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41. Patellofemoral Pain

- toms can recur and can persist for years. 74 Patients with PFP symptoms frequently present to health care professionals for diagnosis and treatment. 74,277 This CPG will allow physical therapists and other rehabilitation specialists to stay up to date with evolving PFP knowledge and practices, and help them to make evidence-based treatment decisions. 166 Content experts were appointed by the Academy of Ortho- paedic Physical Therapy, APTA, Inc to conduct a review of the literature and to develop (...) evidence A preponderance of evidence from animal or cadaver studies, from conceptual models/ principles, or from basic science/bench research supports this recommendation F Expert opinion Best practice based on the clinical experi- ence of the guidelines development team supports this recommendation DESCRIPTION OF GUIDELINE VALIDATION Identified reviewers who are experts in PFP management and rehabilitation reviewed this CPG content and methods for in- tegrity and accuracy and to ensure that they fully

2019 The Orthopaedic Section of the American Physical Therapy Association (APTA), Inc.

42. Child Abuse, Elder Abuse, and Intimate Partner Violence

by the application of tests, examinations, history or other procedures which can be applied rapidly.” 1 A positive screen identifies patients with higher probability of abuse that require additional testing or evaluation. However, screening does not lead to a diagnosis of abuse, and an initial negative screen does not “rule out” abuse. Screening must occur across the trauma/emergency care continuum (emergency department [ED], intensive care unit [ICU], medical-surgical units, and rehabilitation

2019 American College of Surgeons

43. The Utility and Practice of Electrodiagnostic Testing in the Pediatric Population: An AANEM Consensus Statement

, University of Florida College of Medicine, Gainesville, Florida 3 Department of Pediatrics, University of Ottawa and Children’s Hospital of Eastern Ontario, Ottawa, Ontario, Canada 4 Department of Pediatrics, Northwestern University Feinberg School of Medicine and Lurie Children’s Hospital, Chicago, Illinois 5 National Institute of Neurological Disorders and Stroke, Bethesda, Maryland 6 Functional and Applied Biomechanics Section, Rehabilitation Medicine, National Institutes of Health Clinical Center (...) , Bethesda, Maryland 7 Inova Neuroscience and Spine Institute, Inova Fairfax Hospital, Falls Church, Virginia 8 Centre de Référence Maladies Neuromusculaires, Service de Neurologie, Réanimation et RéeducationPédiatriques, Hôpital Raymond Poincaré, Garches, France Correspondence to: American Association of Neuromuscular &Electrodiagnostic Medicine (AANEM) 2621 Superior Drive NW Rochester, MN 55901 Email: This article is protected by copyright. All rights reserved.Pediatric EDX Statement

2019 American Association of Neuromuscular & Electrodiagnostic Medicine

44. Assessing Fitness to Drive

of Rehabilitation Medicinevi Assessing Fitness to Drive 2016 Acknowledgements Setting these standards involved extensive consultation across a wide range of stakeholders including regulators, employers and health professionals. The NTC and Austroads gratefully acknowledge all contributors including the members of the Maintenance Advisory Group and various working groups, and the project team and consultants. In particular, the contributions of various health professional organisations and individual health (...) conditions, progressive disorders and undifferentiated illness - the effects of prescription and over-the-counter drugs - the role of practical driver assessments and driver rehabilitation • the roles and responsibilities of drivers, licensing authorities and health professionals • what standards to apply (private or commercial) for particular driver classes • the application of conditional licences, and • the steps involved in assessing fitness to drive. Part B comprises a series of chapters relating

2016 Cardiac Society of Australia and New Zealand

45. Supporting Adults Who Anticipate or Live with an Ostomy

, and policy across a range of health service organizations, practice areas, and sectors. These experts shared their insights on supporting and caring for adults who anticipate or live with an ostomy across the continuum of care (e.g., acute care, rehabilitation, community, and primary care). A systematic and comprehensive analysis was completed by the RNAO Best Practice Guideline Development and Research Team and the RNAO expert panel to determine the scope of this BPG and to prioritize recommendation (...) settings where adults who anticipate or live with an ostomy are accessing services (such as, but not limited to, acute care, long-term care, community settings, and rehabilitation settings). In this BPG, no recommendation questions were identified that addressed the core education and training strategies required for curricula, ongoing education, and professional development of nurses or the interprofessional team in order to support adults living with or anticipating an ostomy. Please refer

