BACKGROUND:In 2021, the American Academy of Physical Medicine and Rehabilitation established the Multi-Disciplinary Post-Acute Sequelae of SARS-CoV-2 Infection Collaborative to provide guidance from established Long COVID clinics for the evaluation and management of Long COVID. The collaborative previously published eight Long COVID consensus guidance statements using a primarily symptom-based approach. However, Long COVID symptoms most often do not occur in isolation. AIMS:This compendium aims to equip clinicians with an efficient, up-to-date clinical resource for evaluating and managing adults experiencing Long COVID symptoms. The primary intended audience includes physiatrists, primary care physicians, and other clinicians who provide first-line assessment and management of Long COVID symptoms, especially in settings where subspecialty care is not readily available. This compendium provides a holistic framework for assessment and management, symptom-specific considerations, and updates on prevalence, health equity, disability considerations, pathophysiology, and emerging evidence regarding treatments under investigation. Because Long COVID closely resembles other infection-associated chronic conditions (IACCs) such as myalgic encephalomyelitis/chronic fatigue syndrome, the guidance in this compendium may also be helpful for clinicians managing these related conditions. METHODS:Guidance in this compendium was developed by the collaborative's established modified Delphi approach. The collaborative is a multidisciplinary group whose members include physiatrists, primary care physicians, pulmonologists, cardiologists, psychiatrists, neuropsychologists, neurologists, occupational therapists, physical therapists, speech and language pathologists, patients, and government representatives. Over 40 Long COVID centers are represented in the collaborative. RESULTS:Long COVID is defined by the National Academies of Sciences, Engineering, and Medicine as "an IACC that occurs after SARS-CoV-2 infection and is present for at least 3 months as a continuous, relapsing and remitting, or progressive disease state that affects one or more organ systems." The current global prevalence of Long COVID is estimated to be 6%. Higher prevalence has been identified among female gender, certain racial and ethnic groups, and individuals who live in nonurban areas. However, anyone can develop Long COVID after being infected with the SARS-CoV-2 virus. Long COVID can present as a wide variety of symptom clusters. The most common symptoms include exaggerated fatigue and diminished energy windows, postexertional malaise (PEM)/postexertional symptom exacerbation (PESE), cognitive impairment (brain fog), dysautonomia, pain/myalgias, and smell and taste alterations. Holistic assessment should include a traditional history, physical examination, and additional diagnostic testing, as indicated. A positive COVID-19 test during acute SARS-CoV-2 infection is not required to diagnose Long COVID, and currently, there is no single laboratory finding that is definitively diagnostic for confirming or ruling out the diagnosis of Long COVID. A basic laboratory assessment is recommended for all patients with possible Long COVID, and consideration for additional labs and diagnostic procedures is guided by the patient's specific symptoms. Current management strategies focus on symptom-based supportive care. Critical considerations include energy conservation strategies and addressing comorbidities and modifiable risk factors. Additionally, (1) it is essential to validate the patient's experience and provide reassurance that their symptoms are being taken seriously because many patients have had their symptoms dismissed by loved ones and clinicians; (2) physical activity recommendations must be carefully tailored to the patient's current activity tolerance because overly intense activity can trigger PEM/PESE and worsened muscle damage; and (3) treatment recommendations should be delivered with humility because there are many persistent unknowns related to Long COVID. To date, there are limited data to guide medication management specifically in the context of Long COVID. As such, medication use generally follows standard practice regarding indications and dosing, with extra attention to prioritize (1) patient preference via shared decision-making and (2) cautious use of medications that may improve some symptoms (eg, cognitive/attention impairment) but may worsen other symptoms (eg, PEM/PESE). Numerous clinical trials are investigating additional treatments. The return-to-work process for individuals with Long COVID can be challenging because symptoms can fluctuate, vary in nature, affect multiple functional areas (eg, physical and cognitive), and often manifest as an "invisible disability" that may not be readily acknowledged by employers or coworkers. Clinicians can help patients return to work by identifying suitable workplace accommodations and resources, providing necessary documentation, and recommending occupational or vocational therapy when needed. If these efforts are unsuccessful and work significantly worsens Long COVID symptoms or impedes recovery, applying for disability may be warranted. Long COVID is recognized as a potential disability under the Americans with Disabilities Act. CONCLUSION:To contribute to the overall health and well-being for all patients, Long COVID care should be delivered in a holistic manner that acknowledges challenges faced by the patient and uncertainties in the field. For more detailed information on assessment and management of specific Long COVID symptoms, readers can reference the collaborative's symptom-specific consensus guidance statements.

