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8% in 2004-2006 to 0.5% in 2013-2015. Other insurance coverage (versus private) and neurologists and other specialists (versus otolaryngologists) were associated with a greater odds of PT referral for BPPV. Visits made in the Midwest and West (versus Northeast) and in rural versus metropolitan areas had greater odds of PT referral for BPPV. WNK-IN-11 research buy Relative to otolaryngologists, primary care physicians were less likely to refer to PT for other PVDs. Visits made in metropolitan versus rural areas and visits with 1 or more comorbidities (versus none) had greater odds of PT referral for other PVDs. Conclusions PT referrals remain low for ambulatory care visits for BPPV and other PVDs in the US. Referral to PT for BPPV and other PVDs varied by insurance type, physician specialty, and office location.Objective This study was performed to compare the effects of a vapocoolant spray and an eutectic mixture of local anesthetics (EMLA) cream on reducing pain during intraarticular (IA) injection of the shoulder. Design Double-blind randomized placebo-controlled clinical trial. Setting University hospital. Participants Sixty-three patients who underwent IA injection of the shoulder joint were randomized into the spray group, EMLA group, or placebo group. Intervention Placebo cream + vapocoolant spray (spray group), EMLA cream + placebo spray (EMLA group), or placebo cream + placebo spray (placebo group) before IA injection. Main outcome measures A 100-mm visual analog scale (VAS) for injection pain and 5-point Likert scales for participant satisfaction and preference for repeated use were administered immediately after IA injection. Results The VAS scores for pain during IA injection were 30.0 (95% confidence interval 19.7-41.2) in the spray group, 50.0 (37.7-63.0) in the EMLA group, and 53.8 (41.6-65.0) in the placebo group (F = 6.403, P less then 0.01). The spray group showed significantly better Likert scale scores than the placebo group for participant satisfaction (P = 0.003) and preference for repeated use (P less then 0.001). Conclusions Vapocoolant spray was effective in reducing pain during IA injection of the shoulder.Objective To determine the effects of exercise on individual cardiometabolic syndrome (CMS) risk factors in adults with chronic spinal cord injury (SCI). Data sources English language searches of PubMed, Web of Science, EMBASE, and Scopus (01/01/1970 to 31/07/2019). Study selection Articles were included if they met the following criteria (1) original articles with statistical analysis, (2) participants were adults with a SCI sustained ≥ 1-year ago, (3) exercise intervention duration ≥ 2 weeks, and (4) included any CMS risk factor as an outcome. Data extraction The methodological quality of articles was assessed using the Downs and Black score. Data synthesis Sixty-five studies were included for the final analysis, including nine studies classified as high quality (≥66%), 35 studies classified as fair quality (50-66%), and 21 studies classified as low quality (75% maximum heart rate) appears to improve waist circumference and hepatic insulin sensitivity, but appears insufficient for improving fasting glucose, lipid profile, or resting blood pressure. The addition of RT to upper-body aerobic exercise may elicit favourable changes in the lipid profile. More high-quality studies are needed to confirm if FES-cycling is effective at improving peripheral insulin sensitivity.Objective To investigate pain catastrophizing presentations up to 6-months postoperatively and subsequent changes in pain intensity and physical function. Design Prospective observational multisite study SETTING Two tertiary care facilities between 2016 and 2019 PARTICIPANTS Adult patients undergoing a mastectomy, thoracic surgery, total knee or hip arthroplasty, spinal fusion, or major abdominal surgery. Interventions Not applicable. Main outcome measure(s) Pain Catastrophizing Scale (PCS) scores, Defense and Veterans Pain Rating Scale (DVPRS) Average Pain Intensity, and Patient Reported Outcomes Measurement Information System (PROMIS) Physical Function. Results Four pain catastrophizing trajectories were identified in 348 surgical patients throughout the six months of postoperative recovery stable, remitting, worsening, and unremitting. Linear mixed-effects models found that the unremitting trajectory was associated with higher pain intensity over time. The average pain intensity of participants in the remif early interventions to surgical patients at risk of experiencing a pain catastrophizing trajectory associated with suboptimal outcomes during rehabilitation.Objective To evaluate the effects of respiratory muscle training in a population of stroke patients. Data sources PubMed, EMBASE, the Cochrane Library, CINAHL and CNKI databases were searched for clinical trials up to December 2019. Study selection Nine randomized controlled trials (RCTs) published in English met the inclusion criteria. Data extraction Data were extracted and assessed for accuracy by two reviewers. Any disagreements were resolved after discussions with an independent third reviewer. The quality of the included RCTs was assessed using the Cochrane bias tool. Data synthesis The meta-analysis showed increased maximal inspiratory pressure (SMD 0.88, 95% CI 0.62 - 1.15, P less then 0.001; at the 12-week follow-up period SMD 0.94, 95% CI 0.42 - 1.45, P less then 0.001); maximal expiratory pressure (SMD 0.83, 95% CI 0.15 - 1.52, P = 0.017; at the 12-week follow-up period SMD 0.99, 95% CI 0.47 - 1.51, P less then 0.001); forced expiratory volume in 1 s (SMD = 1.41, 95% CI 0.57 - 2.24, P = 0.001), forced vital capacity (SMD = 1.36, 95% CI 0.55 - 2.16, P less then 0.001), peak expiratory flow (SMD = 0.74, 95% CI 0.16 - 1.32, P = 0.013), 6-minute walk test (SMD = 0.67, 95% CI 0.11 - 1.23, P = 0.020), and decreased respiratory complications (OR = 0.55, 95% CI 0.30 - 1.00, P = 0.050) compared with no respiratory intervention or a sham intervention. Conclusions Respiratory muscle training improved post-stroke muscle strength and the benefits were carried over for up to 12-weeks, including improved lung function, walking capacity and a reduced risk of respiratory impediments.