1
|
Nnoromele CC, Chen YT, Olezene CS, Blauwet CA, Brady Wagner LC, Katz NB, Hunter T, Silver JK. Diversity, Equity, and Inclusion Curriculum Embedded in a Physical Medicine and Rehabilitation Residency Program. Am J Phys Med Rehabil 2024; 103:256-260. [PMID: 38063306 DOI: 10.1097/phm.0000000000002372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/17/2024]
Abstract
ABSTRACT Diversity, equity, and inclusion initiatives are continuing to have increased importance in medical training, including rehabilitation medicine. Although resident-led curricula have been integrated into medical education in other training programs, to our knowledge, this the first report focusing on integrating these topics into resident education for a physical medicine and rehabilitation program. We created a didactic curriculum for our rehabilitation residents that included: quarterly lectures on diversity, equity, and inclusion topics followed by small group discussions. Each session also included an article that was included in the discussion. The sessions used both anonymous presurvey and postsurvey data to assess the efficacy of our initiative. Our initial data showed that our quarterly sessions created a safe and comfortable environment for discussing diversity, equity, and inclusion topics. In addition, our session specific data supported that increased awareness of diversity, equity, and inclusion disparities with rehabilitation and medicine was achieved. Our committee used the data and feedback to create further iterations of this initiative within our program, and we believe that this is a model that can be adopted by other physical medicine and rehabilitation residencies.
Collapse
Affiliation(s)
- Chinenye C Nnoromele
- From the Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts
| | | | | | | | | | | | | | | |
Collapse
|
2
|
Davis GA, Schneider KJ, Anderson V, Babl FE, Barlow KM, Blauwet CA, Bressan S, Broglio SP, Emery CA, Echemendia RJ, Gagnon I, Gioia GA, Giza CC, Leddy JJ, Master CL, McCrea M, McNamee MJ, Meehan WP, Purcell L, Putukian M, Moser RS, Takagi M, Yeates KO, Zemek R, Patricios JS. Pediatric Sport-Related Concussion: Recommendations From the Amsterdam Consensus Statement 2023. Pediatrics 2024; 153:e2023063489. [PMID: 38044802 DOI: 10.1542/peds.2023-063489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/07/2023] [Indexed: 12/05/2023] Open
Abstract
The 6th International Consensus Conference on Concussion in Sport, Amsterdam 2022, addressed sport-related concussion (SRC) in adults, adolescents, and children. We highlight the updated evidence-base and recommendations regarding SRC in children (5-12 years) and adolescents (13-18 years). Prevention strategies demonstrate lower SRC rates with mouthguard use, policy disallowing bodychecking in ice hockey, and neuromuscular training in adolescent rugby. The Sport Concussion Assessment Tools (SCAT) demonstrate robustness with the parent and child symptom scales, with the best diagnostic discrimination within the first 72 hours postinjury. Subacute evaluation (>72 hours) requires a multimodal tool incorporating symptom scales, balance measures, cognitive, oculomotor and vestibular, mental health, and sleep assessment, to which end the Sport Concussion Office Assessment Tools (SCOAT6 [13+] and Child SCOAT6 [8-12]) were developed. Rather than strict rest, early return to light physical activity and reduced screen time facilitate recovery. Cervicovestibular rehabilitation is recommended for adolescents with dizziness, neck pain, and/or headaches for greater than 10 days. Active rehabilitation and collaborative care for adolescents with persisting symptoms for more than 30 days may decrease symptoms. No tests and measures other than standardized and validated symptom rating scales are valid for diagnosing persisting symptoms after concussion. Fluid and imaging biomarkers currently have limited clinical utility in diagnosing or assessing recovery from SRC. Improved paradigms for return to school were developed. The variable nature of disability and differences in evaluating para athletes and those of diverse ethnicity, sex, and gender are discussed, as are ethical considerations and future directions in pediatric SRC research.
Collapse
Affiliation(s)
- Gavin A Davis
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Department of Neurosurgery, Austin Health, Melbourne, Victoria, Australia
- Neurosurgery, Cabrini Health, Melbourne, Victoria, Australia
| | - Kathryn J Schneider
- Sport Injury Prevention Research Centre, Faculty of Kinesiology
- Hotchkiss Brain Institute
- Alberta Children's Hospital Research Institute, University of Calgary, Calgary, Alberta, Canada
| | - Vicki Anderson
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Franz E Babl
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Royal Children's Hospital, Melbourne, Victoria, Australia
- Departments of Paediatrics and Critical Care, University of Melbourne, Victoria, Australia
| | - Karen M Barlow
- University of Queensland, Children's Hospital and Health Services,Brisbane, Queensland, Australia
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston, Massachusetts
| | | | | | - Carolyn A Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology
- Hotchkiss Brain Institute
| | - Ruben J Echemendia
- University Orthopedics Concussion Care Clinic, State College, Pennsylvania
- University of Missouri - Kansas City, Kansas City, Missouri
| | - Isabelle Gagnon
- McGill University, Montreal, Quebec, Canada
- Montreal Children's Hospital, McGill University Health Center, Montreal, Quebec, Canada
| | | | | | - John J Leddy
- University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York
| | - Christina L Master
- University of Pennsylvania Perelman School of Medicine, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | | | | | - Laura Purcell
- Department of Pediatrics, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Michael Takagi
- Murdoch Children's Research Institute, Melbourne, Victoria, Australia
- Melbourne School of Psychological Sciences, University of Melbourne, Victoria, Australia
- Turner Institute for Brain and Mental Health, School of Psychological Sciences, Monash University, Victoria, Australia
| | - Keith Owen Yeates
- Hotchkiss Brain Institute
- Department of Psychology, University of Calgary, Calgary, Alberta, Canada
| | - Roger Zemek
- Children's Hospital of Eastern Ontario, University of Ottawa, Ottawa, Canada
| | - Jon S Patricios
- Wits Sport and Health (WiSH), School of Clinical Medicine, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
3
|
Steinacker JM, van Mechelen W, Bloch W, Börjesson M, Casasco M, Wolfarth B, Knoke C, Papadopoulou T, Wendt J, Al Tunaiji H, Andresen D, Andrieieva O, Bachl N, Badtieva V, Beucher FJ, Blauwet CA, Casajus Mallen JA, Chang JH, Clénin G, Constantini N, Constantinou D, Di Luigi L, Declercq L, Doutreleau S, Drozdovska S, Duclos M, Ermolao A, Fischbach T, Fischer AN, Fossati C, Franchella J, Fulcher M, Galle JC, Gerloff C, Georgiades E, Gojanovic B, González Gross M, Grote A, Halle M, Hauner H, Herring MP, Hiura M, Holze K, Huber G, Hughes D, Hutchinson MR, Ionescu A, Janse van Rensburg DC, Jegier A, Jones N, Kappert-Gonther K, Kellerer M, Kimura Y, Kiopa A, Kladny B, Koch G, Kolle E, Kolt G, Koutedakis Y, Kress S, Kriemler S, Kröger J, Kuhn C, Laszlo R, Lehnert R, Lhuissier FJ, Lüdtke K, Makita S, Manonelles Marqueta P, März W, Micallef-Stafrace K, Miller M, Moore M, Müller E, Neunhäuserer D, Onur IR, Ööpik V, Perl M, Philippou A, Predel HG, Racinais S, Raslanas A, Reer R, Reinhardt K, Reinsberger C, Rozenstoka S, Sallis R, Sardinha LB, Scherer M, Schipperijn J, Seil R, Tan B, Schmidt-Trucksäss A, Schumacher N, Schwaab B, Schwirtz A, Suzuki M, Swart J, Tiesler R, Tippelt U, Tillet E, Thornton J, Ulkar B, Unt E, Verhagen E, Weikert T, Vettor R, Zeng S, Budgett R, Engebretsen L, Erdener U, Pigozzi F, Pitsiladis YP. Global Alliance for the Promotion of Physical Activity: the Hamburg Declaration. BMJ Open Sport Exerc Med 2023; 9:e001626. [PMID: 37533594 PMCID: PMC10391804 DOI: 10.1136/bmjsem-2023-001626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/29/2023] [Indexed: 08/04/2023] Open
Abstract
Non-communicable diseases (NCDs), including coronary heart disease, stroke, hypertension, type 2 diabetes, dementia, depression and cancers, are on the rise worldwide and are often associated with a lack of physical activity (PA). Globally, the levels of PA among individuals are below WHO recommendations. A lack of PA can increase morbidity and mortality, worsen the quality of life and increase the economic burden on individuals and society. In response to this trend, numerous organisations came together under one umbrella in Hamburg, Germany, in April 2021 and signed the 'Hamburg Declaration'. This represented an international commitment to take all necessary actions to increase PA and improve the health of individuals to entire communities. Individuals and organisations are working together as the 'Global Alliance for the Promotion of Physical Activity' to drive long-term individual and population-wide behaviour change by collaborating with all stakeholders in the community: active hospitals, physical activity specialists, community services and healthcare providers, all achieving sustainable health goals for their patients/clients. The 'Hamburg Declaration' calls on national and international policymakers to take concrete action to promote daily PA and exercise at a population level and in healthcare settings.