2019 Registered Nurses' Association of Ontario

46. Benign paroxysmal positional vertigo

with regular Brandt-Daroff exercises. Despite their comparative efficacy with the Epley manoeuvre, Brandt–Daroff exercises are unlikely to do harm and can be done at home by the patient, so they are recommended on the basis of expert opinion from previous reviewers of the CKS topic on . It has also been noted that vestibular rehabilitation such as Brandt Daroff exercises may have a role in people who have persistent symptoms following repositioning manoeuvres; are unable to undergo repositioning manoeuvres (...) because of physical comorbidities such as cervical or thoracic spine disease; or refuse to undergo them [ ; ; ]. Symptomatic drug treatment A US guideline on the management of BPPV recommends, based on evidence in observational studies, that vestibular suppressant drugs are not a suitable routine treatment for BPPV or a substitute for repositioning manoeuvres. Those studies that showed improvement with medication were carried out over the same period that spontaneous resolution would be expected

2017 NICE Clinical Knowledge Summaries

47. Vestibular neuronitis

neuronitis from a central lesion. Hearing and otoscopy are normal on examination. Vestibular neuronitis is a clinical diagnosis — a careful history and examination are all that is usually required. Investigations are not usually necessary, unless another cause of vertigo is suspected. For more information, see the CKS topic on . Head impulse test Head impulse test Use caution if the person has neck pathology (for example cervical spine disease), as the head impulse test involves rapid repositioning (...) or consideration of vestibular rehabilitation, (involving exercises to promote central nervous system compensation) if: Symptoms are not typical of vestibular neuronitis (for example additional neurological symptoms). Symptoms persist without improvement for more than 1 week despite treatment (urgently refer). Symptoms persist for longer than 6 weeks — investigation to exclude other causes, or vestibular rehabilitation may be required. Basis for recommendation Basis for recommendation Admission to hospital

2017 NICE Clinical Knowledge Summaries

48. Management of Osteoporosis in Survivors of Adult Cancers With Nonmetastatic Disease

hormone (GnRH) agonists or chemotherapy-induced ovarian failure [CIOF]) and long-term cancer survivors. Target Audience Oncologists, endocrinologists, specialists in rehabilitation, orthopedics, primary care physicians, and any other relevant member of a comprehensive multidisciplinary cancer care team, as well as patients and their caregivers. Methods An Expert Panel was convened to develop clinical practice guideline recommendations based on a systematic review of the medical literature (...) , flexibility or stretching exercises, endurance exercise, and resistance and/or progressive strengthening exercises, to reduce the risk of fractures caused by falls. Whenever possible, exercise should be tailored according to the needs and abilities of the individual patient. Patients with an impairment hindering their gait or balance should be offered medical rehabilitation (Type: evidence based, benefits outweigh harms; Evidence quality: low; Strength of recommendation: moderate). Recommendation 3.3

2019 American Society of Clinical Oncology Guidelines

49. Sprains and strains

. CKS has not recommended referral of all muscle strains, because conservative management will result in a good outcome in most cases [ ]. However, the expert opinion of previous reviewers of this CKS topic is that appropriate rehabilitation reduces the likelihood of a further strain and/or residual symptoms, so referral to physiotherapy may be justified. Prevention of further strains and sprains What should I advise on preventing further strains and sprains? Advise that the person should: Take care

2016 NICE Clinical Knowledge Summaries

50. Multiple sclerosis

damage caused by MS lesions. The most frequent manifestations include dysesthetic extremity pain, painful tonic spasms, Lhermitte's sign (a shock like sensation radiating down the spine induced by neck flexion), trigeminal neuralgia, headaches, and low back pain [ ; ]. Musculoskeletal pain is usually secondary to problems with mobility and posture [ ]. Bladder problems: lower urinary tract dysfunction is common in people with MS, and can have a considerable impact on quality of life [ ]. One survey (...) describe a tight band sensation around the trunk at the level of the inflammation, or a shock like sensation radiating down the spine induced by neck flexion (Lhermitte’s phenomena). There may be urinary symptoms such as urgency, frequency, or retention. Examination may reveal focal muscle weakness and reduced sensation below the affected spinal level. Muscle tone is initially reduced. Symptoms and signs may be symmetrical or asymmetrical, and tend to reflect a partial myelitis that only affects a part

2018 NICE Clinical Knowledge Summaries

51. Knee Pain and Mobility Impairments: Meniscal and Articular Cartilage Lesions

return to activity depending on the type of articular cartilage surgery. Interventions — Supervised Rehabilitation 2018 Recommendation Clinicians should use exercises as part of the in-clinic supervised rehabilitation program after arthroscopic meniscectomy and should provide and supervise the progression of a home-based exercise program, providing education to ensure independent performance. Interventions — Therapeutic Exercises 2018 Recommendation Clinicians should provide supervised, progressive (...) . The authors of this guideline revision worked with the CPG Editors and medical librarians for methodological guidance. The research librarians were chosen for their expertise in systematic review rehabilitation literature search, and to perform systematic searches for concepts associated with meniscus and articular cartilage injuries of the knee in articles published from 2008 related to classification, examination, and intervention strategies consistent with previous guideline development methods related

