Abstract Background Plantar fasciitis (PF) is a common cause of heel pain that significantly affects daily activities. Although custom foot orthoses (CFOs) are widely used to treat this condition, there is limited evidence comparing different orthotic designs and their effects on balance parameters. Objective To investigate the effects of different types of CFOs on pain and static and dynamic balance in individuals with PF. Design Randomized controlled trial. Patients 120 participants with PF (age 44.3 ± 10.1 years; 72.5% female; body mass index 26.5 ± 4.9 kg/m 2 ). Interventions All participants were randomly allocated to receive either CFOs without wedge (control group), CFOs with orthotic wedge type 1 (W1), or CFOs with orthotic wedge type 2 (W2), all of which were prescribed for daily weight‐bearing activities. Main Outcome Measures Pain intensity, dynamic balance from the Y Balance Test, and static balance were assessed at baseline, 3‐month, and 6‐month follow‐up. Static balance parameters were measured using a force platform under four conditions: eyes closed on firm surface (ECFS), eyes closed on soft surface (ECSS), eyes open on firm surface (EOFS), and eyes open on soft surface (EOSS). Results All three interventions significantly reduced pain and improved dynamic balance over the 6‐month period ( p < .01). The CFO group showed significantly better static balance in center of mass sway during ECFS ( p < .01), ECSS (95% confidence ellipse area; p = .042), and EOSS ( p < .05) compared to both the W1 and W2 groups. Conclusion Although all three interventions effectively reduced pain and improved dynamic balance. The CFOs without wedge demonstrated greater improvements in static balance parameters under the more challenging conditions (eyes closed and/or soft surface) compared to wedged designs. These findings suggest that basic CFOs may be sufficient for managing pain in PF; however, if balance is a concern, then the selection of specific orthotic designs may be warranted.
Objective To introduce the ExerciseRxTM digital health platform as a scalable approach to support personalized physical activity (PA) and home exercise as part of clinical care.Design Narrative review of Physical Activity Vital Sign (PAVS) integration within an academic healthcare system as well as description and ongoing research on a digital health platform to support physical activity as part of patient care.Setting Outpatient clinics within an academic medical center.Participants Patients across multiple populations, including individuals with limb loss, multiple sclerosis, and primary care cohorts, as well as participants in pediatric rehabilitation, oncology, and rheumatology clinics.Interventions Integration of two standardized PAVS questions into the electronic health record and development of the ExerciseRx digital health platform incorporating smartphone and wearable step count tracking, personalized activity goals, and AI/ML home exercise sensing innovations.Main Outcome Measures Self-reported PA levels, associations with demographic and clinical factors, healthcare utilization, and feasibility and usability of the digital health platform.Results PAVS assessment implementation demonstrated that a majority of patients across multiple clinic populations did not meet PA recommendations and highlighted demographic and clinical differences in activity levels. Higher self-reported PA was associated with lower healthcare utilization while controlling for confounding factors. Preliminary findings involving the ExerciseRx platform showed feasibility, high usability, and increased PA engagement, while enabling providers to monitor patient progress with actionable data.Conclusions Routine assessment of PA through PAVS, combined with digital health tools such as the ExerciseRx platform, may help identify insufficiently active patients and support personalized, home-based exercise at scale. This approach aligns with priorities in lifestyle medicine and population health, with further research needed on clinical integration at scale.