Collapse
Affiliation(s)
- Jürgen M Steinacker
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Institute for Rehabilitation Medicine Research at Ulm University, Institut für rehabilitationsmedizinische Forschung an der Universität Ulm, Bad Buchau, Germany
| | - Willem van Mechelen
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- Department of Public and Occupational Health, location Vrije Universiteit, Amsterdam University Medical Centers, Amsterdam, Netherlands
- School of Human Movement and Nutrition Sciences, Faculty of Health and Behavioural Sciences, University of Queensland, Brisbane, Queensland, Australia
- Division of Exercise Science and Sports Medicine (ESSM), Department of Human Biology, Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
- UCD School of Public Health, Physiotherapy and Sports Science, University College Dublin, Dublin, Ireland
| | - Wilhelm Bloch
- Institute for Cardiology and Sports Medicine, German Sport University, Cologne, Germany
- Exercise is Medicine Germany, Frankfurt, Germany
| | - Mats Börjesson
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- Department of Molecular and Clinical Medicine, University of Gothenburg, Goteborg, Sweden
- Institute of Medicine, Sahlgrenska University Hospital, Goteborg, Region Västra Götaland, Sweden
| | | | - Bernd Wolfarth
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Department of Sport Medicine, Humboldt University and Charité University School of Medicine, Berlin, Deutschland, Germany
- German Society for Sports Medicine and Prevention, Deutsche Gesellschaft für Sportmedizin und Prävention (DGSP), Frankfurt, Germany
| | - Carolin Knoke
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
| | - Theodora Papadopoulou
- Defence Medical Rehabilitation Centre, Stanford Hall, Loughborough, UK
- British Association of Sport and Exercise Medicine, Doncaster, South Yorkshire, UK
| | - Janine Wendt
- Division of Sports and Rehabilitation Medicine, University Hospital Ulm, Ulm, Germany
| | - Hashel Al Tunaiji
- Sports Medicine, United Arab Emirates National Olympic Committee, Dubai, UAE
- Sports Medicine & Sciences Unit, Zayed Military University, Abu Dhabi, UAE
| | | | - Olena Andrieieva
- Department of Health, Fitness and Recreation, National University of Physical Education and Sport of Ukraine, Kiew, Ukraine
| | - Norbert Bachl
- Institute of Sports Science, University of Vienna, Vienna, Austria
- International Federation of Sports Medicine, Lausanne, Switzerland
| | - Victoriya Badtieva
- Sport Medicine, I M Sechenov First Moscow State Medical University, Moscow, Russia
- Sport Medicine, Moscow Scientific and Practical Center of Medical Rehabilitation and Sports Medicine, Moscow, Russian
| | - Friedhelm J Beucher
- National Paralympic Committee Germany (Deutscher Behindertensportverband (DBS), Bonn, Germany
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Jose-Antonio Casajus Mallen
- University of Zaragoza, GENUD “Growth, Exercise, NUtrition and Development” Research Group, Zaragoza, Spain
- Department of Physiatry and Nursing, Faculty of Health and Sport Science (FCSD), University of Zaragoza, Zaragoza, Spain
- Exercise is Medicine Spain, University of Zaragoza, Zaragoza, Spain
| | - Ju-Ho Chang
- The Association for International Sport for All (TAFISA), Frankfurt, Germany
| | - German Clénin
- Sportsmedical Centre Bern-Ittigen, Ittigen, Switzerland
- Sport and Exercise Medicine Switzerland (SEMS), Bern, Switzerland
| | - Naama Constantini
- Shaare Zedek Medical Center, Hebrew University, Jerusalem, Israel
- Exercise is Medicine Israel, Hebrew University, Jerusalem, Israel
| | - Demitri Constantinou
- Centre for Exercise Science and Sports Medicine, University of Witwatersrand, Johannesburg, South Africa
- South African Sports Medicine Association (SASMA), Pretoria, South Africa
| | - Luigi Di Luigi
- Unit of Endocrinology - Department of Movement, Human and Health Sciences, University of Rome Foro Italico, Rome, Italy
| | | | - Stephane Doutreleau
- Department of Sports Medicine, University Grenoble Alpes, Grenoble, Auvergne-Rhône-Alpes, France
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
| | - Svitlana Drozdovska
- National University of Physical Education and Sport of Ukraine, Kyiv, Ukraine
| | - Martine Duclos
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
- Department of Sport Medicine and Functional Explorations, University-Hospital (CHU), G. Montpied Hospital, Clermont-Ferrand, France
- UMR 1019, INRAE, French National Research Institute for Agriculture, Food and Environment, Clermont-Ferrand, France
| | - Andrea Ermolao
- Sports and Exercise Medicine Division, Department of Medicine, Università degli Studi di Padova, Padova, Italy
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
| | - Thomas Fischbach
- German Association of Paediatric and Adolescent Care Specialists, BVKJ - Berufsverband der Kinder- und Jugendärzte, Cologne, Germany
| | - Anastasia N Fischer
- Sports Medicine and Pediatrics, Nationwide Children's Hospital and The Ohio State University, Columbus, Ohio, USA
- American College of Sports Medicine, Indianapolis, Indiana, USA
| | - Chiara Fossati
- Faculty of Sport and Exercise Sciences, University of Rome 'Foro Italico', Roma, Lazio, Italy
| | - Jeorge Franchella
- Hospital de Clínicas José San Martin, University of Buenos Aires, Buenos Aires, Argentina
| | - Mark Fulcher
- Australasian College of Sport and Exercise Physicians, Melbourne, Victoria, Australia
- AUT Sports Performance Research Institute New Zealand, Auckland, New Zealand
| | - Jan C Galle
- German Society of Nephrology (Deutsche Gesellschaft für Nephrologie (DGfN)), Berlin, Germany
| | - Christian Gerloff
- German Society for Neurology (Deutsche Gesellschaft für Neurologie (DGN)), Berlin, Germany
| | | | - Boris Gojanovic
- Sports Medicine, Swiss Olympic Medical Center, Hopital de la Tour, Meyrin, Geneva, Switzerland
- SportAdo Consultation - Multidisciplinary Unit of Adolescent Health, University Hospital of Lausanne, Lausanne, Switzerland
| | - Marcela González Gross
- Exercise is Medicine Spain, University of Zaragoza, Zaragoza, Spain
- Department of Health and Human Performance - Facultad de CC de la Actividad Física y del Deporte, INEF Universidad Politécnica de Madrid, Madrid, Spain
| | - Andy Grote
- Senat, Freie und Hansestadt Hamburg, Hamburg, Germany
| | - Martin Halle
- European Association of Preventive Cardiology (EAPC), European Society of Cardiology (ECS), Biot, France
- Department of Prevention and Sports Medicine, Klinikum rechts der Isar, Technische Universität München, München, Germany
| | - Hans Hauner
- German Diabetes Foundation, Deutsche Diabetes Stiftung, Düsseldorf, Germany
| | | | - Mikio Hiura
- Center for Brain and Health Sciences, Aomori University, Aomori, Japan
| | - Kerstin Holze
- German Olympic Sports Confederation, Deutscher Olympischer Sportbund, Frankfurt am Main, Germany
| | - Gerhard Huber
- Institute of Sports and Sport Science, University Heidelberg, Heidelberg, Germany
- Deutscher Verband für Gesundheitssport und Sporttherapie e.V. (DVGS), Hamburg, Germany
| | - David Hughes
- Sports Medicine, Australian Institute of Sport, Canberra, Canberra, Australia
- Australian Institute of Sport, Australian Sports Commission, Canberra, Canberra, Australia
| | - Mark R. Hutchinson
- American College of Sports Medicine, Indianapolis, Indiana, USA
- Department of Orthopaedics, University of Illinois at Chicago, Chicago, Illinois, USA
- American College of Sports Medicine Foundation, Indianapolis, Indiana, USA
| | - Anca Ionescu
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Carol Davila University of Medicine and Pharmacy, Bucharest, Bucharest, Romania
| | - Dina Christina Janse van Rensburg
- South African Sports Medicine Association (SASMA), Pretoria, South Africa
- Section Sports Medicine, University of Pretoria Faculty of Health Sciences, Pretoria, Gauteng, South Africa
| | - Anna Jegier
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Department of Sports Medicine, Medical University of Lodz, Lodz, Poland
| | - Natasha Jones
- Moving Medicine, Faculty of Sport and Exercise Medicine UK, Edinburgh, UK
| | | | - Monika Kellerer
- German Diabetes Foundation, Deutsche Diabetes Stiftung, Düsseldorf, Germany
| | - Yutaka Kimura
- Health Science Center, Kansai Medical University, Osaka, Japan
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
| | | | - Bernd Kladny
- German Society of Orthopaedics and Trauma (Deutsche Gesellschaft für Orthopädie und Unfallchirurgie (DGOU)) with the German Society for Trauma Surgery (DGU) and German Society of Orthopaedics and Orthopaedic Surgery (DGOOC), Berlin, Germany
| | - Gerhard Koch
- Platform on Nutrition and Physical Activity, Plattform Ernährung und Bewegung e.V. (peb), Berlin, Germany
| | - Elin Kolle
- Exercise is Medicine Norway, Oslo, Norway
| | - Greg Kolt
- School of Science and Health, University of Western Sydney, Sydney, New South Wales, Australia
| | - Yiannis Koutedakis
- Exercise is Medicine Greece, National and Kapodistrian University of Athens, Athens, Greece
- School of Exercise Science and Dietetics, University of Thessaly, Trikala, Greece
| | - Stephan Kress
- German Diabetes Association (Deutsche Diabetes Gesellschaft (DDG)), Berlin, Germany
| | - Susi Kriemler
- Sport and Exercise Medicine Switzerland (SEMS), Bern, Switzerland
- Institute of Epidemiology, Biostatistics and Prevention, Zuerich University, Zuerich, Switzerland
| | - Jens Kröger
- German Diabetes Support (diabetesDE - Deutsche Diabetes-Hilfe), Charlottenburg, Germany
| | - Christian Kuhn
- German Alliance for Baths, Bäderallianz Deutschland, Köln, Germany
- International Assocation for Sport and Leisure Facilities, Köln, Germany
| | - Roman Laszlo
- German Cardiac Society (Deutsche Gesellschaft für Kardiologie – Herz- und Kreislaufforschung (DGK)), Düsseldorf, Nordrhein-Westfalen, Germany
| | - Ralph Lehnert
- Hamburg Sport Association (Hamburger Sportbund e.V.), Hamburg, Germany
| | - François J Lhuissier
- French Society of Exercise and Sports Medicine, Société Française de Médecine de l'Exercice et du Sport, Paris, France
- UMR INSERM 1272 Hypoxie et poumon, Université Sorbonne Paris Nord - Campus de Bobigny, Bobigny, France
- Hôpital Jean-Verdier, Médecine de l’exercice et du sport, Assistance Publique - Hôpitaux de Paris, Bondy, France
| | - Kerstin Lüdtke
- German Society for Physiotherapy Science (Deutsche Gesellschaft für Physiotherapiewissenschaft (DGPTW)), Hamburg, Germany
| | - Shigeru Makita
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
- Dept. of Rehabilitation, Saitama Medical University, Saitama, Japan
| | - Pedro Manonelles Marqueta
- International Federation of Sports Medicine, Lausanne, Switzerland
- Dept. of Rehabilitation, Saitama Medical University, Saitama, Japan
| | - Winfried März
- D.A.CH Society Prevention of Cardiovascular Diseases, D.A.CH-Gesellschaft Prävention von Herz-Kreislauf-Erkrankungen, Hamburg, Germany
| | - Kirill Micallef-Stafrace
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- University Sports Complex, Institute for Physical Education and Sport, Msida, Malta
| | - Mike Miller
- World Olympians Association (WOA), Lausanne, Switzerland
| | | | - Erich Müller
- European College of Sport Science, Köln, Germany
| | - Daniel Neunhäuserer
- Sports and Exercise Medicine Division, Department of Medicine, Università degli Studi di Padova, Padova, Italy
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
| | - I. Renay Onur
- Istanbul Spor Etkinlikleri ve Isletmeciligi A S, City of Istanbul, Istanbul, Turkey
| | - Vahur Ööpik
- Institute of Sport Sciences and Physiotherapy, Faculty of Medicine, University of Tartu, Tartu, Estonia
| | | | - Anastassios Philippou
- Exercise is Medicine Greece, National and Kapodistrian University of Athens, Athens, Greece
