Debra L. Braverman

Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome.

Slipman CW, Lipetz JS, Plastaras CT, Jackson HB, Vresilovic EJ, Lenrow DA, Debra L. Braverman DL: Fluoroscopically guided therapeutic sacroiliac joint injections for sacroiliac joint syndrome. Am J Phys Med Rehabil 2001;80:425–432. ObjectiveTo investigate the outcomes resulting from the use of fluoroscopically guided therapeutic sacroiliac joint injections in patients with sacroiliac joint syndrome. DesignA retrospective study design with independent clinical review was utilized. Thirty-one patients were included; each patient met specific physical examination criteria and failed to improve clinically after at least 4 wk of physical therapy. Each patient demonstrated a positive response to a fluoroscopically guided diagnostic sacroiliac joint injection. Therapeutic sacroiliac joint injections were administered in conjunction with physical therapy. Outcome measures included Oswestry scores, Visual Analog Scale pain scores, work status, and medication usage. ResultsPatients’ symptom duration before diagnostic injection averaged 20.6 mo. An average of 2.1 therapeutic injections was administered. Follow-up data collection was obtained at an average of 94.4 wk. A significant reduction (P = 0.0014) in Oswestry disability score was observed at the time of follow-up. Visual Analog Scale pain scores were reduced (P < 0.0001) at the time of discharge and at follow-up. Work status was also significantly improved at the time of discharge (P = 0.0313) and at follow-up (P = 0.0010). A trend (P = 0.0645) toward less drug usage was observed. ConclusionsThese initial findings suggest that fluoroscopically guided therapeutic sacroiliac joint injections are a clinically effective intervention in the treatment of patients with sacroiliac joint syndrome. Controlled, prospective studies are necessary to further clarify the role of therapeutic injections in this patient population.

Cardiac rehabilitation: a contemporary review.

Cardiac rehabilitation is increasingly recognized as an essential part of the continuum of care for patients with cardiovascular disease. The discipline has evolved over the last 15 yrs to reflect the importance of targeted initiatives in the management of cardiovascular risk factors. Changes in program scope have broadened to shift the emphasis away from primarily focusing on exercise therapy to embracing a comprehensive secondary prevention strategy addressing the multiple medical, exercise, nutritional, and behavioral factors that place a patient at increased risk of a subsequent cardiac event. Cardiac rehabilitation is a class I recommendation in most current cardiovascular clinical practice guidelines. Despite the large body of literature verifying the sizeable morbidity and mortality benefits, cardiac rehabilitation services are vastly underused. The implementation of recent performance measures will provide the potential to boost referral to, enrollment in, and completion of cardiac rehabilitation programs. The goals, core components, benefits, risks, and outcome measures of cardiac rehabilitation will be reviewed.

Persistent hiccup associated with thoracic epidural injection.

Epidural steroid injections are commonly used to treat lumbosacral radicular and discogenic pain. When used in this manner, these agents can cause minor, transient systemic side effects and rarely result in any serious complications. Because adverse reactions are uncommon and transient, epidural injections are considered a safe therapeutic intervention. We describe the first case of persistent hiccups as a consequence of a thoracic epidural steroid injection in a patient with thoracic discogenic pain.

Poster 23: Enhanced external counterpulsation and functional improvement in octogenarians with symptomatic ischemic heart disease1

Abstract Objective: To assess the functional outcomes of octogenarians with angina who receive enhanced external counterpulsation (EECP). Design: Retrospective review. Setting: Outpatient cardiac treatment facility. Participants: 24 octogenarians (avg age, 84.75y) with Canadian Cardiovascular Society (CCS) functional class III angina. Interventions: EECP is a safe, noninvasive outpatient therapy that uses computerized electrocardiographic sequencing to trigger pneumatic cuffs wrapped around the lower extremities. These cuffs sequentially inflate during diastole and rapidly deflate just prior to systole, resulting in diastolic augmentation, presystolic unloading, increased venous return, and improved cardiac output. The clinical outcomes of EECP therapy include marked symptom reduction and improved exercise tolerance in nearly 80% of patients. Main Outcome Measures: CCS angina classification and Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36). Results: Our patients received an average of 38.75 hours of EECP therapy and reported no adverse events. 23 of the 24 patients improved their CCS angina classification by at least 1 class (8 by 2 classes) and 3 patients were entirely asymptomatic by the end of the program. All patients demonstrated improvement in exercise tolerance and functional status. The SF-36 was used to assess functional outcomes. The improvement in physical functioning ( P P P Conclusions: EECP is a safe, efficacious treatment alternative for octogenarians with angina. This therapeutic physical modality leads to significant functional improvement, particularly in mobility and emotional outlook, in octogenarians with symptomatic ischemic heart disease and should be considered readily as a treatment option for this high-risk population.