2018 American Physical Therapy Association

52. Assessment and Management of Pressure Injuries for the Interprofessional Team, Third Edition

to the resources listed in Appendix D. Th is Guideline is designed to help interprofessional teams become more comfortable, confi dent, and competent when caring for people with existing pressure injuries. It is intended for use in all domains of health care (including clinical, administration, and education) across health-care settings (including acute care, rehabilitation, long-term care, out-patient clinics, community care, and home care). It focuses on the core competencies and the evidence-based (...) Rebecca Macaal, BScN Registered Nurse Rouge Valley Health System Toronto, Ontario Anne MacLaurin, RN, BScN Patient Safety Improvement Lead Canadian Patient Safety Institute Miscouche, Prince Edward Island Mary Mark, RN, MHS, MCIScWH, CETN(C) Clinical Nurse Specialist Glenrose Rehabilitation Hospital Edmonton, Alberta Lina Martins, RN, BScN, MScN, CETN(C) APN, Clinical Nurse Specialist, CETN(C) London Health Sciences Centre London, Ontario Colleen McGillivray, MD, FRCPC Assistant Professor, Dept

2016 Registered Nurses' Association of Ontario

54. Greater trochanteric pain syndrome (trochanteric bursitis)

pain syndrome frequently occurs together with other conditions [ ; ]: Lumbar spine conditions, such as osteoarthritis, degenerative disc disease, and radiculopathy. Osteoarthritis of the knee, especially on the affected side. Hip osteoarthritis (on the affected or unaffected side). Rheumatoid arthritis. Fibromyalgia. Obesity and leg length discrepancy may be associated with greater trochanteric pain syndrome [ ]. Incidence and prevalence How common is it? Greater trochanteric pain syndrome affects (...) are seldom palpable. Check for such as lumbar spine conditions and arthritis of the hip or knee. Exclude with presentations similar to that of greater trochanteric pain syndrome. Exclude any underlying infection of the bursae. A tender palpable mass, redness, oedema, or warmth around the lateral hip would suggest possible infection. Physical examination Physical examination A number of tests are used to diagnose greater trochanteric pain syndrome. The tests put tension on the muscles and tendons attached

2016 NICE Clinical Knowledge Summaries

55. Head injury

by disorders of the brain and spine. It has a telephone helpline 0808 8081000. Child Brain Injury Trust ( ) which supports children, young people, and families affected by an acquired brain injury. It has a telephone helpline 0845 6014939. Headway — The Brain Injury Association ( ) is a charity which supports people affected by a head injury. It runs a telephone helpline 0808 8002244 and a network of local support groups and offers rehabilitation programmes, carer support, community outreach, and respite (...) (accompanied by a competent adult) to a hospital emergency department should be arranged if there are any of the following risk factors, which may indicate an intracranial complication or cervical spine injury: A Glasgow Coma Scale (GCS) score of less than 15 on initial assessment. Evidence of shock, or other significant injuries. A history of bleeding or coagulation disorders, or current anticoagulant medication. Current alcohol or drug intoxication. Any loss of consciousness after the injury (even

2016 NICE Clinical Knowledge Summaries

56. Impact of Affordable Care Act on Trauma and Emergency General Surgery

— importantoutcome Holzmacher etal.,2017 Retrospectivecohortstudy,Trauma patients from Maryland,WashingtonDC, andVirginiaseenata single LevelItrauma center inWashington, DC Discharge home,% Washington DC89.8%,Virginia 87.5%,Maryland 93.2% Discharge to SAR, SNF, oracute rehabilitation, % Washington DC7.9%,Virginia 12.5%, Maryland6.8% Virginiavs.DC,p=0.75 Marylandvs. DC, p=0.68 Leeetal.,2014 Retrospectivepre-/post-MHRstudy,Trauma patients admitted totheICUfromasingleLevelI trauma centerinMassachusetts (...) Dispositionoutcomes,Propensitymatchedodds ratiowith discharge home as referent (not prepolicy/postpolicy) Homehealth servicesOR1.70(95%CI,1.08–2.68) SNF/Rehabilitation OR0.91 (95%CI,0.72–1.31) Other OR1.15 (95%CI,0.79–1.67) Santryetal., 2014 Retrospectivepre-/post-MHRstudy,Trauma patients froma single LevelI trauma center inMassachusetts Discharge Disposition,AdjustedOR for uninsured vs. insured patients (not prepolicy/postpolicy) HomewithservicesAOR0.64 (95%CI, 0.44–0.93) RehabilitationAOR0.08(95%CI,0.05–0.96