| | - Hans-Georg Predel
- German Hypertension League (Deutsche Hochdruckliga e.V. (DHL)), Heidelberg, Baden-Württemberg, Germany
- German Society for Hypertension and Prevention (Deutsche Gesellschaft für Hypertonie und Prävention), Heidelberg, Germany
| | - Sebastien Racinais
- Research Education Centre, ASPETAR - Qatar Orthopaedic and Sports Medicine Hospital, Doha, Qatar
| | - Algirdas Raslanas
- Department of Educational Assistance, Physical and Health Education, Vytautas Magnus University, Vilnius, Lithuania
| | - Ruediger Reer
- European Initiative for Exercise in Medicine (EIEIM), Ulm, Germany
- European Federation of Sports Medicine Associations (EFSMA), Lausanne, Switzerland
- Department of Movement Science, University of Hamburg, Hamburg, Germany
| | - Klaus Reinhardt
- German Medical Association (Bundesaerztekammer), Berlin, Germany
| | - Claus Reinsberger
- German Society for Sports Medicine and Prevention, Deutsche Gesellschaft für Sportmedizin und Prävention (DGSP), Frankfurt, Germany
| | - Sandra Rozenstoka
- International Federation of Sports Medicine, Lausanne, Switzerland
- Rīga Stradiņš University, Riga, Latvia
- Sports Laboratory, Sports Medicine and Physical Health Centre, Riga, Latvia, Riga, Latvia
- Latvian Sports Medicine Association, Riga, Latvia
| | - Robert Sallis
- Family Medicine, Kaiser Permanente, Fontana, California, USA
| | - Luis B Sardinha
- Exercise is Medicine Portugal, Universidade de Lisboa, Lisboa, Portugal
- Exercise and Health Laboratory, CIPER, Faculdade de Motricidade Humana, Universidade de Lisboa, Lisboa, Portugal
| | - Martin Scherer
- German Society of General Practice and Family Medicine (Deutsche Gesellschaft für Allgemeinmedizin und Familienmedizin (DEGAM)), Berlin, Germany
- Department of General Practice and Primary Care, University Medical Center, Hamburg, Germany
| | - Jasper Schipperijn
- International Society for Physical Activity and Health (ISPAH), Vancouver, British Columbia, Canada
| | - Romain Seil
- Society for Orthopaedic and Traumatologic Sports Medicine (GOTS), Jena, Germany
| | - Benedict Tan
- Exercise is Medicine Singapore, Singapore
- Department of Sport & Exercise Medicine, Changi General Hospital, Singapore
| | - Arno Schmidt-Trucksäss
- Division of Sports and Exercise Medicine, Department of Sport, Exercise and Health, Basel, Switzerland
| | - Nils Schumacher
- Department of Movement Science, University of Hamburg, Hamburg, Germany
| | - Bernhard Schwaab
- German Society for the Prevention and Rehabilitation of Cardiovascular Diseases (Deutsche Gesellschaft für Prävention und Rehabilitation von Herz-Kreislauferkrankungen (DGPR)), Koblenz, Germany
| | - Ansgar Schwirtz
- German Society of Sports Science, Deutsche Vereinigung für Sportwissenschaft (DVS), Frankfurt, Germany
| | - Masato Suzuki
- Exercise is Medicine Japan, Japanese Society of Physical Fitness and Sports Medicine, Osaka, Japan
| | - Jeroen Swart
- International Federation of Sports Medicine, Lausanne, Switzerland
- Health through Physical Activity, Lifestyle and Sport (HPALS) Research Centre, University of Cape Town, Cape Town, South Africa
| | - Ralph Tiesler
- Federal Institute for Sports Science (Bundesinstitut für Sportwissenschaft (BISp)), Bonn, Nordrhein-Westfalen, Germany
| | - Ulf Tippelt
- Institute for Applied Training Science Leipzig, Leipzig, Sachsen, Germany
| | - Eleanor Tillet
- British Association of Sport and Exercise Medicine, Doncaster, South Yorkshire, UK
- Division of Surgery and Interventional Science, University College London, London, UK
| | - Jane Thornton
- Public Health and Family Medicine, University of Western Ontario Schulich School of Medicine and Dentistry, London, Ontario, Canada
| | - Bulent Ulkar
- International Federation of Sports Medicine, Lausanne, Switzerland
- Sports Medicine Department, Faculty of Medicine, Ankara University, Ankara, Ankara, Turkey
| | - Eve Unt
- Department of Sports Medicine and Rehabilitation, Institute of Clinical Medicine, University of Tartu, Tartu, Estonia
| | - Evert Verhagen
- Department of Public and Occupational Health, location Vrije Universiteit, Amsterdam University Medical Centers, Amsterdam, Netherlands
| | - Thomas Weikert
- German Olympic Sports Confederation, Deutscher Olympischer Sportbund, Frankfurt am Main, Germany
| | - Roberto Vettor
- Exercise is Medicine Italy, Università degli Studi di Padova, Padova, Italy
- Department of Medicine, Università degli Studi di Padova, Padova, Italy
| | - Sheng Zeng
- International Federation of Sports Medicine, Lausanne, Switzerland
- Laboratory of Regenerative Medicine, Haikou, Hainan, China
| | | | - Lars Engebretsen
- International Olympic Committee, Lausanne, Switzerland
- Division of Orthopedic Surgery, University of Oslo, Oslo, Norway
| | - Ugur Erdener
- International Olympic Committee, Lausanne, Switzerland
| | - Fabio Pigozzi
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- Department of Movement, Human and Health Sciences, University of Rome “Foro Italico”, Rome, Italy
| | - Yannis P Pitsiladis
- International Federation of Sports Medicine, Fédération Internationale de Médecine du Sport (FIMS), Lausanne, Switzerland
- School of Sport and Health Sciences, University of Brighton, Eastbourne, UK
| |
Collapse
|
4
|
Morgenroth DC, Knowlton T, Apkon S, Blauwet CA, Burns AS, Córdova Vallejos C, Frontera W, Hearn SL, Jayabalan P, Lim PA, Moroz A, Perret D, Powell D, Puderbaugh M, Rivers E, Sowa G, Verduzco-Gutierrez M, Celnik PA. Challenges and Opportunities in Academic Physiatry: An Environmental Scan. Am J Phys Med Rehabil 2023; 102:159-165. [PMID: 36634238 PMCID: PMC10233907 DOI: 10.1097/phm.0000000000002127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
ABSTRACT Environmental scans determine trends in an organization's or field's internal and external environment. The results can help shape goals, inform strategic decision making, and direct future actions. The Association of Academic Physiatrists convened a strategic planning group in 2020, composed of physiatrists representing a diversity of professional roles, career stages, race and ethnicity, gender, disability status, and geographic areas of practice. This strategic planning group performed an environmental scan to assess the forces, trends, challenges, and opportunities affecting both the Association of Academic Physiatrists and the entire field of academic physiatry (also known as physical medicine and rehabilitation, physical and rehabilitation medicine, and rehabilitation medicine). This article presents aspects of the environmental scan thought to be most pertinent to the field of academic physiatry organized within the following five themes: (1) Macro/Societal Trends, (2) Technological Advancements, (3) Diversity and Global Outreach, (4) Economy, and (5) Education/Learning Environment. The challenges and opportunities presented here can provide a roadmap for the field to thrive within the complex and evolving healthcare systems in the United States and globally.
Collapse
Affiliation(s)
- David C. Morgenroth
- Department of Rehabilitation Medicine, University of Washington, Seattle, WA, USA
- Rehabilitation Care Service, VA Puget Sound Health Care System, Seattle, WA, USA
| | | | - Susan Apkon
- Department of PM&R, Children’s Hospital Colorado/University of Colorado, Aurora, CO, USA
| | - Cheri A. Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital/Harvard Medical School, Boston MA, USA
| | - Anthony S. Burns
- Division of Physical Medicine & Rehabilitation, Department of Medicine, University of Toronto, Toronto, ON, Canada
| | - Cecilia Córdova Vallejos
- Department of Physical Medicine and Rehabilitation, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY, USA
| | - Walter Frontera
- Department of Physical Medicine, Rehabilitation and Sports Medicine, University of Puerto Rico School of Medicine, San Juan, Puerto Rico, USA
| | - Sandra L. Hearn
- Department of Physical Medicine and Rehabilitation, University of Michigan, Ann Arbor, MI, USA
| | - Prakash Jayabalan
- Department of Physical Medicine and Rehabilitation, Northwestern Feinberg School of Medicine, Chicago, IL, USA
| | - Peter A. Lim
- Physical Medicine and Rehabilitation Service, Michael E. DeBakey Veterans Affairs Medical Center, Houston, TX, USA
- H. Ben Taub Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, TX, USA
| | - Alex Moroz
- Department of Rehabilitation Medicine, New York University Grossman School of Medicine, New York, NY, USA
| | - Danielle Perret
- University of California, Irvine, Department of Physical Medicine and Rehabilitation, Orange, CA, USA
| | - Danielle Powell
- University of Alabama Heersink School of Medicine, Department of Physical Medicine and Rehabilitation, Birmingham, AL, USA
| | - Matt Puderbaugh
- Department of Physical Medicine and Rehabilitation, Hennepin Healthcare, Minneapolis, MN, USA
| | - Evan Rivers
- Physical Medicine and Rehabilitation Service, Tennessee Valley Healthcare System, Nashville, TN, USA
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical System, Nashville, TN, USA
| | - Gwendolyn Sowa
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh, Pittsburgh, PA, USA
- UPMC Rehabilitation Institute, Pittsburgh, PA, USA
| | - Monica Verduzco-Gutierrez
- Department of Rehabilitation Medicine, University of Texas Health Science Center at San Antonio, San Antonio, TX, USA
| | - Pablo A. Celnik
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| |
Collapse
|
5
|
Blauwet CA, Chakraverty J, Derman W, Idrisova G, Martin P, Miller SC, Morrissey D, Webborn N. Shoulder Pain, Function, and Ultrasound-Determined Structure in Elite Wheelchair-Using Para Athletes: An Observational Study. Med Sci Sports Exerc 2022; 54:896-904. [PMID: 35081095 DOI: 10.1249/mss.0000000000002875] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
PURPOSE This study aimed to determine the relationship between shoulder pain, physical examination, and tissue pathology in manual wheelchair users competing in elite sport. METHODS Eighty elite para athletes who used a manual wheelchair for daily mobility were recruited from international track (n = 40), field (n = 19), and powerlifting (n = 21) competitions. Athletes were surveyed regarding shoulder pain history and symptoms (Wheelchair User's Shoulder Pain Index (WUSPI)), whereas independent blind observers measured signs (Physical Examination of the Shoulder Scale (PESS)) and tissue pathology (Ultrasound Shoulder Pathology Rating Scale (USPRS)). Relationships between measures for the total cohort and for subgroups defined by sporting discipline were calculated. RESULTS A large proportion of athletes reported a history of upper limb pain (39% dominant and 35% nondominant). For the total cohort, WUSPI score was 22.3 ± 26.9, PESS score was 7.4 ± 6.7, and USPRS score was 5.2 ± 4.0. There were no USPRS score differences between athlete subgroups; however, track athletes had lower WUSPI and PESS scores, especially compared with field athletes. The first principal component explained most of the variance in the WUSPI and PESS, which were strongly correlated (r = 0.71), and the second orthogonal component explained the USPRS, which did not correlate with either the PESS (r = 0.21) or WUSPI (r = 0.20). Subgroup analysis showed that track athletes had lower symptom scores for a given physical examination score. CONCLUSIONS Elite para athletes who use manual wheelchairs for daily mobility have a high prevalence of shoulder symptoms, positive signs on physical examination, and ultrasound-determined tissue pathology. Ultrasound-determined tissue pathology does not correlate with symptoms or signs. This information can help to guide clinicians in managing shoulder problems in this athlete population at high risk of injury.