Background: The annual demand for total knee arthroplasty (TKA) will increase by 182%, from more than 700,000 in 2014 to 1.2M in the year 2030, placing an immense financial and social burden on healthcare systems to control medical costs and quality of care. This study aimed to examine the long-term effect of a home-based, non-surgical biomechanical intervention on surgery incidence amongst patients with moderate-severe knee osteoarthritis (OA). Methods: This is a retrospective registry review done at the Department of Rehabilitation Medicine of Albert Einstein College of Medicine, Montefiore Medical Center. Between September 2015 and December 2018, 95 patients (81% females, mean age 62.6± 8.3 years) diagnosed with primary knee OA were referred to receive a new non-invasive biomechanical foot-worn device after exhausting other non-surgical care. Patients were personally fitted with a non-invasive, biomechanical device, that alters the foot’s pressure points to reduce loads, minimize symptoms, and promote neuromuscular control training using adjustable, convex pods under the sole. Patients used the device for short periods during regular home/work activities. The primary outcome was the occurrence of knee surgery during an average follow-up time of 5.6 years. TKA incidence was compared to that of a reference group of patients with knee OA who were referred to receive traditional physical therapy (PT). Results: Of the patients who were treated with the biomechanical intervention, 12/95 patients (12.6%) had a TKA, compared to 23/67 patients (34.3%) who received traditional PT and had a TKA. Conclusion: The use of the biomechanical intervention was associated with avoiding TKA in more than 87% of patients at five years. Increased use of biomechanical intervention to treat knee OA may help reduce some of the burden on healthcare and society associated with end-stage knee OA by delaying or avoiding surgery.

Background: Aerobic exercise (AE) training has been shown to enhance aerobic fitness in people with schizophrenia. Traditionally, such training has been administered in person at gyms or other communal exercise spaces. However, following the advent of the COVID-19 pandemic, many clinics transitioned their services to telehealth-based delivery. Yet, at present, there is scarce information about the feasibility, safety, and efficacy of telehealth-based AE in this population. Objective: To examine the feasibility, safety, and efficacy of trainer-led, at-home, telehealth-based AE in individuals with schizophrenia. Methods: We analyzed data from the AE arm (n=37) of a single-blind, randomized clinical trial examining the impact of a 12-week AE intervention in people with schizophrenia. Following the onset of the COVID-19 pandemic, the AE trial intervention transitioned from in-person to at-home, telehealth-based delivery of AE, with the training frequency and duration remaining identical. We compared the feasibility, safety, and efficacy of the delivery of trainer-led AE training among participants undergoing in-person (pre-COVID-19; n=23) versus at-home telehealth AE (post-COVID-19; n=14). Results: The telehealth and in-person participants attended a similar number of exercise sessions across the 12-week interventions (26.8, SD 10.2 vs 26.1, SD 9.7, respectively; P=.84) and had similar number of weeks with at least 1 exercise session (10.4, SD 3.4 vs 10.6, SD 3.1, respectively; P=.79). The telehealth-based AE was associated with a significantly lower drop-out rate (telehealth: 0/14, 0%; in-person: 7/23, 30.4%; P=.04). There were no significant group differences in total time spent exercising (telehealth: 1246, SD 686 min; in-person: 1494, SD 580 min; P=.28); however, over the 12-week intervention, the telehealth group had a significantly lower proportion of session-time exercising at or above target intensity (telehealth: 33.3%, SD 21.4%; in-person: 63.5%, SD 16.3%; P<.001). There were no AE-related serious adverse events associated with either AE delivery format. Similarly, there were no significant differences in the percentage of participants experiencing minor or moderate adverse events, such as muscle soreness, joint pain, blisters, or dyspnea (telehealth: 3/14, 21%; in-person: 5/19, 26%; P>.99) or in the percentage of weeks per participant with at least 1 exercise-related adverse event (telehealth: 31%, SD 33%; in-person: 40%, SD 33%; P=.44). There were no significant differences between the telehealth versus in-person groups regarding changes in aerobic fitness as indexed by maximum oxygen consumption (VO(2)max; P=.27). Conclusions: Our findings provide preliminary support for the delivery of telehealth-based AE for individuals with schizophrenia. Our results indicate that in-home telehealth-based AE is feasible and safe in this population, although when available, in-person AE appears preferable given the opportunity for social interactions and the higher intensity of exercises. We discuss the findings' clinical implications, specifically within the context of the COVID-19 pandemic, as well as review potential challenges for the implementation of telehealth-based AE among people with schizophrenia.