2019 Eastern Association for the Surgery of Trauma

57. Carpal tunnel syndrome

of the carpal ligament (proximal wrist crease) with the thumbs produces or worsens paraesthesia in the distribution of the median nerve. Alternative causes for symptoms such as radiculopathies (especially C6/7), vibration white finger, and osteoarthritis of the metacarpophalangeal joint of the thumb. Examine the cervical spine and carry out a musculoskeletal and neurological examination of the upper limb. Arrange appropriate investigations (such as blood tests or ultrasound scan) if a specific underlying (...) . Royal College of Physicians. . [ ] RCS ( 2013 ) Commissioning guide: Treatment of painful tingling fingers. Royal College of Surgeons . [ ] Wainner, R., Fritz, J., Irrgang, J. and et al. ( 2005 ) Development of a clinical prediction rule for the diagnosis of carpal tunnel syndrome. Archives of Physical Medicine and Rehabilitation. 86 ( 4 ), 609 - 618 . [ ] Washington State Department of Labour and Industries ( 2014 ) Work-Related Carpal Tunnel Syndrome Diagnosis and Treatment Guideline. Washington

2016 NICE Clinical Knowledge Summaries

58. Shoulder pain

, if this is possible within the limits of discomfort (pain between 70–120 degrees of active abduction), and if present, check if there is pain on abduction with the thumb down, worse against resistance. Perform the cross-arm test. This is positive if there is pain over the acromioclavicular joint when the person raises the affected arm to 90 degrees, then actively adducts it. Examine the neck, arms, axillae and chest wall for possible sources of . Assess the range of movement of the cervical spine. Perform (...) a short time off work, for example, one week, if there appears to be a direct link between this and the shoulder pain. Advise rest from activities that worsen the shoulder pain for a few weeks, such as sport, and if relevant, advise 'light duties' at work for a few weeks. Explain that although common shoulder problems tend to be self-limiting, the rehabilitation period can be at least 6 months. Consider reviewing the person in 2 weeks. If symptoms are severe, arrange an earlier review. Advise

2017 NICE Clinical Knowledge Summaries

59. Pelvic Girdle Pain in the Antepartum Population: Physical Therapy Clinical Practice Guidelines Linked to the International Classification of Functioning, Disability, and Health From the Section on Women's Health and the Orthopaedic Section of the American

and Women's Hospital, Boston, Massachusetts David A. Hoyle, PT, DPT, MA, OCS, MTC, CEAS—National Director of Clinical Quality: WorkStrategies, Select Medical, Mechanicsburg, Pennsylvania Zacharia Isaac, MD, Board certified in physical medicine and rehabilitation and pain management Division Chief of Spine Care and Pain Management, Spaulding Rehabilitation Hospital, Charlestown, Massachusetts Associate Chairman, Department of Physical Medicine and Rehabilitation, Brigham and Woman's Hospital, Boston (...) course of PGP, impairments are failing to normalize, and the symptoms are worsening with increased disability. This should include the presence of transient osteoporosis and diastasis rectus abdominis (DRA) as possible comorbidities in this population, as well as the presence of pelvic floor muscle, hip, and lumbar spine dysfunctions. (Recommendations are based on strong evidence.) | Imaging Studies: F In the absence of good evidence, expert opinion and foundation science may be used to guide

2017 American Physical Therapy Association

60. Knee Stability and Movement Coordination Impairments: Knee Ligament Sprain

soft tissue structures, such as those associated with knee extension range-of-motion loss. Interventions – Cryotherapy Clinicians should use cryotherapy immediately after ACL reconstruction to reduce postoperative knee pain. Interventions – Supervised Rehabilitation Clinicians should use exercises as part of the in-clinic supervised rehabilitation program after ACL reconstruction and should provide and supervise the progression of a home-based exercise program, providing education to ensure (...) , including how directly the studies addressed the question on knee stability and movement coordination impairments/knee ligament sprain population. In developing their recommendations, the authors considered the strengths and limitations of the body of evidence and the health benefits, side effects, and risks of tests and interventions. Guideline Review Process and Validation Identified reviewers who are experts in knee ligament injury management and rehabilitation reviewed the content and methods

2017 American Physical Therapy Association


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