Publications by Year: 2025

The fundamental goal of research that develops and tests rehabilitation interventions is to improve the health, function, and quality of life of patients with disabling health conditions. Rehabilitation medicine frequently uses multicomponent interventions delivered by multidisciplinary teams. This care may also occur over time across a continuum of care (eg, acute care, postacute care, outpatient clinics). Thus, research-developed rehabilitation interventions may be challenging to implement and sustain in routine care settings, particularly for disabling health conditions that persist over time. The field of implementation science has emerged in direct response to these challenges by supporting more rapid, consistent implementation of evidence-based practices in routine care through carefully designed, systematic implementation efforts. Implementation science aims to elucidate the factors that influence implementation success (ie, barriers and facilitators), to identify and evaluate implementation strategies likely to facilitate successful implementation, and to study the underlying mechanisms through which implementation strategies produce their effects on implementation outcomes. This article introduces the field of implementation science and provides an overview of the PM&R special issue on implementation science. The article presents core implementation science concepts and approaches and discusses their application to specific evidence-based rehabilitation interventions that are underused in treating disabling health conditions. The successful application of implementation science methods offers the promise of improved adoption of evidence-based rehabilitation practices to optimize patient outcomes and help maximize realization of their societal value and benefits.

This study evaluated death ascertainment from publicly available internet sources for patients in two large tertiary care US healthcare systems, Mass General Brigham (MGB) and Vanderbilt University Medical Center (VUMC), benchmarked against state and federal vital statistics data. Names, dates of birth, and dates of death were extracted from 8.1 million internet media records using previously developed natural language processing models. Internet records were matched to 78 848 deceased patients from MGB and VUMC on first name, last name, and date of birth. Dates of death were validated against state vital statistics databases or the National Death Index as reference standards. We calculated sensitivity and positive predicted values (PPV) of internet sources in identifying dates of death within 7 days of the reference standard. Exact matching of records between internet media and reference standards on first name, last name, and date of birth, resulted in 30 067 (38.8%) matches, which showed PPV for death identification (98.2%-MGB; 98.9%-VUMC) in internet media and increased sensitivity of death capture over EHR alone by 24% at MGB and 18% at VUMC. In conclusion, using internet sources to augment mortality data increased capture of death meaningfully over reliance on EHR records alone.

PURPOSE: The Promoting Resilience in Stress Management (PRISM) intervention is a brief, positive psychological skills-based intervention delivered by lay-coaches with demonstrated efficacy at decreasing distress in young adults with cancer. We recently completed a pilot trial of "PRISM for women with breast cancer" (PRISM-BC) and demonstrated feasibility. Here, we conducted qualitative analyses to better understand the experiences of women who participated in PRISM-BC.

METHODS: For this single-armed, pilot study of PRISM-BC, we recruited women who were receiving chemotherapy for any stage of breast cancer. All received the PRISM intervention, including six individual, virtual sessions and access to a companion mobile app for skill practice. Following PRISM completion, participants completed a 30-60-minute semi-structured, qualitative interview. We employed coding reliability thematic analysis to identify themes, with two team members applying codes to ensure satisfactory inter-rater reliability.

RESULTS: Women (N=33) were on average 54.1 years old (SD=9.5); most had early stage disease (76%), identified as Black/African American (58%), and downloaded the companion app (70%). We identified four themes: 1) PRISM was helpful due to both new skill acquisition and experiential relevance; 2) The app was helpful to many, but barriers prevented use among some; 3) Both facilitators and barriers to PRISM engagement were present; 4) Opportunities exist to tailor PRISM further to the specific needs of breast cancer survivors CONCLUSION: PRISM was well-received among women with breast cancer. Future work should examine the efficacy of PRISM in larger, controlled trials in breast oncology incorporating suggested modifications (e.g., content around medication adherence).

BACKGROUND AND HYPOTHESIS: Cognitive impairment is a core disabling feature of schizophrenia (SZ). Changes in gut microbiota have been linked to cognitive dysfunction in SZ; however, changes in the oral microbiota in relation to immune dysregulation have only been recently reported, and their relevance to cognition remains unclear. The objective of this study was to explore the relationship between oral microbiota alterations and cognitive impairment in patients with SZ and to evaluate potential mediating mechanisms, including neuroinflammation and microbial functions.