Study Design Randomized Controlled Trial. Objective Chronic low back pain (CLBP) is a major public health concern that will continue to grow with the expected aging of the population. The purpose of this study was to examine the clinical effect of a personalized, home-based biomechanical intervention compared to traditional physical therapy in patients with CLBP. Methods This was a randomized controlled trial. One-hundred and sixty-two patients were randomized in a 2:1 ratio to a home-based biomechanical intervention (HBBI, AposHealth) or traditional physical therapy (TPT), respectively. Patients were assessed at baseline and after 12 weeks and 52 weeks. The primary outcome measure was pain at 52 weeks, using a standard Numeric Rating Scale (NRS). Secondary outcomes included pain and function metrics, quality of life and objective spatio-temporal gait test. A Linear Mixed Model assessed changes over time across all study visits. Results A significant reduction in NRS was found after 52 weeks with a superiority effect of the HBBI arm compared to TPT (F = 13.82, P < 0.001). Patients in the HBBI arm demonstrated a marginal mean reduction of 3.5 points, from 6.2 to 2.7 (a 56% reduction), while patients in the TPT arm reported a mean decrease of 1.8 points from 6.9 to 5.1 (a 26% reduction). Conclusions A new foot-worn, home-based, biomechanical intervention for patients with chronic non-specific back pain was found to be clinically effective. Given the lack of non-surgical, non-pharmacological interventions for this populations, this treatment might serve as an adjunct to the current standard of care.

BACKGROUND:There is a lack of integrated treatment for chronic pain and opioid use disorder (OUD). Yoga and physical therapy (PT) may improve pain and physical function of people living with (PLW) chronic low back pain (CLBP) and may also reduce opioid craving and use, but PLW with OUD face barriers to accessing these interventions. We hypothesize that compared to treatment as usual (TAU), providing yoga and PT onsite at opioid treatment programs (OTPs) will be effective at improving pain, opioid use, and quality of life among people with CLBP and OUD, and will be cost-effective. METHODS:In this hybrid type-1 effectiveness-implementation study, we will randomly assign 345 PLW CLBP and OUD from OTPs in the Bronx, NY, to 12 weeks of onsite yoga, onsite PT, or TAU. Primary outcomes are pain intensity, opioid use, and cost-effectiveness. Secondary outcomes include physical function and overall well-being. DISCUSSION:This trial tests an innovative, patient-centered approach to combined management for pain and OUD in real-world settings. We rigorously examine the efficacy of yoga and PT onsite at OTPs as nonpharmacologic, cost-effective treatments among people with CLBP and OUD who face barriers to integrated care.