Collapse
Affiliation(s)
| | - Julian Chakraverty
- University Hospitals of Bristol & Weston NHS Foundation Trust, Bristol, UNITED KINGDOM
| | | | | | - Paul Martin
- English Institute of Sport, Manchester Institute of Health and Performance, Manchester, UNITED KINGDOM
| | - Stuart C Miller
- Sport and Exercise Medicine, Queen Mary University of London, London, UNITED KINGDOM
| | | | | |
Collapse
|
6
|
Alexander LAJ, Eken MM, Teoh CS, Stuart MC, Derman EW, Blauwet CA. Patterns of Athlete Medication Use at the 2018 PyeongChang Paralympic Games: A Descriptive Cohort Study. Am J Phys Med Rehabil 2022; 101:270-278. [PMID: 33782274 DOI: 10.1097/phm.0000000000001751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Medication use among elite athletes has received growing attention over the past decades. However, only limited studies have focused on para athletes, and trends in medication use among this cohort remain unclear. The aims of this study were (1) to describe the pattern of medication use in elite Paralympic athletes, with a particular focus on analgesics, (2) to analyze whether medications declared by athletes were included in the 2018 World Anti-Doping Agency's prohibited list and monitoring program, (3) to report on a variety of novel supplements, and (4) to review whether athlete analgesic needs will be met by the new Olympic & Paralympic Model Formulary. DESIGN This is a retrospective, descriptive cohort study. RESULTS Of all athletes who underwent doping control, 21% declared the use of an analgesic medication. Athletes with limb deficiency and para snowboarders declared the most analgesic medications in their respective categories. It was determined that 84% of the athletes' analgesic medication needs were provided from the new Olympic & Paralympic Model Formulary. CONCLUSIONS Analgesic use among athletes who participated at the 2018 PyeongChang Winter Paralympics was high. Para snowboarders and athletes with limb deficiency declared the most analgesics. The new Olympic & Paralympic Model Formulary adequately addressed the medication needs of the athletes attending the 2018 games.
Collapse
Affiliation(s)
- Laine A J Alexander
- From the Institute of Sport and Exercise Medicine, Division of Orthopaedic Surgery, Department of Surgical Sciences, Stellenbosch University, Cape Town, South Africa (LAJA, MME, EWD); Sports Medicine Centre, Khoo Teck Puat Hospital, Singapore (CST); International Olympic Committee Medical and Scientific Commission Games Group, Lausanne, Switzerland (MCS); Centre for Metabolism and Inflammation, Division of Medicine, University College London, London, United Kingdom (MCS); International Olympic Committee Research Centre, Stellenbosch, South Africa (EWD); and Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts (CAB)
| | | | | | | | | | | |
Collapse
|
7
|
Chandan P, Kirschner KL, Prokup J, Blauwet CA. Demonstrating the vital role of physiatry throughout the health care continuum: Lessons learned from impacts of the COVID-19 pandemic on the disability community. PM R 2021; 13:589-598. [PMID: 34097360 PMCID: PMC8207074 DOI: 10.1002/pmrj.12611] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2021] [Accepted: 04/16/2021] [Indexed: 12/30/2022]
Abstract
COVID White Paper Series
Collapse
Affiliation(s)
- Priya Chandan
- Division of Physical Medicine & Rehabilitation, Department of Neurological Surgery, ULP Restorative NeuroscienceUniversity of Louisville School of MedicineLouisvilleKentuckyUSA
- Department of Health Promotion and Behavioral SciencesUniversity of Louisville School of Public Health and Information SciencesLouisvilleKentuckyUSA
| | - Kristi L. Kirschner
- Departments of Medical Education and Neurology and RehabilitationUniversity of Illinois College of Medicine and University of IllinoisChicagoIllinoisUSA
| | - Jessica Prokup
- Department of PM&RUniversity of Pittsburgh Medical CenterPittsburghPennsylvaniaUSA
| | - Cheri A. Blauwet
- Department of Physical Medicine & RehabilitationSpaulding Rehabilitation Hospital and Harvard Medical SchoolBostonMassachusettsUSA
- Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation NetworkBostonMassachusettsUSA
| |
Collapse
|
8
|
Blauwet CA, Robinson D, Riley A, MacEwan K, Patstone M, Dubon ME. Developing a Virtual Adaptive Sports Program in Response to the
COVID
‐19 Pandemic. PM R 2020; 13:211-216. [DOI: 10.1002/pmrj.12481] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Revised: 08/09/2020] [Accepted: 08/24/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Cheri A. Blauwet
- Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital/Harvard Medical School Boston, MA
- Department of Physical Medicine and Rehabilitation and Kelley Adaptive Sports Research Institute Spaulding Rehabilitation Hospital, Harvard Medical School Boston, MA
| | - David Robinson
- Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital/Harvard Medical School Boston, MA
| | | | | | | | - Mary E. Dubon
- Department of Physical Medicine and Rehabilitation Spaulding Rehabilitation Hospital/Harvard Medical School Boston, MA
- Department of Physical Medicine and Rehabilitation and Kelley Adaptive Sports Research Institute Spaulding Rehabilitation Hospital, Harvard Medical School Boston, MA
- Department of Orthopedics Boston Childrenʼs Hospital Boston, MA
| |
Collapse
|
9
|
Hayano T, Blauwet CA, Tenforde AS. Management of Hamstring Pain in an Elite Female Para-Swimming Athlete Using Radial Shockwave Therapy: A Case Report. PM R 2020; 13:1435-1436. [PMID: 32890449 DOI: 10.1002/pmrj.12482] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 08/10/2020] [Accepted: 08/19/2020] [Indexed: 11/08/2022]
Affiliation(s)
- Todd Hayano
- Spaulding Rehabilitation Hospital, Charlestown, MA
| | | | | |
Collapse
|
10
|
Blauwet CA, Brashler R, Kirschner KL, Mukherjee D. Vulnerability, Interdependence, and Trust in the COVID-19 Pandemic. PM R 2020; 12:1038-1044. [PMID: 32888396 DOI: 10.1002/pmrj.12480] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 07/27/2020] [Indexed: 11/06/2022]
Affiliation(s)
- Cheri A Blauwet
- Department of Physical Medicine & Rehabilitation, Kelley Spaulding Rehabilitation Hospital and Harvard Medical SchoolAdaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA, USA
| | - Rebecca Brashler
- Assistant Professor of PM&R at Northwestern University Feinberg School of Medicine Clinical Bioethicist and Director of Global Patient Service at Shirley Ryan AbilityLab, Chicago, IL, USA
| | - Kristi L Kirschner
- Departments of Medical Education and Neurology and Rehabilitation, University of Illinois College of Medicine and University of Illinois at Chicago, Chicago, IL, USA
| | - Debjani Mukherjee
- Division of Medical Ethics, Weill Cornell Medical College, New York, NY, USA
| |
Collapse
|
11
|
Tenforde AS, Iaccarino MA, Borgstrom H, Hefner JE, Silver J, Ahmed M, Babu AN, Blauwet CA, Elson L, Eng C, Kotler D, Homer S, Makovitch S, McInnis KC, Vora A, Borg-Stein J. Telemedicine During COVID-19 for Outpatient Sports and Musculoskeletal Medicine Physicians. PM R 2020; 12:926-932. [PMID: 32424977 PMCID: PMC7276758 DOI: 10.1002/pmrj.12422] [Citation(s) in RCA: 66] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 05/08/2020] [Accepted: 05/11/2020] [Indexed: 12/12/2022]
Abstract
Introduction The global pandemic due to SARS‐CoV‐2 has resulted in an expansion of telemedicine. Measures of quality and barriers for rapid use by patients and physicians are not well described. Objective To describe results from a quality improvement initiative during a rapid adoptive phase of telemedicine during the pandemic. Design Patient and physician satisfaction with synchronous audiovisual telemedicine visits was measured during the early adoptive phase (6 April 2020‐17 April 2020) within the division of sports medicine in an academic Physical Medicine and Rehabilitation (PM&R) department. Patients were invited to participate in a quality improvement initiative by completing an online survey at the end of a telemedicine visit. Physicians completed a separate survey. Primary Outcome Measures Patient measures included visit type, duration of encounter, quality, and satisfaction. Physicians reported on experiences performed telemedicine. Results Surveys were completed by 119 patients (293 telemedicine encounters, response rate 40.6%) and 14 physiatrists. Telemedicine was utilized primarily for follow‐up visits (n = 74, 70.6%), and the most common duration was 15 to 29 minutes. Patients rated their telemedicine visit as “excellent” or “very good” across measures (91.6%‐95.0%) including addressing concerns, communication, developing a treatment plan, convenience, and satisfaction. Value of completing a future telemedicine visit was measured at 84.9%. Most reported estimated travel time saved was in excess of 30 minutes. Rate of no‐show was 2.7%. Most physicians (57.1%) had no prior experience with telemedicine visits, and most were comfortable performing these visits after completing 1 to 4 sessions (71%). Nearly all physicians (92.9%) rated their telemedicine experience as very good or excellent. The key barrier identified for telemedicine was technical issues. All physicians reported plans to perform telemedicine visits if reimbursement continues. Conclusions In summary, rapid expansion of telemedicine during the COVID‐19 pandemic was well‐received by a majority of patients and physicians. This suggests feasibility in rapid expansion of telemedicine for other outpatient sports medicine practices.