STUDY DESIGN: In this cross-sectional study, we recruited 68 patients with SZ and 32 healthy controls (HC). Cognitive function was assessed using the Wechsler Adult Intelligence Scale-Fourth Edition. Oral microbiota composition was characterized by 16S rRNA gene sequencing, and microbial functions were predicted using Phylogenetic Investigation of Communities by Reconstruction of Unobserved States 2 (PICRUSt2) based on the 16S profiles. Neuroinflammation was assessed using peripheral kynurenine (KYN) pathway activity as a proxy.

STUDY RESULTS: The patients with SZ exhibited significantly lower oral microbiota alpha diversity (driven by reduced evenness) and showed greater cognitive impairment and differences in the KYN pathway markers (neuroinflammation proxies) compared to HC. They also showed shifts in specific bacterial genera and the PICRUSt2-predicted functional pathways. Importantly, the oral microbiota alterations were significantly associated with cognitive impairment. Exploratory mediation analysis suggested that several pathways, including glycan biosynthesis and metabolism, may play a role in this association. In contrast, KYN pathway markers showed no significant association.

CONCLUSIONS: Our findings show an association between the oral microbiota alpha diversity and cognitive impairment in SZ, with the PICRUSt2-predicted functional pathways potentially implicated.

PURPOSE OF REVIEW: Lumbar transforaminal epidural steroid injections (TFESIs) are a widely used interventional procedure for managing lumbosacral radicular pain and other spinal conditions. TFESIs help reduce inflammation and enhance function by delivering corticosteroids into the nerve root and epidural space. The transforaminal approach is commonly utilized for its precise targeting, offering both diagnostic and therapeutic benefits. Furthermore, this technique can be performed in patients with a history of laminectomy or contraindications to performing an interlaminar approach at the targeted levels. This study reviews current practice patterns, technical preferences, and procedural experiences of interventional pain physicians performing lumbar TFESIs.

RECENT FINDINGS: A survey was distributed to interventional pain physicians via email, web links, and social media platforms. Respondents included academic physicians in ACGME-accredited fellowship programs, as well as hospital-based and private practice physicians. The survey contained questions focusing on fluoroscopic views used for TFESIs, frequency of one-level versus two-level injections, and the occurrence of paresthesias during lumbar TFESIs. Data were collected anonymously, and descriptive statistics were used to analyze responses. A total of 87 respondents completed the survey. For fluoroscopic guidance, 60.9% (53/87) preferred using a combination of AP, oblique, and lateral views. Regarding injection levels, 63.2% (55/87) reported sometimes performing two-level injections, while 27.6% (24/87) always performed two levels, and 9.2% (8/87) exclusively performed one-level injections. The frequency of paresthesia during TFESIs varied, with 73.6% (64/87) reporting paresthesia occurring sometimes, 18.4% (16/87) reporting it most of the time, and 6.9% (6/87) stating it never occurred. This study highlights diverse practice patterns among interventional pain physicians performing lumbar TFESIs. Most physicians prefer multi-view fluoroscopic guidance and adapt the number of injection levels based on clinical need. Paresthesia during TFESIs is commonly reported but varies in frequency. These findings provide preliminary insights into procedural techniques and decision-making in lumbar TFESIs, offering a foundation for future research to refine best practices and improve patient outcomes.

Individuals with cancer are at increased risk of severe COVID-19 and immunogenicity of SARS-CoV-2 vaccines may be compromised, especially in those receiving systemic anti-cancer treatment. Understanding how treatment affects vaccine-induced humoral responses is critical to optimize vaccination strategies in this vulnerable population. This study evaluated neutralizing antibody responses to SARS-CoV-2 vaccination in cancer cohorts undergoing active treatment or not, measured at multiple timepoints before and after vaccination using a pseudovirus-based neutralization assay. We observed significantly lower seroconversion rates and impaired neutralizing antibody responses in the cancer cohort on active treatment compared to those not on treatment, suggesting an association between active treatment and a compromised functional immune response. Although strong correlations between anti-spike IgG and neutralizing antibodies were observed across all groups, regression analyses revealed potential differences in the relationship between binding and functional antibodies. We also observed the correlation between avidity and neutralizing antibodies varied across groups. These findings suggest that active systemic therapy impaired both the quantity and quality of antibody responses. Tailored vaccination timing and monitoring may be critical in reducing the risk of severe COVID-19 symptoms and improving COVID-19 vaccine efficacy in this population.

