Faculty Bibliography

CONTEXT/BACKGROUND:Osteopathic manipulative treatment (OMT) utilizes manual techniques to address somatic dysfunctions (SDs) and promote physiologic function. Although SDs commonly develop following traumatic injury, the role of OMT in postinjury remains incompletely characterized. Patients recovering from trauma frequently experience persistent pain and functional limitations requiring ongoing healthcare utilization. To address this need, we established a novel OMT for trauma program (OTP) to complement interventions for patients with subacute and chronic postinjury pain and mobility impairments. OBJECTIVES/OBJECTIVE:This study aims to evaluate the growth and effectiveness of the novel OTP over its first 3 years. METHODS:We retrospectively analyzed data for all patients treated at the OTP between January 1, 2021 and December 31, 2023. The outcomes included patient volume, relative value units (RVUs), and referral patterns as well as changes in pain, mobility, and other subjective improvement patients attributed to OMT. We performed subgroup analyses of patients who reported a mechanism of injury (MOI, "Injured") and those who did not ("No MOI"). Data are presented as percentages or medians (interquartile range [IQR]). RESULTS:During its first 3 years, the OTP provided 279 OMT sessions for 95 patients (41 [43.16 %] male and 54 [56.84 %] female; median 52 [41.50-64.50] years-old), applying a trauma-informed biomechanical OMT model. Quarterly patient encounters, RVUs generated, and new patient referrals increased per calendar-year quarter (CYQ; r=0.74, 0.62 and 0.56 with p=0.0028, 0.028, and 0.016, respectively). Referral patterns shifted from trauma/acute care surgery (T/ACS) and Physical Medicine and Rehabilitation (PM&R; 51.85 to 25.0 % and 33.33 to 2.78 %) toward OTP patient referrals and Primary Care referrals (0-19.44 % and 11.11-47.22 %). Median pain scores decreased immediately following the first OMT session (3 [2-5] on a 10-point pain scale). OTP patients whose first follow-up was within the study period (61, 64.21 %) reported a similar decrease between OMT sessions #1 and #2 (4 [3-6]). All patients reported improved mobility immediately after OMT. Additional benefits that patients attributed to the OTP included improvements in daily activity level (75.41 %), mood (60.66 %), sleep quality (36.07 %), and pain-free periods (36.07 %). The rate of immediate post-OMT complications (universally described as musculoskeletal discomfort or pain) was 2.87 %. We detected no significant differences during subgroup analyses. Median pain scores improved similarly between Injured and No MOI subgroups immediately after OMT session #1 (3 [2-5] vs. 3.5 [1.5-4.25], p=0.337) and between OMT sessions #1 and 2 (4 [3-6] vs. 4 [1.5-6], p=0.363). CONCLUSIONS:Our data demonstrate that not only is it possible to integrate a novel OTP into a level 1 trauma center but also that such a program is likely to grow significantly over time and consistently provide potentially beneficial OMT services for patients who do and do not identify a MOI. Programs like the OTP may provide a distinct modality to help improve postinjury pain and mobility limitations, among other potential benefits, although further analysis is necessary to assess causality. The present data informed updates to OTP operations, including the implementation of prospective, higher-fidelity data collection to enable more detailed and accurate analyses. Further research, including comparative studies, is warranted to explore the potential benefits of OMT for the trauma population.

Physiatrists are at elevated risk of burnout, a work-related exhaustion syndrome resulting from chronic stress associated with emotionally draining work demands. The high reported rate of burnout in physical medicine and rehabilitation led the Association of Academic Physiatrists Chair Council to convene a workgroup to address burnout among academic physical medicine and rehabilitation physicians. The council recognizes that leaders of departments are accountable for all organizational stakeholders, including faculty, trainees, and staff. Department leaders are expected to understand and effectively manage the drivers of burnout among stakeholders. The workgroup identified several opportunities, including identifying and disseminating effective burnout mitigation across US academic medical center physical medicine and rehabilitation programs. As a result, in 2019, a work group conducted a survey of US academic physical medicine and rehabilitation program leaders to ascertain the use of strategies for reducing physician burnout. With the aim of identifying, educating, and advancing the development of effective interventions to address burnout among academic physical medicine and rehabilitation departments, the Association of Academic Physiatrists Chair Council advocates for increased education and utilization of effective strategies aimed at promoting physician well-being across organizational levels (national, organizational, work unit, and individual).

ABSTRACT/UNASSIGNED:The Association of Academic Physiatrists (AAP) convened a Women's Task Force in 2016, under the leadership of then AAP President Gerard Francisco, MD, to evaluate data and metrics pertaining to the representation and inclusion of women physiatrists in the society. An initial published report focused on a retrospective analysis of data in categories such as leadership, conference presentations, and recognition awards. The findings, which highlighted areas in which the AAP had been successful in supporting gender equity as well as areas in which women physiatrists were underrepresented, provided a base from which to strategically focus on closing gaps in representation. The task force developed an action plan that was approved by the Board of Trustees and included strategies aimed at closing gaps and collecting data to determine corresponding effectiveness. Because most of the categories fell under the supervision of various AAP committees, an appointee from each committee ("diversity steward") liaised with the Women's Task Force. The diversity stewards reviewed the plan with their respective committees and collected data within their committee's purview. This task force follow-up report documents recent progress, consistent with the AAP Board of Trustees commitment to transparency and gender equity.

Professionalism in medicine is universally embraced, and it is the foundation for core competencies in medical education, clinical practice, and research. Physical Medicine and Rehabilitation physicians must master a complex body of knowledge and use this to responsibly care for patients. Rehabilitation professionals work in various settings; however, each one must establish and maintain ethical standards consistent with the specialty and national standards. For example, the Accreditation Council for Graduate Medical Education lists professionalism as 1 of its 6 core competencies which trainees must master. There is a growing interest in professionalism and some of the ethical issues that it encompasses. This report provides a general overview of professionalism. Future reports are needed, and there is an opportunity to consider many facets of professionalism in greater detail.