Collapse
Affiliation(s)
- Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Mary A Iaccarino
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Haylee Borgstrom
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Jaye E Hefner
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Julie Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Marwa Ahmed
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Ashwin N Babu
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Lauren Elson
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Christine Eng
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Dana Kotler
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Scott Homer
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Steven Makovitch
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Kelly C McInnis
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Ariana Vora
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| | - Joanne Borg-Stein
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Boston, MA, USA
| |
Collapse
|
12
|
Breslow RG, Tenforde AS, Collins JE, Blauwet CA. The Boston Marathon: A Tale of Two Races. Curr Sports Med Rep 2020; 19:196-198. [DOI: 10.1249/jsr.0000000000000716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
13
|
Silver JK, Bean AC, Slocum C, Poorman JA, Tenforde A, Blauwet CA, Kirch RA, Parekh R, Amonoo HL, Zafonte R, Osterbur D. Physician Workforce Disparities and Patient Care: A Narrative Review. Health Equity 2019; 3:360-377. [PMID: 31312783 PMCID: PMC6626972 DOI: 10.1089/heq.2019.0040] [Citation(s) in RCA: 117] [Impact Index Per Article: 23.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
Background: Ensuring the strength of the physician workforce is essential to optimizing patient care. Challenges that undermine the profession include inequities in advancement, high levels of burnout, reduced career duration, and elevated risk for mental health problems, including suicide. This narrative review explores whether physicians within four subpopulations represented in the workforce at levels lower than predicted from their numbers in the general population—women, racial and ethnic minorities in medicine, sexual and gender minorities, and people with disabilities—are at elevated risk for these problems, and if present, how these problems might be addressed to support patient care. In essence, the underlying question this narrative review explores is as follows: Do physician workforce disparities affect patient care? While numerous articles and high-profile reports have examined the relationship between workforce diversity and patient care, to our knowledge, this is the first review to examine the important relationship between diversity-related workforce disparities and patient care. Methods: Five databases (PubMed, the Cochrane Library of Systematic Reviews, EMBASE, Web of Knowledge, and EBSCO Discovery Service) were searched by a librarian. Additional resources were included by authors, as deemed relevant to the investigation. Results: The initial database searches identified 440 potentially relevant articles. Articles were categorized according to subtopics, including (1) underrepresented physicians and support for vulnerable patient populations; (2) factors that could exacerbate the projected physician deficit; (3) methods of addressing disparities among underrepresented physicians to support patient care; or (4) excluded (n=155). The authors identified another 220 potentially relevant articles. Of 505 potentially relevant articles, 199 (39.4%) were included in this review. Conclusions: This report demonstrates an important gap in the literature regarding the impact of physician workforce disparities and their effect on patient care. This is a critical public health issue and should be urgently addressed in future research and considered in clinical practice and policy decision-making.
Collapse
Affiliation(s)
- Julie K Silver
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
| | - Allison C Bean
- Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York
| | - Chloe Slocum
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, and Massachusetts General Hospital, Boston, Massachusetts
| | - Julie A Poorman
- Department of Physical Medicine and Rehabilitation, Harvard Medical School and Spaulding Rehabilitation Network, Boston, Massachusetts
| | - Adam Tenforde
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brigham and Women's Hospital, and Spaulding Rehabilitation Network, Boston, Massachusetts
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Brigham and Women's Hospital, and Spaulding Rehabilitation Network, Boston, Massachusetts
| | - Rebecca A Kirch
- National Patient Advocate Foundation, Washington, District of Columbia
| | - Ranna Parekh
- Department of Psychiatry, Massachusetts General Hospital, Boston, Massachusetts.,American Psychiatric Association, Washington, District of Columbia
| | - Hermioni L Amonoo
- Department of Psychiatry, Harvard Medical School and Brigham and Women's Hospital, Boston, Massachusetts.,Department of Psychosocial Oncology and Palliative Care, Dana-Farber Cancer Institute, Boston, Massachusetts
| | - Ross Zafonte
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Network, Massachusetts General Hospital, and Brigham and Women's Hospital, Boston, Massachusetts
| | - David Osterbur
- Countway Library of Medicine, Harvard Medical School, Boston, Massachusetts
| |
Collapse
|
14
|
Bank AM, Slocum CS, Blauwet CA, Bhatnagar S, Poorman JA, Goldstein R, Reilly JM, Zafonte RD, Silver JK. Author response: Women physicians underrepresented in American Academy of Neurology recognition awards. Neurology 2019; 92:924. [DOI: 10.1212/wnl.0000000000007462] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
|
15
|
Brook EM, Tenforde AS, Broad EM, Matzkin EG, Yang HY, Collins JE, Blauwet CA. Low energy availability, menstrual dysfunction, and impaired bone health: A survey of elite para athletes. Scand J Med Sci Sports 2019; 29:678-685. [PMID: 30644600 DOI: 10.1111/sms.13385] [Citation(s) in RCA: 41] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2018] [Revised: 11/08/2018] [Accepted: 01/08/2019] [Indexed: 12/30/2022]
Abstract
INTRODUCTION The Female Athlete Triad (Triad) is a syndrome describing three interrelated conditions: low energy availability (LEA), menstrual dysfunction, and low bone mineral density (BMD). Relative Energy Deficiency in Sport (RED-S) expands the Triad to include multiple physiologic consequences of LEA in both sexes. The purpose of this study is to determine the prevalence of factors associated with the Triad/RED-S in an elite para athlete population. METHODS Athletes were U.S. elite para athletes training to qualify for the 2016 or the 2018 Paralympic Games. Participants completed an online questionnaire characterizing nutrition, menstrual status (in females), bone health, and awareness of the Triad/RED-S. RESULTS The athletes were 260 elite para athletes (150 male, 110 female). While few reported prior eating disorder (3.1%), 32.4% had elevated Eating Disorder Examination Questionnaire (EDE-Q) pathologic behavior subscale scores. Most athletes (95 male, 65 female) were attempting to change their body composition or weight to improve performance. Forty-four percent of premenopausal females had oligomenorrhea/amenorrhea. Bone stress injury was reported in 9.2% of athletes; of these, 54.5% (n = 12) had low BMD. Less than 10% of athletes reported awareness of the Triad/RED-S. CONCLUSIONS Factors associated with the Triad/RED-S are present in an elite para athlete population, regardless of sex or sport type. Awareness of the Triad/RED-S in para athletes is low. The consequences of LEA in para athlete populations are poorly understood. However, the high prevalence of factors observed suggests value in advancing screening tools and education efforts to optimize health in this population.
Collapse
Affiliation(s)
- Emily M Brook
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | | | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Heidi Y Yang
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
| | - Jamie E Collins
- Orthopedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Harvard Medical School, Boston, Massachusetts
| | - Cheri A Blauwet
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts.,International Paralympic Committee (IPC) Medical Committee, Bonn, Germany
| |
Collapse
|
16
|
Blauwet CA, Brook EM, Tenforde AS, Broad E, Hu CH, Abdu-Glass E, Matzkin EG. Low Energy Availability, Menstrual Dysfunction, and Low Bone Mineral Density in Individuals with a Disability: Implications for the Para Athlete Population. Sports Med 2018; 47:1697-1708. [PMID: 28213754 DOI: 10.1007/s40279-017-0696-0] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Low energy availability, functional hypothalamic amenorrhea, and low bone mineral density are three interrelated conditions described in athletic women. Although described as the female athlete triad (Triad), males experience similar health concerns. The literature suggests that individuals with a disability may experience altered physiology related to these three conditions when compared with the able-bodied population. The goal of this review is to describe the unique implications of low energy availability, low bone mineral density, and, in females, menstrual dysfunction in individuals with a disability and their potential impact on the para athlete population. A literature review was performed linking search terms related to the three conditions with six disability categories that are most represented in para sport. Few articles were found that directly pertained to athletes, therefore, the review additionally characterizes literature found in a non-athlete population. Review of the available literature in athletes suggests that both male and female athletes with spinal cord injury demonstrate risk factors for low energy availability. Bone mineral density may also show improvements for wheelchair athletes or athletes with hemiplegic cerebral palsy when compared with a disabled non-athlete population. However, the prevalence of the three conditions and implications on the health of para athletes is largely unknown and represents a key gap in the sports medicine literature. As participation in para sport continues to increase, further research is needed to understand the impact of these three interrelated health concerns for athletes with a disability, accompanied by educational initiatives targeting athletes, coaches, and health professionals.
Collapse
Affiliation(s)
- Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, Boston, MA, 02129, USA. .,International Paralympic Committee (IPC) Medical Committee, Bonn, Germany.
| | - Emily M Brook
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA
| | - Adam S Tenforde
- Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, 300 1st Avenue, Charlestown, Boston, MA, 02129, USA
| | | | - Caroline H Hu
- University of Minnesota Medical School, Minneapolis, MN, USA
| | | | - Elizabeth G Matzkin
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, MA, USA.,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| |
Collapse
|
17
|
Silver JK, Bank AM, Slocum CS, Blauwet CA, Bhatnagar S, Poorman JA, Goldstein R, Reilly JM, Zafonte RD. Women physicians underrepresented in American Academy of Neurology recognition awards. Neurology 2018; 91:e603-e614. [PMID: 30030329 PMCID: PMC6105044 DOI: 10.1212/wnl.0000000000006004] [Citation(s) in RCA: 70] [Impact Index Per Article: 11.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2018] [Accepted: 05/18/2018] [Indexed: 01/07/2023] Open
Abstract
OBJECTIVE To investigate representation by gender among recipients of physician recognition awards presented by the American Academy of Neurology (AAN). METHODS We analyzed lists of individual recipients over the 63-year history of the AAN recognition awards. Included were awards intended primarily for physician recipients that recognized a body of work over the course of a career. The primary outcome measures were total numbers and proportions of men and women physician award recipients. RESULTS During the period studied, the proportion of women increased from 18% (1996) to 31.5% (2016) among AAN US neurologist members and from 18.6% (1992) to 35% (2015) in academia, and the AAN presented 323 awards to physician recipients. Of these recipients, 264 (81.7%) were men and 59 (18.3%) were women. During the most recent 10-year period studied (2008-2017), the proportion of women increased from 24.7% (2008) to 31.5% (2016) among AAN US neurologist members and from 28% (2009) to 35% (2015) in academia, and the AAN presented 187 awards to physician recipients, comprising 146 men (78.1%) and 41 women (21.9%). Although it has been more than 2 decades since the proportion of women among US neurologist members of the AAN was lower than 18%, 1 in 4 AAN award categories demonstrated 0% to 18% representation of women among physician recipients during the most recent decade. Moreover, for highly prestigious awards, underrepresentation was more pronounced. CONCLUSION Although the reasons why are not clear, women were often underrepresented among individual physician recognition award recipient lists, particularly for highly prestigious awards.
