American journal of physical medicine & rehabilitation
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Am J Phys Med Rehabil · Aug 2008
Electrodiagnostic medicine skills competency in physical medicine and rehabilitation residents: a method for development and assessment.
This project sought to create an educational module including evaluation methodology to instruct physical medicine and rehabilitation (PM&R) residents in electrodiagnostic evaluation of patients with neuromuscular problems, and to verify acquired competencies in those electrodiagnostic skills through objective evaluation methodology. Sixteen residents were trained by board-certified neuromuscular and electrodiagnostic medicine physicians through technical training, lectures, and review of self-assessment examination (SAE) concepts from the American Academy of Physical Medicine & Rehabilitation syllabus provided in the Archives of Physical Medicine and Rehabilitation. After delivery of the educational module, knowledge acquisition and skill attainment were measured in (1) clinical skill in diagnostic procedures via a procedure checklist, (2) diagnosis and ability to design a patient-care management plan via chart simulated recall (CSR) exams, (3) physician/patient interaction via patient surveys, (4) physician/staff interaction via 360-degree global ratings, and (5) ability to write a comprehensive patient-care report and to document a patient-care management plan in accordance with Medicare guidelines via written patient reports. ⋯ Validation of the assessment tools is evidenced by collected data correlating with significantly improved SAE scores and American Association of Neuromuscular and Electrodiagnostic Medicine (AANEM) exam scores, as outlined in the result section. In addition, the clinical development tool (procedure checklist) was validated by residents being individually observed performing skills and deemed competent by an AANEM-certified physician. The standardized educational module and evaluation methodology provide a potential framework for the definition of baseline competency in the clinical skill area of EDX.
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Am J Phys Med Rehabil · Jul 2008
Withdrawal of analgesic medication for chronic low-back pain patients: improvement in outcomes of multidisciplinary rehabilitation regardless of surgical history.
To determine the posttreatment outcomes of multidisciplinary pain rehabilitation that incorporates analgesic medication withdrawal for chronic low-back pain patients on the basis of lumbar spine surgical history. ⋯ Study results demonstrate that multidisciplinary pain rehabilitation treatment incorporating analgesic medication withdrawal is associated with significant clinical improvements in physical and emotional functioning, regardless of lumbar spine surgical history.
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Am J Phys Med Rehabil · Jul 2008
Multicenter StudyA multicenter examination of the Center for Medicare Services eligibility criteria in total-joint arthroplasty.
The Centers for Medicare and Medicaid Services (CMS) use a diagnostic category (revised in 2004) as one of eight criteria to determine whether a hospital is eligible for payment as an inpatient rehabilitation facility (IRF). Among the 13 specific categories of patients, there are three particular ones involving total knee arthroplasty (TKA) and hip arthroplasty (THA) patients. The purpose of this investigation was to analyze inpatient rehabilitation outcomes in TKA and THA patients, using these CMS criteria. ⋯ All arthroplasty patients demonstrated improved physical function after inpatient rehabilitation. Those aged >or=85 yrs demonstrated the lowest efficiency, the greatest cost, and were the least likely to return home.
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Am J Phys Med Rehabil · Jul 2008
Case ReportsBack and thigh pain of unusual etiology complicates rehabilitation after bilateral total knee arthroplasty.
Total knee arthroplasty is frequently performed and usually associated with favorable results. A case is presented where persistent back and thigh pain limited rehabilitation progress following bilateral total knee arthroplasty procedures. The pain was found to be related to the presence of a symptomatic 5.24-cm infrarenal abdominal aortic aneurysm with the pain resolving after endovascular repair of the aneurysm.