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Osteoarthritis (OA) is the second most frequent chronic musculoskeletal (MSK) condition after low back pain and a leading cause of disability in the elderly. The number of people living with disability will continue to rise with the aging of the population. Moreover, the rapid increase in rates of surgical intervention, i.e. Total knee replacement (TKR) and revision TKRs, is expected to place an immense burden on the health care system and society. There is a call for better rehabilitation, new interventions, and disease management for patients with knee OA. The purpose of this article is to review the biomechanics of knee OA and biomechanical interventions and to summarize the current literature on a non-invasive, home-based biomechanical treatment for patients with knee OA. The evidence suggests an improvement in symptoms and biomechanical indicators after using the home-based biomechanical intervention. In the presence of value-based payment to improve efficiency and effectiveness in delivering medical care, these results are promising.

health equity, health disparities, and social determinants of health. The literature demonstrates that marginalized groups face socioeconomic barriers and access to care barriers, though these may or may not be barriers for a specific individual patient. People with intersectional identities (e.g., those who identify with more than one underrepresented or marginalized group), often face enhanced levels of bias and discrimination.

Division of Pulmonary, Critical Care, and Sleep Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA Division of Pulmonary and Critical Care, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA Good Shepherd Penn Partners, Penn Therapy & Fitness – University City, Philadelphia, Pennsylvania, USA Department of Rehabilitation Medicine, Montefiore Health System, Albert Einstein College of Medicine, Bronx, New York, USA JFK Johnson Rehabilitation Institute at Hackensack Meridian Health, Edison, New Jersey, USA Department of Physical Medicine and Rehabilitation, The MetroHealth System, Case Western Reserve University, Cleveland, Ohio, USA Department of Physical Medicine and Rehabilitation, Shirley Ryan AbilityLab, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA SLSampsel Consulting, LLC, Albuquerque, New Mexico, USA Department of Physical Medicine & Rehabilitation, Spaulding Rehabilitation Hospital, Harvard Medical School, Boston, Massachusetts, USA Physical Medicine & Rehabilitation, UT Southwestern Medical Center, Dallas, Texas, USA Department of Rehabilitation Medicine, UT Health San Antonio, San Antonio, Texas, USA Abilities Research Center, Department of Rehabilitation and Human Performance, Icahn School of Medicine at Mount Sinai, New York, New York, USA Department of Rehabilitation Medicine and Department of Medicine, Rusk Rehabilitation, NYU Langone Health, New York, New York, USA

Objective: Determine the relationship between frequency of steroid injections, duration between injections and diabetic status among shoulder impingement patients. Design: Retrospective. Setting: Outpatient. Participants: Charts of 412 patients presented with unilateral or bilateral shoulder pain diagnosed shoulder impingement syndrome and treated with steroid injections over a period of 01/2019-12/2020. Exclusion criteria: Those having manifestations suggesting of cervical radiculopathy, neuromuscular diseases, or shoulder trauma history. Interventions: Reviewing and collecting patient charts data; demographic data including occupation, body mass index, detailed medical history including DM history. Shoulder exam including impingement provocative tests; Hawkins test, Neer’s sign. Neck exam including Spurling test. Full neurological exam. Main outcome measures: Number of steroid injections received and duration between each injection over past 2 years. Laboratory results: Glycosylated hemoglobin (HgA1c), liver and kidney functions. MRI shoulder results if available. Results: Mean age 59.4 ± 11.123. All patients were right-handed, Male 37.1%, female 62.9%, Mean body mass index (BMI) 32.2 ± 8.2. Majority were manual workers (55.1%). significant relationship between shoulder impingement and sex and BMI. HgA1c <5.5 has the fewest patients (7.3%), highest number of patients with HgA1c 5.5-6.0. significant incidence of shoulder impingement with rising category of HgA1c with highest among HgA1c >7 (p=0.0001) with significant bilateral disease. Significant incidence of shoulder impingement (unilateral or bilateral among diabetics (HgA1c>6) compared to non- diabetics (p=0.011). Mean number of injections among diabetics 1.1756 ± 1.17283, non-diabetics 0.6391 ± 0.89051 (p=0.0001). No significant relation between DM and duration between injections (p=0.129). Conclusion: Steroid injection has proven efficacy in diabetic shoulder impingement patients. No studies discussed effect of DM on frequency of steroid injection. This study showed that presence of DM among shoulder impingement patients significantly increases the frequency of steroid injection but not affecting duration between injections.