Collapse
Affiliation(s)
- Julie K Silver
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA
| | - Anna M Bank
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA.
| | - Chloe S Slocum
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA
| | - Cheri A Blauwet
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA
| | - Saurabha Bhatnagar
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA
| | - Julie A Poorman
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA
| | - Richard Goldstein
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA
| | - Julia M Reilly
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA
| | - Ross D Zafonte
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R., R.D.Z.); Spaulding Rehabilitation Hospital (J.K.S., C.A.B., S.B., J.A.P., R.G., J.M.R.); Massachusetts General Hospital (J.K.S.); Brigham and Women's Hospital (J.K.S., C.A.B.); Department of Neurology (A.M.B.), Massachusetts General Hospital, Brigham and Women's Hospital, and Harvard Medical School; Harvard Medical School (C.S.S.); Department of Physical Medicine & Rehabilitation (C.S.S.), Spaulding Rehabilitation Hospital and Massachusetts General Hospital; VA Boston Healthcare System (S.B.); Medical Affairs, Research and Education (R.D.Z.), Spaulding Rehabilitation Network; Department of Physical Medicine and Rehabilitation (R.D.Z.), Massachusetts General Hospital; and Department of Physical Medicine and Rehabilitation (R.D.Z.), Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
18
|
Iezzoni LI, Wint AJ, Boudreau AA, Blauwet CA, Kuhlthau KA. Views of teenage children about the effects of a Parent's mobility disability. Disabil Health J 2018; 11:405-411. [PMID: 29331657 DOI: 10.1016/j.dhjo.2017.12.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2017] [Revised: 12/05/2017] [Accepted: 12/26/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND Few U.S. studies have explored how children experience a parent's mobility disability and its effects on their daily lives. OBJECTIVE We aimed to engage youth ages 13-17 who had at least one parent with mobility disability in describing their perceptions of their parent's disability and its consequences for their daily and family life. METHODS Participants videoed and photographed their experiences following general guidelines from the researchers about topics of interest. Participants made their own choices about what they submitted. We used conventional content analysis to identify broad themes. RESULTS The mean (standard deviation) age of the 10 participants was 15.2 (1.9) years; 5 were male; 9 participants were white. All 5 girls submitted multiple self-focused (selfie) videos made in their bedrooms; the 5 boys submitted more diverse data files. Several broad themes or topics emerged including: the effects of timing and trajectory of the parent's disability; perceptions of early maturity and responsibility; fears and frustrations relating to the parent's disability; support and emerging resilience; and sense of social justice. Participants generally felt their parents' disability made them become - compared to their peers - more mature, responsible, capable of performing household tasks, and aware of disability civil rights. CONCLUSIONS Participants raised many issues that health care providers should be aware of when youth have parents with mobility disability. A parent's mobility disability may be associated with resilience but also may pose challenges for youth. More research is needed to understand better adolescents' experiences and how clinicians might best assist these youth.
Collapse
Affiliation(s)
- Lisa I Iezzoni
- Mongan Institute Health Policy Center, Massachusetts General Hospital, USA; Department of Medicine, Harvard Medical School, USA.
| | - Amy J Wint
- Mongan Institute Health Policy Center, Massachusetts General Hospital, USA
| | - Alexy Arauz Boudreau
- Department of Pediatrics, Massachusetts General Hospital for Children, USA; Department of Pediatrics, Harvard Medical School, USA
| | - Cheri A Blauwet
- Spaulding Rehabilitation Network, USA; Department of Physiatry, Harvard Medical School, USA
| | - Karen A Kuhlthau
- Department of Pediatrics, Massachusetts General Hospital for Children, USA; Department of Pediatrics, Harvard Medical School, USA
| |
Collapse
|
19
|
Silver JK, Blauwet CA, Bhatnagar S, Slocum CS, Tenforde AS, Schneider JC, Zafonte RD, Goldstein R, Gallegos-Kearin V, Reilly JM, Mazwi NL. Women Physicians Are Underrepresented in Recognition Awards From the Association of Academic Physiatrists. Am J Phys Med Rehabil 2017; 97:34-40. [PMID: 28678034 PMCID: PMC5757674 DOI: 10.1097/phm.0000000000000792] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Determine representation by gender for individual recognition awards presented to physicians by the Association of Academic Physiatrists (AAP). DESIGN Cross-sectional survey was used. Lists of individual recognition award recipients for the 27-yr history of the AAP awards (1990-2016) were analyzed. The primary outcome measures were the total numbers of men versus women physician award recipients overall and for the past decade (2007-2016). RESULTS No awards were given to women physicians for the past 4 yrs (2013-2016) or in half of the award categories for the past decade (2007-2016). No woman received the outstanding resident/fellow award since its inception (2010-2016). There was a decrease in the proportion of awards given to women in the past decade (2007-2016, 7 of 39 awards, 17.9%) as compared with the first 17 yrs (1990-2006, 10 of 46 awards, 21.7%). Furthermore, compared with their proportional membership within the specialty, women physicians were underrepresented for the entire 27-yr history of the AAP awards (1990-2016, 17 of 85 awards, 20%). According to the Association of American Medical Colleges, the proportion of full-time female physical medicine and rehabilitation faculty members was 38% in 1992 and 41% in 2013. CONCLUSIONS Women physicians have been underrepresented by the AAP in recognition awards. Although the reasons are not clear, these findings should be further investigated.
Collapse
Affiliation(s)
- Julie K Silver
- From the Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Massachusetts General Hospital; Brigham and Women's Hospital, Boston, Massachusetts (JKS); Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Brigham and Women's Hospital, Boston, Massachusetts (CAB, AST); Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Massachusetts General Hospital; VA Boston Healthcare System, Boston, Massachusetts (SB); Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital, Boston, Massachusetts (CSS, RG, VG-K, JMR, NLM); Department of Physical Medicine and Rehabilitation, Harvard Medical School; Spaulding Rehabilitation Hospital; Massachusetts General Hospital, Boston, Massachusetts (JCS); and Department of Physical Medicine and Rehabilitation, Harvard Medical School; Medical Affairs, Research and Education, Spaulding Rehabilitation Network; Physical Medicine and Rehabilitation, Massachusetts General Hospital; Physical Medicine and Rehabilitation, Brigham and Women's Hospital, Boston, Massachusetts (RDZ)
| | | | | | | | | | | | | | | | | | | | | |
Collapse
|
20
|
Lape EC, Katz JN, Losina E, Kerman HM, Gedman MA, Blauwet CA. Participant-Reported Benefits of Involvement in an Adaptive Sports Program: A Qualitative Study. PM R 2017; 10:507-515. [PMID: 29111464 DOI: 10.1016/j.pmrj.2017.10.008] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/16/2017] [Accepted: 10/23/2017] [Indexed: 10/18/2022]
Abstract
BACKGROUND Although participation in adaptive sports offers numerous benefits for persons with disabilities, a substantial number of eligible persons do not take part. Previous studies have identified personal and environmental factors that promote or inhibit adaptive sports participation. However, these studies have considered a relatively narrow range of factors. OBJECTIVE To use qualitative research techniques to identify novel factors that influence participation in a community-based adaptive sports program. DESIGN Qualitative focus group study. SETTING Community-based adaptive sports programs affiliated with a rehabilitation hospital network. PARTICIPANTS Participants were recruited from among 134 adults who registered for the sports program in 2013-2014. Participants with mobility or sensory impairment, absence of cognitive impairment, and English proficiency were included. The 90 former participants with adequate contact information were contacted, and 17 participated in the focus groups. METHODS Two moderators led each of 3 audio-recorded focus groups using a moderator's guide. We conducted a thematic analysis of transcript data to identify perceived benefits, barriers, and facilitators of participation. RESULTS Our analysis identified 5 themes: physical well-being and health/safety; interpersonal and social relationships; intrapersonal and beliefs/attitudes; physical environment; and access. Participants experienced participation both as physically beneficial and as transformative in terms of how they view themselves. However, programs drew on limited personal resources and sometimes presented a perceived risk of injury. Finding information about and transportation to programs was a challenge. Participants formed an informal community that modeled what athletes with disabilities are capable of, helping to overcome initial doubts. CONCLUSIONS To gain the benefits of participation, athletes overcame significant barriers, several of which may be modifiable, including transportation and difficult-to-find information about program offerings. The importance of community and raising awareness of athletes' own abilities suggests a key role for mentorship. Our study contributes to the understanding of experiential aspects that motivate participation in adaptive sports. LEVEL OF EVIDENCE IV.
Collapse
Affiliation(s)
- Emma C Lape
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, BTM 5016, Boston, MA 02115.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA.,Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Boston, MA
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, BTM 5016, Boston, MA 02115.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA.,Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Boston, MA
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, BTM 5016, Boston, MA 02115.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA.,Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Boston, MA
| | - Hannah M Kerman
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, BTM 5016, Boston, MA 02115.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA.,Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Boston, MA
| | - Marissa A Gedman
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, BTM 5016, Boston, MA 02115.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA.,Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Boston, MA
| | - Cheri A Blauwet
- Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, 75 Francis St, BTM 5016, Boston, MA 02115.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Medicine, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA; Department of Orthopedic Surgery, Harvard Medical School, Boston, MA; Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Department of Biostatistics, Boston University School of Public Health, Boston, MA.,Orthopaedic and Arthritis Center for Outcomes Research, Brigham and Women's Hospital, Boston, MA.,Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA.,Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA; Kelley Adaptive Sports Research Institute, Spaulding Rehabilitation Network, Boston, MA; Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Boston, MA
| |
Collapse
|
21
|
Abstract
It is well known that individuals with disabilities, constituting 15% to 20% of the adult population, experience a disproportionate risk of cardiometabolic disease and are more likely to live sedentary lifestyles when compared with their able-bodied peers. Although many complex factors likely lead to these disparities, targeted exercise programs can be influential in improving the health outcomes of this population. Additionally, it is important to keep several factors in mind when tailoring the exercise prescription for individuals with varied types of disability, given unique factors related to medical history, mobility, and community barriers. By safely engaging individuals with disabilities in exercise programs, clinicians can promote inclusion while making a significant contribution to health outcomes, ensuring that the principles of "Exercise is Medicine" are accessible to individuals of all abilities.
