate that further systematic investigation of the mechanisms and the putative clinical applications of ITB should be undertaken.