Background Ultrasound (US)-guided hydrodissection is a minimally invasive treatment for cubital tunnel syndrome (CuTS) with promising early results. However, data on patient-perceived outcomes, durability of relief, and impact on surgical need remain limited. Objective To assess the effectiveness of US-guided cubital tunnel hydrodissection in improving CuTS symptoms via patient-centered outcomes. Design Retrospective chart review with cross-sectional telephone follow-up. Setting Quaternary medical center multidisciplinary outpatient hand clinic. Participants Seventeen patients (19 arms) with clinical CuTS who received US-guided hydrodissection from one physician. Interventions Patients were contacted by telephone for cross-sectional outcome assessment. Main Outcome Measures Patient-reported improvements in weakness, paresthesias, and/or pain, percent pain relief, symptom improvement duration, adverse events, and Patient Global Impression of Change (PGIC) scores. Results At mean 7 +/- 5 month follow-up, improvement in weakness, paresthesia, and pain was reported in 12 (63%) extremities (95% confidence interval [CI] 41%-85%; p < .001) . Pain relief >= 50% occurred in 12 (63%) and >= 75% in 8 (42%) extremities, with mean duration 4 months. PGIC scores showed 14 (74%; 95% CI 54%-94%; p < .001) at least "minimally improved" and 8 (42%) (95% CI 20%-64%; p < .001) "much improved." No adverse events occurred. Two patients without improvement underwent surgical decompression with anterior transposition at 1 and 3 months after hydrodissection, achieving 90%-100% pain relief and "much or very much improved" PGIC scores. Of 19 extremities, 7 (37%) were McGowan Grade I and 12 (63%) Grade II; none were Grade III. Grade II extremities showed significantly greater overall symptom relief (p = .004) and pain relief >= 50% (p = .004). PGIC scores did not differ significantly between grades (both p > .062). Conclusion US-guided cubital tunnel hydrodissection was associated with meaningful symptom improvement and no adverse events. Limitations include small sample size, no control group, single operator, and potentially time-limited relief. The procedure appears safe and a potential nonoperative treatment option.
Objective To determine the dose-response relationship of a walking program and compare different delivery methods of walking exercise for patients with chronic low back pain (CLBP).Methods A systematic search of PubMed/MEDLINE, Web of Science, Scopus, Embase, and the Cochrane Library was conducted from inception to October 21, 2024. We included randomized controlled trials (RCTs) of walking programs without other exercise cointerventions in people with CLBP. Outcome measures were pain intensity and disability. The dose-response relationship was assessed using a restricted cubic spline model.Results Thirteen RCTs were included. The meta-analysis showed a statistically significant reduction in pain intensity (standardized mean difference [SMD]: -0.59, 95% confidence interval [CI]: -0.95 to -0.24) and disability (SMD: -0.69, 95% CI: -1.14 to -0.23) with low and moderate certainty of evidence, respectively. The spline model showed a U-shaped association between total minutes of walking programs and reduction in pain intensity and disability. The largest effect for pain reduction was obtained at a total duration of 1000 minutes (SMD: -0.67, 95% CI: -0.76 to -0.59) distributed over a mean of 8 weeks, whereas for disability, the largest effect was found with a total of 900 minutes (SMD: -0.61, 95% CI: -0.69 to -0.53). Subgroup analysis showed larger effect sizes when walking exercise was performed outdoors and when motivational support was considered; however, no significant differences between subgroups were found.Conclusion Accruing 1000 minutes of walking over 8 weeks is associated with the largest reduction in back pain, while 900 minutes is associated with the largest reduction in disability. These findings may be valuable in optimizing walking programs for people with CLBP.
Abstract Background Post‐acute care (PAC) plays an increasingly critical role in the health care system due to an aging population, shorter hospital stays, and the complex needs of patients. However, studies show that medical students often lack essential knowledge of PAC options, which may compromise safe care transitions. In the United States, medical education provides limited training on PAC and the rehabilitation requirements associated with these settings. Objective To assess fourth‐year medical students' knowledge of and confidence in PAC options following a targeted educational program delivered within a physical medicine and rehabilitation (PM&R) clerkship. Design Pre‐ and postintervention surveys. Setting A single institution U.S. allopathic medical school. Participants Fourth‐year medical students enrolled in the mandatory PM&R clerkship between January and May 2025. Of 104 eligible students, 53 completed both surveys and were included in the analysis. Intervention The mandatory 2‐week PM&R clerkship included a didactic lecture that (1) reviewed admission and rehabilitation eligibility criteria for each PAC setting based on Centers for Medicare and Medicaid Services guidelines; (2) highlighted differences in physician oversight, nursing care, and average length of stay; and (3) applied concepts through patient case scenarios. Main Outcome Measures The change from medical students' baseline to postclerkship knowledge of and confidence in PAC options. Results Students showed statistically significant improvements in both knowledge of PAC eligibility criteria ( p < .001) and self‐reported confidence in PAC discharge planning ( p < .001). Conclusions A structured educational module on PAC in addition to clinical experiences in a mandatory PM&R clerkship was associated with improved medical students' knowledge and confidence in PAC discharge planning. These findings support incorporating PAC education into medical school curricula, particularly within PM&R rotations, to better prepare future physicians for the complexities of care transitions.