Collapse
Affiliation(s)
- Hector Luis Osoria
- 1Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, 2 Brigham and Women's Hospital, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA, and 3Kelley Adaptive Sports Research Institute, Harvard Medical School, Spaulding Rehabilitation Hospital, Charlestown, MA
| | | |
Collapse
|
22
|
Webborn N, Blauwet CA, Derman W, Idrisova G, Lexell J, Stomphorst J, Tuakli-Wosornu YA, Kissick J. Heads up on concussion in para sport. Br J Sports Med 2017; 52:1157-1158. [DOI: 10.1136/bjsports-2016-097236] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/15/2017] [Indexed: 11/04/2022]
|
23
|
Silver JK, Slocum CS, Bank AM, Bhatnagar S, Blauwet CA, Poorman JA, Villablanca A, Parangi S. Where Are the Women? The Underrepresentation of Women Physicians Among Recognition Award Recipients From Medical Specialty Societies. PM R 2017; 9:804-815. [DOI: 10.1016/j.pmrj.2017.06.001] [Citation(s) in RCA: 119] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 06/02/2017] [Indexed: 10/19/2022]
|
24
|
Blauwet CA, Brook EM, Tenforde AS, Broad E, Matzkin EG. An Analysis of Female Athlete Triad Components in Elite Para-Athletes. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518866.94630.39] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
25
|
Blauwet CA, Brook EM, Tenforde AS, Broad E, Matzkin EG. An Analysis of Female Athlete Triad Components in Elite Para-Athletes. Med Sci Sports Exerc 2017. [DOI: 10.1249/01.mss.0000518757.93120.e4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
26
|
Cruz S, Blauwet CA. Implications of altered autonomic control on sports performance in athletes with spinal cord injury. Auton Neurosci 2017; 209:100-104. [PMID: 28457670 DOI: 10.1016/j.autneu.2017.03.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2016] [Revised: 03/25/2017] [Accepted: 03/31/2017] [Indexed: 11/26/2022]
Abstract
It is well known that athletes with spinal cord injury (SCI) may experience altered autonomic physiology that impacts their exercise capacity and sports performance. This is particularly relevant given the ever-increasing number of individuals with SCI who are actively engaged in sports at all levels, from community-based adaptive sports to elite Paralympic competitions. As such, the purpose of this article is to review the present literature regarding the implications of altered autonomic control on the safety and performance of athletes with SCI. A particular emphasis will be placed on the autonomic aspects of cardiovascular and thermoregulatory control in the athlete population, as well as the implications of autonomic dysreflexia in enhancing sports performance. Further research is needed to understand the autonomic factors that influence athletes with SCI in order to ensure optimal and safe sports competition. Additionally, this information is crucially relevant to the coaches, sports administrators, and team medical staff who work closely with athletes with SCI.
Collapse
Affiliation(s)
- Sebastian Cruz
- University of Chicago Pritzker School of Medicine, Chicago, IL, USA
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, MA, USA; Spaulding Rehabilitation Hospital/Brigham and Women's Hospital, Boston, MA, USA.
| |
Collapse
|
27
|
Blauwet CA, Yang HY, Cruz SA, Collins JE, Smith KC, Losina E, Katz JN. Functional and Environmental Factors Are Associated With Sustained Participation in Adaptive Sports. PM R 2016; 9:668-675. [PMID: 27810582 DOI: 10.1016/j.pmrj.2016.10.015] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2016] [Revised: 10/16/2016] [Accepted: 10/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Although community-based adaptive sports have become a popular means of rehabilitation for individuals with disabilities, little is known regarding the factors that lead to sustained participation. OBJECTIVE To determine the demographic, environmental, disability-related, and functional factors associated with sustained participation in a community-based adaptive sports program. DESIGN Retrospective cohort study. SETTING Community-based adaptive sports program. PARTICIPANTS Adults with mobility-related disabilities. METHODS Data were collected from registration forms and participation logs. Participants were described as "sustainers" if they attended ≥2 sessions, or as "nonsustainers" if they attended 0 or 1 session. We examined the associations between sustained participation and demographic, environmental, disability-related, and functional factors in bivariate and multivariable analyses. MAIN OUTCOME MEASUREMENT Sustained participation in the adaptive sports program. RESULTS Of the 134 participants, 78 (58%) were sustainers and 56 (42%) were nonsustainers. In multivariable analyses, participants who ambulated independently had lower odds of being sustainers (odds ratio [OR] = 0.33, 95% confidence interval [CI] = 0.11, 0.96), and those who used an ambulatory assistive device had twice the odds of being sustainers (OR = 2.0, 95% CI = 0.65, 6.2) compared to those who used a manual wheelchair. Moreover, participants who lived within 5.3 miles of the program site (OR = 3.8, 95% CI = 1.1, 13.0) and those who lived between 5.3 and 24.4 miles from the program site (OR = 2.8, 95% CI = 1.0, 7.7) had significantly higher odds of sustained participation than those who lived more than 24.4 miles from the program site. CONCLUSION Sustained participation in community-based adaptive sports is associated with living closer to the program site and the presence of a moderate level of functional impairment. These findings suggest that programs might consider increasing the number of satellite sites and expanding offerings for individuals with mild or more significant mobility-related disabilities to effectively increase program participation. LEVEL OF EVIDENCE II.
Collapse
Affiliation(s)
- Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Spaulding Rehabilitation Hospital and the Brigham and Women's Hospital, 300 First Ave, Charlestown, MA 02129(∗).
| | - Heidi Y Yang
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA(†)
| | | | - Jamie E Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA(§)
| | - Karen C Smith
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA(‖)
| | - Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA(¶)
| | - Jeff N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Department of Orthopedic Surgery, Brigham and Women's Hospital, Boston, MA; Harvard Medical School, Boston, MA; Division of Rheumatology, Immunology and Allergy, Brigham and Women's Hospital, MA(#)
| |
Collapse
|
28
|
Babu AN, Blauwet CA. Knee Injuries and Conditions. Sports Med 2016. [DOI: 10.1891/9781617052644.0025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
29
|
Blauwet CA, Cushman D, Emery C, Willick SE, Webborn N, Derman W, Schwellnus M, Stomphorst J, Van de Vliet P. Risk of Injuries in Paralympic Track and Field Differs by Impairment and Event Discipline: A Prospective Cohort Study at the London 2012 Paralympic Games. Am J Sports Med 2016; 44:1455-62. [PMID: 26920432 DOI: 10.1177/0363546516629949] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The incidence rates (IRs) and factors associated with injuries in the sport of Paralympic athletics (track and field) have not been comprehensively and prospectively studied. PURPOSE To determine injury IRs, characteristics of injuries, and associated factors in the sport of athletics at the London 2012 Paralympic Games. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS A total of 977 athletes competing in the sport of athletics were followed over a total 10-day competition period of the Paralympic Games. Daily injury data were obtained via 2 databases: (1) a custom-built, web-based injury and illness surveillance system (WEB-IISS), maintained by team medical personnel; and (2) the organizing committee database, maintained by medical providers in the medical stations operated by the London Organising Committee of the Olympic and Paralympic Games. Athlete impairment and event discipline were obtained via the International Paralympic Committee athlete database. IRs (injuries per 1000 athlete-days) by impairment, event discipline, sex, and age were examined. RESULTS The overall IR was 22.1 injuries per 1000 athlete-days (95% CI, 19.5-24.7). In track disciplines, ambulant athletes with cerebral palsy experienced a lower incidence of injuries (IR, 10.2; 95% CI, 4.2-16.2) when compared with ambulant athletes from other impairment categories. Athletes in seated throwing experienced a higher incidence of injuries (IR, 23.7; 95% CI, 17.5-30.0) when compared with athletes in wheelchair racing (IR, 10.6; 95% CI, 5.5-15.6). In both track and field disciplines, the majority of injuries did not result in time loss from competition or training. Ambulant athletes experienced the greatest proportion of injuries to the thigh (16.4% of all injuries; IR, 4.0), observed predominantly in track athletes. Wheelchair or seated athletes experienced the greatest proportion of injuries to the shoulder/clavicle (19.3% of all injuries; IR, 3.4), observed predominantly in field athletes. CONCLUSION This is the first prospective cohort study examining injury IRs and associated factors in the sport of athletics at the Paralympic Games. Injury patterns were specific to the event discipline and athlete impairment. The majority of injuries occurred to the thigh (ambulant athletes) or shoulder/clavicle (wheelchair or seated athletes) and did not result in time loss.