Anti-LGI1 encephalitis is an autoimmune disorder of the brain, characterized by subacute cognitive impairment, faciobrachial dystonic seizures, and hyponatremia. Although rare, recent reports suggest that LGI1 encephalitis may be triggered following COVID-19 exposure whether through infection or vaccination. It usually presents with insidious progression which, along with old age predominance, may delay the diagnosis. We herein report a 67-year-old patient with positive LGI1 antibody titers, who developed subacute parkinsonism after serial COVID-19 vaccination. To our knowledge, this is the first documented case report highlighting a potential association between COVID-19 vaccination and the development of parkinsonism in the context of LGI1 encephalitis.

OBJECTIVES: This study aimed to assess the risk of venous thromboembolism (VTE) among obese and nonobese females aged 10 to 44 years prescribed hormonal therapy (HT) and compare VTE rates between different HT types in a large national database.

METHODS: A retrospective cohort study was conducted using TriNETX data, which includes electronic health records and pharmaceutical claims from 81 million patients across 56 US tertiary care hospitals. Females prescribed HT between 2000 and 2022 were stratified by body mass index. VTE incidence was identified using International Classification of Diseases, Ninth/Tenth Revision, codes and anticoagulant prescriptions. Propensity score matching controlled for confounders.

RESULTS: Of 4,020,467 females, 34% (1,370,481) were obese. VTE incidence was higher in obese HT users (0.99%) than nonobese users (0.51%; P < .01). Obese users of levonorgestrel + ethinyl estradiol (EE) had a VTE rate of 0.55% vs 0.33% in nonobese users (P = .01, relative risk [RR] = 1.63). Similarly, obese users of norethindrone + EE (0.44% vs 0.24%; P < .01; RR = 1.8) and norgestimate + EE (0.44% vs 0.22%; P < .01; RR = 1.97) had higher VTE rates. No significant differences were found for progesterone-only HT users.

CONCLUSION: In this large study comparing rates of VTE among obese and nonobese females on HT, a significantly higher risk of VTE was observed among obese females using certain HTs, particularly EE with levonorgestrel, norethindrone, and norgestimate. These results highlight the importance of considering obesity as a key risk factor when prescribing HT, particularly for females with higher body mass index.

PURPOSE: To report a rare case of endocrine mucin-producing sweat gland carcinoma (EMPSGC) of the eyelid, initially misdiagnosed as a chalazion.

OBSERVATIONS: A 76-year-old South-Asian male presented with a 9-month history of a painless left upper eyelid lesion. Initial ophthalmic assessment suggested presence of a chalazion that did not resolve with medical management. Examination revealed a 5.5 × 5.5 mm mass at the central left eyelid margin. The lesion transilluminated and extended over the eyelid margin, with splayed lashes but no madarosis. Histopathological examination demonstrated cribriforming glandular epithelium with extracellular mucin and synaptophysin expression, confirming EMPSGC with associated mucinous carcinoma. The patient underwent successful Mohs micrographic surgery with oculoplastic reconstruction and with no evidence of recurrence at five-month follow-up.

CONCLUSION AND IMPORTANCE: EMPSGC is an uncommon, low-grade adnexal neoplasm, often under-recognized due to its benign appearance. This case highlights the importance of considering EMPSGC in the differential diagnosis of persistent eyelid lesions, particularly those unresponsive to conservative treatment. Histopathologic evaluation is critical for early recognition and appropriate management of lesions.

Men who have sex with men (MSM) with a history of childhood sexual abuse (CSA) are more likely to report crystal methamphetamine use and condomless anal intercourse (CAI) than MSM without CSA. MSM with CSA may benefit less in HIV prevention interventions due to long-term psychological effects. Data are from a pilot randomized, controlled trial testing an integrated HIV risk reduction and behavioral activation counseling intervention vs standard of care among MSM with methamphetamine use disorder, which showed effects at reducing CAI. We conducted a secondary analysis (N = 38) to preliminarily assess whether CSA moderated the intervention effects on the two primary outcomes: CAI acts with men whose HIV serostatus was either positive or unknown (1) overall (CAI overall) and (2) while under the influence of methamphetamine (CAI with methamphetamine). At the immediate postintervention assessment, the interaction term between CSA and intervention arm was not statistically significant for either outcome, indicating no moderation effect. However, at the 3-month postintervention assessment, the interaction term was significant for both outcomes. At this time point, for those without CSA, there was a significantly lower number of CAI acts in the intervention condition vs the comparison condition for both outcomes. For those with CSA, however, there was no significant difference between the intervention and comparison conditions for CAI overall, although for the outcome CAI with methamphetamine, the intervention condition had higher levels. Future HIV prevention interventions among MSM with methamphetamine use disorder should consider screening for CSA and addressing CSA-related psychological distress, which may potentially preserve intervention effects.