Individuals with schizophrenia display substantial deficits in social functioning (SF), characterized by chronic, lifelong presentations. Yet, at present there are few effective interventions to enhance SF in this population. Emerging evidence from studies of clinical populations that display similar SF deficits suggests that aerobic exercise (AE) may improve social skills. However, this putative impact has not been investigated in schizophrenia. Employing a single-blind, randomized clinical trial design, 33 individuals with schizophrenia were randomized to receive 12 weeks of Treatment-As-Usual (TAU; n = 17) or TAU + AE (n = 16) utilizing active-play video games (Xbox 360 Kinect) and traditional AE equipment. Participants completed an evaluation of aerobic fitness (VO2max) as well as self-, informant-, and clinician-reported SF measures at baseline and after 12 weeks. Twenty-six participants completed the study (79%; TAU = 13; AE = 13). At follow-up, the AE participants improved their VO2max by 18.0% versus − 0.5% in the controls (group x time interaction, F1,24 = 12.88; p = .002). Hierarchical stepwise regression analyses indicated improvements in VO2max significantly predicted enhancement in SF as indexed by self-, informant-, and clinician-reported measures, predicting 47%, 33%, and 25% of the variance, respectively (controlling for baseline demographics, medications, mood symptoms, and social networks). Compared to the TAU group, AE participants reported significant improvement in SF (23.0% vs. − 4.2%; group × time interaction, F1,24 = 7.48, p = .012). The results indicate that VO2max enhancement leads to improvements in SF in people with schizophrenia. Furthermore, low VO2max represents a modifiable risk factor of SF in people with schizophrenia, for which AE training offers a safe, non-stigmatizing, and nearly side-effect-free intervention.

OBJECTIVE:The aim of the study was to present: (1) physiatric care delivery amid the SARS-CoV-2 pandemic, (2) challenges, (3) data from the first cohort of post-COVID-19 inpatient rehabilitation facility patients, and (4) lessons learned by a research consortium of New York and New Jersey rehabilitation institutions.DESIGN:For this clinical descriptive retrospective study, data were extracted from post-COVID-19 patient records treated at a research consortium of New York and New Jersey rehabilitation inpatient rehabilitation facilities (May 1-June 30, 2020) to characterize admission criteria, physical space, precautions, bed numbers, staffing, employee wellness, leadership, and family communication. For comparison, data from the Uniform Data System and eRehabData databases were analyzed. The research consortium of New York and New Jersey rehabilitation members discussed experiences and lessons learned.RESULTS:The COVID-19 patients (N = 320) were treated during the study period. Most patients were male, average age of 61.9 yrs, and 40.9% were White. The average acute care length of stay before inpatient rehabilitation facility admission was 24.5 days; mean length of stay at inpatient rehabilitation facilities was 15.2 days. The rehabilitation research consortium of New York and New Jersey rehabilitation institutions reported a greater proportion of COVID-19 patients discharged to home compared with prepandemic data. Some institutions reported higher changes in functional scores during rehabilitation admission, compared with prepandemic data.CONCLUSIONS:The COVID-19 pandemic acutely affected patient care and overall institutional operations. The research consortium of New York and New Jersey rehabilitation institutions responded dynamically to bed expansions/contractions, staff deployment, and innovations that facilitated safe and effective patient care.

