Physical Medicine and Rehabilitation

Case studies in clinical leadership

Faculty Mentor’s Name: Dr. Yula Levites Strekalova
Email: yulias@ufl.edu
Phone Number: (352) 273-7934
Project Category: Case Review
International Component or Travel: No

Research Project Description:

The goal of this project is to create an educational case study suitable for the use in pre-health and medical education contexts. Examples of case study topics include, but are not limited to quality improvement, clinical leadership, interprofessional collaboration, patient-provider communication, health literacy, social and structural determinants of health, integration of research, technology implementation, and healthcare innovation. The medical student will receive orientation to the educational case development and take the lead on the case development. If suitable, the final case will be submitted for online publication on MedEd portal.

Forging new paths in treating chronic pain and improving function

Faculty Mentor’s Name: Dr. Kimberly Sibille
Email: ksibille@ufl.edu
Phone Number: (352) 294-5846
Project Category: Clinical
International Component or Travel: No

Research Project Description:

Inspired by experiences working in healthcare, research from my lab focuses on bridging the biomedical, behavioral, and psychosocial chasm in chronic pain. Chronic pain is a major public health issue with significant functional and financial consequences affecting individuals, the community, and the healthcare system. Even more concerning, the consequences of chronic pain extend beyond disability and decreased quality of life to include an increased incidence of morbidity and mortality. Research investigation and clinical management of chronic pain is difficult due to significant individual variability and the lack of biological indices with which to evaluate risk and protective factors, progression, and treatment response.

Our scientific pursuits are specific to investigating the biological interface of chronic pain, resilience, and factors contributing to health disparities. Overarching goals are to: 1) improve the phenotyping of chronic pain, 2) delineate resilience and vulnerability factors, and 3) identify biobehavioral strategies to optimize chronic pain treatment and health outcomes. Based on an established physiological model, our lab has developed a pain phenotyping measure, Chronic Pain Stage, with findings spanning biological, cognitive, and physical functioning. Additionally, research is underway on a pain resilience index that is associated with biological measures and clinically applicable.

Long-term research intentions are to increase understanding of the biological interface of chronic pain and associated factors; to formulate a clinical composite for assessing and evaluating treatment interventions; and to identify strategies and targets to prevent, reduce or ameliorate chronic pain and enhance functioning. Please visit our website: https://aging.med.ufl.edu/research/the-pain-trail/

Prevention of Musculoskeletal Deficits after Spinal Cord Injury

Faculty Mentor’s Name: Dr. Joshua Yarrow
Email: joshua.yarrow@medicine.ufl.edu
Phone Number: (352) 548-6477
Project Category: Basic
International Component or Travel: No

Research Project Description:

Muscle and bone loss are hallmarks of severe spinal cord injury (SCI) that are precipitated by the central nervous system insult and the resulting disuse and that are intensified by a host of physiologic abnormalities, including impaired anabolic signaling that are not present in most disuse situations. As a result the rate and magnitude of muscle and bone loss are greater after SCI than in all other disuse conditions. This pathology underlies the inability of most stand-alone physical therapy and drug regimens to produce comprehensive musculoskeletal recovery after severe SCI. My lab is primarily funded by the Department of Veterans Affairs and focuses on identifying multimodal therapies that promote both bone and muscle recovery after severe SCI by combining unique physical therapy regimens that ambulate the paralyzed limbs (e.g., passive-isokinetic cycle training or bodyweight-supported treadmill training) with novel pharmacologic compounds (e.g., insulin-like growth factor or testosterone) that activate anabolic signaling pathways in musculoskeletal tissue. This project involves evaluating muscle and bone changes that occur in preclinical SCI models using high-resolution imaging modalities, including: in vivo microcomputed tomography (microCT), magnetic resonance imaging, and/or dual-energy x-ray absorptiometry (DEXA). Additional duties may include performing: immunohistochemistry to assess various histologic characteristics of skeletal muscle; performing histomorphometry and/or immunoassays to assess bone formation and resorption indices; conducting literature review related to these topics; and/or assisting with live animal studies. Several relevant publications related to these topics are below.