Collapse
Affiliation(s)
- Cheri A Blauwet
- Medical Committee, International Paralympic Committee, Bonn, Germany Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - Daniel Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Carolyn Emery
- Sport Injury Prevention Research Centre, Faculty of Kinesiology, University of Calgary, Calgary, Canada International Olympic Committee Research Centre, Calgary, Canada
| | - Stuart E Willick
- Division of Physical Medicine & Rehabilitation, University of Utah, Salt Lake City, Utah, USA
| | - Nick Webborn
- Medical Committee, International Paralympic Committee, Bonn, Germany Centre for Sport and Exercise Science and Medicine, University of Brighton, Eastbourne, UK
| | - Wayne Derman
- Medical Committee, International Paralympic Committee, Bonn, Germany Institute for Sport and Exercise Medicine, Division of Orthopaedics, Stellenbosch University, Stellenbosch, South Africa International Olympic Committee Research Centre, Cape Town, South Africa
| | - Martin Schwellnus
- International Olympic Committee Research Centre, Cape Town, South Africa Institute for Sport, Exercise Medicine and Lifestyle Research, Department of Orthopaedics, University of Pretoria, Pretoria, South Africa Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - Jaap Stomphorst
- Medical Committee, International Paralympic Committee, Bonn, Germany Sports Medicine Department, Isala Klinieken, Zwolle, the Netherlands
| | - Peter Van de Vliet
- Medical and Scientific Department, International Paralympic Committee, Bonn, Germany
| |
Collapse
|
30
|
Webborn N, Cushman D, Blauwet CA, Emery C, Derman W, Schwellnus M, Stomphorst J, Van de Vliet P, Willick SE. The Epidemiology of Injuries in Football at the London 2012 Paralympic Games. PM R 2016; 8:545-52. [DOI: 10.1016/j.pmrj.2015.09.025] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2015] [Revised: 09/23/2015] [Accepted: 09/27/2015] [Indexed: 11/17/2022]
|
31
|
Willick SE, Cushman DM, Blauwet CA, Emery C, Webborn N, Derman W, Schwellnus M, Stomphorst J, Van de Vliet P. The epidemiology of injuries in powerlifting at the London 2012 Paralympic Games: An analysis of 1411 athlete-days. Scand J Med Sci Sports 2015; 26:1233-8. [PMID: 26453890 DOI: 10.1111/sms.12554] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/17/2015] [Indexed: 11/26/2022]
Abstract
Sport injury epidemiology has received increased recognition as a field of sport medicine research that can improve the health and safety of athletes. Injuries among Paralympic powerlifters have not previously been systematically studied. The purpose of this prospective cohort study was to characterize injuries among Paralympic powerlifters. Athletes competing in the sport of powerlifting were followed over the 7-day competition period of the 2012 London Paralympic Games. The main outcome measurements were injury incidence rate (IR; number of injuries per 1000 athlete-days) and injury incidence proportion (IP; injuries per 100 athletes). A total of 38 injuries among 163 powerlifters were documented. The overall IR was 33.3 injuries/1000 athlete-days (95% CI 24.0-42.6) and the overall IP was 23.3 injuries per 100 athletes (95% CI 16.8-29.8). The majority of injuries were chronic overuse injuries (61%). The most commonly injured anatomical region was the shoulder/clavicle (32% of all injuries), followed by the chest (13%) and elbow (13%). The information obtained in this study opens the door for future study into the mechanisms and details of injuries into powerlifters with physical impairments.
Collapse
Affiliation(s)
- S E Willick
- Division of Physical Medicine & Rehabilitation, University of Utah Orthopaedic Center, Salt Lake City, Utah, USA
| | - D M Cushman
- Division of Physical Medicine & Rehabilitation, University of Utah Orthopaedic Center, Salt Lake City, Utah, USA.
| | - C A Blauwet
- Medical Committee, International Paralympic Committee, Bonn, Germany.,Department of Physical Medicine and Rehabilitation, Spaulding Rehabilitation Hospital and Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | - C Emery
- Sport Injury Prevention Research Centre, University of Calgary, Edmonton, Canada.,International Olympic Committee (IOC) Research Centre, Calgary, Canada
| | - N Webborn
- Medical Committee, International Paralympic Committee, Bonn, Germany.,School of Sport and Service Management, University of Brighton, Brighton, UK
| | - W Derman
- Medical Committee, International Paralympic Committee, Bonn, Germany.,Institute for Sport, Exercise Medicine and Lifestyle Research, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa
| | - M Schwellnus
- Institute for Sport, Exercise Medicine and Lifestyle Research, Faculty of Health Sciences, University of Pretoria, Pretoria, South Africa.,International Olympic Committee (IOC) Research Centre, Cape Town, South Africa.,Faculty of Health Sciences, University of Cape Town, Cape Town, South Africa
| | - J Stomphorst
- Medical Committee, International Paralympic Committee, Bonn, Germany.,Sports Medicine Department, Isala Klinieken, Zwolle, The Netherlands
| | - P Van de Vliet
- Health Leisure and Human Performance Research Institute, University of Manitoba, Winnipeg, Canada
| |
Collapse
|
32
|
Bristo M, Blauwet CA, Frontera W, Tolchin DW, Stein MA, Hoppe KM, Wu SSH, Kirschner KL. The Convention on the Rights of Persons with Disabilities: what is at stake for physiatrists and the patients we serve. PM R 2015; 6:356-62. [PMID: 24766853 DOI: 10.1016/j.pmrj.2014.03.003] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Accepted: 03/06/2014] [Indexed: 11/18/2022]
Affiliation(s)
- Marca Bristo
- Access Living, Chicago, IL, United States International Council on Disabilities, Washington, DC(∗)
| | - Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Rehabilitation Institute of Chicago-Northwestern University Feinberg School of Medicine, Chicago, IL(†)
| | - Walter Frontera
- Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, TN(‡)
| | | | - Michael Ashley Stein
- Harvard Law School Project on Disability, Harvard Law School, Cambridge, MA; and William and Mary Law School, Williamsburg, VA(‖)
| | - Kurtis M Hoppe
- Physical Medicine and Rehabilitation, Mayo Clinic College of Medicine(¶)
| | - Sam S H Wu
- Department of Physical Medicine and Rehabilitation, Geisinger Health System, Danville, PA; Department of Physical Medicine and Rehabilitation, Rutgers-New Jersey Medical School, Newark, NJ; and Department of Physical Medicine and Rehabilitation, Rutgers-Robert Wood Johnson Medical School, New Brunswick, NJ(#)
| | - Kristi L Kirschner
- Medical Humanities and Bioethics, and Physical Medicine and Rehabilitation, Northwestern University Feinberg School of Medicine, Schwab Rehabilitation Hospital, Chicago, IL(∗∗).
| |
Collapse
|
33
|
Blauwet CA, Rho ME. Shoulder Injury - Paratriathlon. Med Sci Sports Exerc 2014. [DOI: 10.1249/01.mss.0000495290.01994.42] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
|
34
|
Blauwet CA, Benjamin-Laing H, Stomphorst J, Van de Vliet P, Pit-Grosheide P, Willick SE. Testing for boosting at the Paralympic games: policies, results and future directions. Br J Sports Med 2013; 47:832-7. [PMID: 23681503 DOI: 10.1136/bjsports-2012-092103] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND 'Boosting' is defined as the intentional induction of autonomic dysreflexia (AD) by athletes with a spinal cord injury (SCI) at or above the level of T6 for the purpose of improving sports performance. Boosting has been shown to confer up to a 9.7% improvement in race time. Additionally, to compete in a hazardous dysreflexic state, whether intentional or unintentional, would present an extreme health risk to the athlete. For these reasons, the International Paralympic Committee strictly bans the practice of boosting, and has developed a protocol to test for its presence. METHODS Testing was performed at three major international Paralympic events. Education regarding the dangers of AD was provided to athletes and team staff. Testing was conducted on athletes from the relevant sport classes: Athletics (wheelchair racing classes T51/T52/T53) and Handcycling (H1). Key parameters included the athlete's demographics (gender, country of origin), classification and blood pressure measurements. An extremely elevated blood pressure was considered to be a proxy maker for AD, and a systolic blood pressure of ≥180 mm Hg was considered a positive test. RESULTS A total of 78 tests for the presence of AD were performed during the three games combined. No athlete tested positive. The number of athletes tested, by classification, was: 6 in Athletics T51, 47 in Athletics T52, 9 in Athletics T53 and 16 in Handcycling H1. Of those tested, the average systolic and diastolic blood pressures were 135 mm Hg (range 98-178) and 82 mm Hg (range 44-112), respectively. All athletes were compliant with testing. No athletes were withdrawn from competition due to the presence of AD. DISCUSSION Testing for the presence of AD in paralympic athletes with SCI prior to competition has been carried out for the first time at three major international paralympic competitions. There have been no positive tests thus far. Knowledge gained during these early testing experiences will be used to guide ongoing refinement of the testing protocol and the development of further educational initiatives.
Collapse
Affiliation(s)
- Cheri A Blauwet
- Department of Physical Medicine and Rehabilitation, Harvard Medical School, Boston, Massachusetts 02118, USA.
| | | | | | | | | | | |
Collapse
|
35
|
Derman W, Schwellnus M, Jordaan E, Blauwet CA, Emery C, Pit-Grosheide P, Marques NAP, Martinez-Ferrer O, Stomphorst J, Van de Vliet P, Webborn N, Willick SE. Illness and injury in athletes during the competition period at the London 2012 Paralympic Games: development and implementation of a web-based surveillance system (WEB-IISS) for team medical staff. Br J Sports Med 2013; 47:420-5. [DOI: 10.1136/bjsports-2013-092375] [Citation(s) in RCA: 94] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
36
|
Schwellnus M, Derman W, Jordaan E, Blauwet CA, Emery C, Pit-Grosheide P, Patino Marques NA, Martinez-Ferrer O, Stomphorst J, Van de Vliet P, Webborn N, Willick SE. Factors associated with illness in athletes participating in the London 2012 Paralympic Games: a prospective cohort study involving 49,910 athlete-days. Br J Sports Med 2013; 47:433-40. [PMID: 23525473 DOI: 10.1136/bjsports-2013-092371] [Citation(s) in RCA: 46] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
BACKGROUND The incidence and factors associated with illness in Paralympic athletes have not been documented. AIM To determine the factors associated with illness in athletes participating in the London 2012 Paralympic Games. METHODS A cohort of 3565 athletes from 160 of the 164 participating countries in the London 2012 Paralympic Games were followed over a 14-day period (precompetition period=3 days, competition period=11 days; 49 910 athlete-days). Daily illness data were obtained from (1) teams with their own medical support who completed a daily illness log (78 teams, 3329 athletes) on a novel web-based system and (2) teams without their own medical support through the local organising committee database (82 teams, 236 athletes). Illness information from all athletes included age, gender, type of sport and the main system affected. MAIN OUTCOME MEASUREMENT Incidence rate (IR) of illness (illness per 1000 athlete-days) and factors associated with IR (time period, gender, age and sport). RESULTS The IR of illness was 13.2 (95% CI 12.2 to 14.2). The highest IR of illness was in the respiratory system, followed by the skin, digestive, nervous and genitourinary systems. The IR in the precompetition period was similar to that in the competition period, but the IR was significantly higher in athletics compared with other sports. Age and gender were not independent predictors of illness. CONCLUSIONS Illness is common in Paralympic athletes and the main factor associated with higher IR of illness was the type of sport (athletics).
Collapse
Affiliation(s)
- Martin Schwellnus
- UCT/MRC Research Unit for Exercise Science and Sports Medicine, Department of Human Biology, University of Cape Town, Cape Town, South Africa.
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
37
|
Willick SE, Webborn N, Emery C, Blauwet CA, Pit-Grosheide P, Stomphorst J, Van de Vliet P, Patino Marques NA, Martinez-Ferrer JO, Jordaan E, Derman W, Schwellnus M. The epidemiology of injuries at the London 2012 Paralympic Games. Br J Sports Med 2013; 47:426-32. [DOI: 10.1136/bjsports-2013-092374] [Citation(s) in RCA: 126] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|