52-y-old diabetic, smoker, man, never hospitalized, exposed to COVID-19 and the course of disease was complicated and not responding to usual COVID-19 treatment.

Objective: Measure the incidence of Diabetes Mellitus (DM)/pre-diabetes among patients with hand nerves entrapment syndromes. Design: Prospective cross sectional. Settings: Outpatient. Participants: 412 patients presented with unilateral or bilateral hand numbness suspecting Carpal Tunnel Syndrome (CTS). Exclusion criteria: Cervical spine or hand trauma history, nerve injury history. Interventions: Each patient was subjected to the following; demographic data including occupation, body mass index, detailed medical history including DM history. Neck exam including Spurling test. Full neurological exam. Main outcome measures: Upper extremities Nerve conduction studies and electromyography of segment pointing muscles. Laboratory testing including glycosylated hemoglobin (HgA1c), liver and kidney functions. Cervical spine MRI if possible. Results: Mean age 59.4 ± 11.123. All patients were right-handed, Male 37.1%, female 62.9%, Mean body mass index (BMI) 32.2 ± 8.2. majority were manual workers (55.1%). HgA1c <5.5 has the fewest patients (7.3%), highest number of patients with HgA1c 5.5-6.0. significant relation between HgA1c categories and sensory CTS p=0.001 and sensory motor CTS p=0.001. No significant relation between HgA1c categories and demyelinating pathology p=0.123 but significant with demyelinating axonal pathology p=0.017. Significant relation between HgA1c and Guyon canal syndrome p=0.001 and polyneuropathy p=0.001. No significance between HgA1c and cervical radiculopathy p=0321. Conclusions: High incidence of DM and pre-diabetes among patients with hand nerve entrapment: CTS, Guyon syndrome together with polyneuropathy. EN may be the earliest neurophysiological abnormalities in DM, particularly in the upper limbs, even in the absence of a generalized polyneuropathy, or it may be superimposed on a generalized diabetic neuropathy. Due to the metabolic alterations consequent to abnormal glucose metabolism, the peripheral nerves show both functional impairment and structural changes, even in the preclinical stage, making them more prone to entrapment in anatomically constrained channels.

Objective: Measure the incidence of Diabetes Mellitus (DM) among patients with shoulder impingement syndrome and the factors that can modify that disease. Design: Prospective. Settings: Outpatient. Participants: 412 patients presented with unilateral or bilateral shoulder pain suspecting shoulder impingement neuromuscular diseases, or syndrome. Exclusion criteria: Those having manifestations suggesting of cervical radiculopathy, shoulder trauma history. Interventions: Each patient was subjected to the following; demographic data including occupation, body mass index, detailed medical history including DM history. Shoulder exam including impingement provocative tests; Hawkin test, Neer’s sign. Neck exam including Spurling test. Full neurological exam. Main outcome measures: Laboratory testing including glycosylated hemoglobin (HgA1c), liver and kidney functions. Shoulder MRI if possible. Results: Mean age 59.4 ± 11.123. All patients were right-handed, Male 37.1%, female 62.9%, Mean body mass index (BMI) 32.2 ± 8.2. Majority were manual workers (55.1%). No significant relationship between shoulder impingement sex but significant with BMI and age. HgA1c <5.5 has the fewest patients (7.3%), highest number of patients with HgA1c 5.5-6.0. significant incidence of shoulder impingement with rising category of HgA1c with highest among Hga1c >7 (p=0.0001) with significant bilateral disease. Significant incidence of shoulder impingement (unilateral or bilateral among diabetics (HgA1c >6) compared to non- diabetics (p=0.011). Conclusions: High incidence of DM /prediabetes among shoulder impingement patients. Level of HgA1c significantly proportionate to incidence and laterality. This suggests that it is part of musculoskeletal complication of DM. that can evidently occur with prediabetes status. Body mass index and age significantly affected the incidence but not the sex.