  1. Sutor TW, Kura JR, Mattingly AJ, Otzel DM, Yarrow JF. The effects of exercise and activity-based physical therapy on bone after spinal cord injury. Int J Mol Sci. 2022, 23(2):608.
  2. Otzel DM, Kok HJ, Barton ER, Graham ZA, Yarrow JF. Pharmacologic approaches to prevent muscle atrophy after spinal cord injury. Curr Opin Pharmacol. 2021, 60: 193-199.
  3. Yarrow JF, Wnek RD, Conover CF, Reynolds MC, Buckley KH, Kura JR, Sutor T, Otzel DM, Mattingly AJ, Aguirre JI, Beck DT, McCullough DJ. Bone loss coincides with reduced bone formation and bone blood flow deficits after severe spinal cord injury. J Appl Physiol. 2021, 131(4): 1288-1299.
  4. Yarrow JF, Kok HJ, Phillips EG, Conover CF, Lee J, Bassett TE, Buckley KH, Reynolds MC, Wnek RD, Otzel DM, Chen C, Jiron JM, Graham ZA, Cardozo C, Vandenborne K, Bose PK, Aguirre JI, Borst SE, Ye F. Locomotor training with adjuvant testosterone preserves cancellous bone and promotes muscle plasticity in male rats after severe spinal cord injury. J Neurosci Res. 2020, 98(5): 843-868.
  5. Otzel DM, Conover CF, Ye F, Phillips EG, Bassett TE, Wnek RD, Flores M, Catter A, Ghosh P, Balaez A, Petusevsky J, Chen C, Gao Y, Zhang Y, Bose PK, Borst SE, Wronski TJ, Aguirre JI, Yarrow JF. Longitudinal examination of bone loss in male rats after moderate-severe contusion spinal cord injury. Calcif Tissue Int. 2019,104(1): 79-91.
  6. Otzel DM, Lee J, Ye F, Borst SE, Yarrow JF. Activity-based physical rehabilitation with adjuvant testosterone to promote neuromuscular recovery after spinal cord injury. Int J Mol Sci. 2018, 19(6): E1701.
  7. Yarrow JF, Phillips EG, Conover CF, Bassett TE, Chen C, Teurlings T, Vasconez A, Alerte J, Flores M, Aguirre JI, Borst SE, Ye F. Testosterone plus finasteride prevents bone loss without prostate growth in a rodent spinal cord injury model. J Neurotrauma. 2017, 34(21): 2972-2981.
  8. Beggs LA, Ye F, Ghosh P, Beck DT, Conover CF, Balaez A, Miller JR, Phillips EG, Zheng N, Williams AA, Aguirre JI, Wronski TJ, Bose PK, Borst SE, Yarrow JF. Sclerostin inhibition prevents spinal cord injury-induced bone loss. J Bone Miner Res. 2015, 30(4): 681-689.
  9. Yarrow JF, Ye F, Otzel DM, Balaez A, Mantione JM, Otzel DM, Chen C, Beggs LA, Baligand C, Keener JE, Lim W, Vohra RS, Batra A, Borst SE, Bose PK, Vandenborne K. Bone loss in a new rodent model combining spinal cord injury and cast immobilization. J Musculoskelet Neuronal Interact. 2014, 14(3): 255-266.

Impact and Interaction of Obesity and Diabetes on Postacute Rehabilitation Outcomes after Traumatic Limb Amputation

Faculty Mentor’s Name: Dr. Heather Vincent
Email: hkvincent@ufl.edu
Phone Number: (352) 273-7459
Project Category: Case Review
International Component or Travel: No

Research Project Description:

Co-mentors: Drs. Andrew Dubin and Parisa Zarreii (Physiatrists)

Obesity and diabetes can independently affect recovery from traumatic amputation injuries or nontraumatic amputation from dysvascular conditions. The combined and separate effects of obesity and diabetes mellitus on key inpatient rehabilitation outcomes after these two types of lower limb extremity amputation are not yet clear.

Thus, the study aims are: 1) To determine whether obese, diabetic patients admitted to inpatient rehabilitation with lower limb traumatic or nontraumatic amputation demonstrate less improvement in Centers for Medicare Services (CMS) GG scores (which include the functional ability scores) than patients with obesity alone, diabetes alone or neither condition; and 2) To determine whether obese, diabetic patients with lower limb amputation demonstrate less favorable clinical outcomes than patients with obesity, diabetes or neither condition. We will analyze national data from the Select Rehabilitation Hospital System in up to 500 patients who received rehabilitation care for either of these two types of lower extremity amputation admission diagnoses.

The main outcome will be the change in GG scores from admission to discharge, and secondary outcomes will include discharge location, length of stay, medical complications (such as infections, wound healing issues, cardiac events, pulmonary embolism, deep vein thrombosis or other), readmissions to acute care, readmissions back to the IRF, mortality, placement in long-term care facility. A combination of univariate analyses of variance, Kruskal-Wallis tests, odds risk ratios and will be used to test the hypotheses that 1) patients with both obesity and diabetes will demonstrate lower gains in GG scores than patients with either or neither condition by discharge, and 2) patients with both obesity and diabetes will demonstrate worse clinical outcomes (longer LOS, more complications, more acute care readmissions and will return to home less frequently) than patients with either or neither condition by discharge. Exploratory analyses will include characterizing the patients who have worse outcomes than others and performing hierarchical regression to determine the relative contribution of body mass index and presence of diabetes on change in GG scores.

The medical student will spend time with Dr. Vincent performing statistical analyses, preparing the results and write up of this very large multisite dataset. In addition, the medical student will also experience some time in the Inpatient Rehabilitation Hospital observing the actual path of care during rehabilitation of this population, the process of inpatient therapy and challenges for patients with these varying comorbidities and amputation injuries. This is a true clinical and translational experience.

Barmparas G, Inaba K, Teixeira P, et al. Epidemiology of post-traumatic limb amputation: A National Trauma Databank analysis. Am Surg. 2010; 76:1214-1222

Bernatchez J, Mayo A, Kayssi A. The epidemiology of lower extremity amputations, strategies for amputation prevention, and the importance of patient-centered care. Semin Vasc Surg. 2021 Mar;34(1):54-58

Choufani C, Barbier O, Caubere A, Ollat D, Versier G. A growing stake in orthopaedic surgery and traumatology for the future management of obese patients. Acta Orthop Belg. 2018; 84(4):377-383

Venkataraman K, Fong NP, Chan KM, Tan BY, Menon E, Ee CH, Lee KK, Koh GC. Rehabilitation outcomes after inpatient rehabilitation for lower extremity amputations in patients with diabetes. Arch Phys Med Rehabil. 2016; 97(9):1473-1480.

Vincent HK, Seay AN, Vincent KR, Atchison JW, Sadasivan K. Effects of obesity on rehabilitation outcomes after orthopedic trauma. Am J Phys Med Rehabil. 2012 Dec;91(12):1051-9.