Two Filipino sisters from Capiz presented with facial muscle weakness followed by weakness of both shoulders and arms, and scapular winging. Both presented with difficulty in performing activities of daily living. The younger sister also had bilateral lower extremity weakness with difficulty in ambulation. The results of electrodiagnostic testing in both sisters were compatible with myopathic disease. Comprehensive individualized rehabilitation addressing different functional limitations, focusing on maintaining mobility and functional capacity, and resulting improvements are presented.

Human ; Female ; Adult ; Rehabilitation ; Activities Of Daily Living ; Lower Extremity ; Muscle Weakness ; Muscular Diseases ; Rhabdomyosarcoma, Alveolar ; Shoulder ; Siblings ; Upper Extremity ; Walking

A 34-year-old, G5P4, non-hypertensive patient presented with headache, left hemiplegia, and dysarthria on her third trimester. Cranial computed tomography scan revealed a right capsuloganglionic bleed. The biophysical report was essentially normal. Non-surgical management was instituted. The patient was referred for rehabilitation consisting of physical and occupational therapy with fetal monitoring to facilitate optimal functioning. This case report highlights the importance of early multidisciplinary management of a patient with stroke during pregnancy.

Human ; Female ; Adult ; Dysarthria ; Fetal Monitoring ; Headache ; Hemiplegia ; Hemorrhage ; Pregnancy ; Pregnancy Trimester, Third ; Stroke ; Tomography, X-ray Computed ; Stroke Rehabilitation

Three brothers, aged 5, 19 and 24 years, from Tuguegarao, consulted because of walking difficulty due to stiffening of lower extremities which started at varying ages. Common findings were mild spasticity and weakness in both lower extremities, consistent with Strumpell-Lorrain Syndrome. Individualized rehabilitation medicine interventions were provided to address different functional deficits, leading to improved outcomes. This case series aims to illustrate the importance of initiating early, comprehensive rehabilitation to maximize function and minimize complications.

Human ; Male ; Adult ; Young Adult ; Child Preschool ; Rehabilitation ; Lower Extremity ; Medicine ; Mobility Limitation ; Physical And Rehabilitation Medicine ; Siblings ; Syndrome ; Walking

Disasters ; Medicine ; Physical And Rehabilitation Medicine ; Rehabilitation

OBJECTIVE: There is no published local data available on falls and fall-related injuries among hospitalized patients. This study aims to determine the incidence of falls, fall-related injuries and related risk factors at the surgical and medical wards of a tertiary government hospital in the Philippines.

METHODS: This is a cross-sectional study using consecutive sampling of patients admitted to the medical and surgical wards of a tertiary government hospital from May 2014 to April 2015. Data collection included the patients' demographic data, diagnosis, medications, details on the fall, consequence of the fall, and risk factors for the fall.

RESULTS: During the one-year period, 25,849 patients were admitted to the medical and surgical wards and only six patients, representing 0.02%, were reported to have sustained a fall. No major injury occurred. The patients had varied neurologic and/or musculoskeletal disorders. Two patients fell from a wheelchair, while one fell from a bedside chair. One patient fell from the bed and one slipped on the floor. All patients had watchers/witnesses at the time of the fall.

CONCLUSION: The incidence of falls and fall-related injuries is low in a local tertiary government hospital. No serious injury resulted from the falls. Prevailing practices, local cultural expectations and under reporting may have affected the relatively low incidence rates of patient falls reported in this study.

Human ; Male ; Female ; Accidental Falls ; Risk Factors ; Wheelchairs ; Hospitalization ; Data Collection ; Tertiary Care Centers ; Musculoskeletal Diseases

Introduction: In compliance with the COVID-19 infection control guidelines outlined by the Center for Disease Control and the World Health Organization, non-urgent and non-essential services have been postponed in most healthcare institutions in the Philippines, including medical training institutions wherein responses and strategies for the residency program vary. These changes may impact the trainees’ knowledge, skills, and attitudes on their training. Specifically, most services were halted indefinitely in Physical Medicine and Rehabilitation (PM&R). Some resident trainees were deployed to treat COVID-19 patients not as PM&R residents but as generalists to augment the number of medical front-liners. Objective: To determine the PM&R residents’ COVID-19 risk preparedness in terms of relevant knowledge, attitudes, practice, and perceived barriers, and to describe the impact of COVID-19 on residency training. Methods: In this descriptive cross-sectional survey, the population consisted of a sample of PM&R residents from the six training institutions in the Philippines. A 15-20-minute web-based assessment tool was used to gather the following: participant characteristics; level of awareness and knowledge of residents towards COVID-19; risk preparedness through risk perception, knowledge, and attitudes regarding COVID-19; and impact of COVID-19 on residency training. Results: A total of 62 PM&R residents participated in the study. The majority were female and aged at least 30 years. The respondents had the following mean scores: 12.84 out of 14 for knowledge (interpreted as good), 9.16 out of 35 for attitude (interpreted as positive), and 5.65 out of 6 for practiced adherence to COVID-19 and infection control measures in their respective institutions (interpreted as good). The most commonly cited barriers to COVID-19 infection control included overcrowding in the emergency room (95%), lack of knowledge about the mode of transmission of the disease (92%), and limitation of infection control resources (92%). The majority reported that the main impact of the pandemic on PM&R residency training included the lack of clinical exposure to cases and procedures. Conclusion The study provided local baseline data on the PM&R residents’ level of COVID-19 risk preparedness and the perceived impact of the pandemic on their training. The study results may help the faculty plan for program improvement measures amid the changing COVID-19 landscape.
COVID-19 ; Physical and Rehabilitation Medicine ; Internship and Residency

BACKGROUND AND OBJECTIVES

Physical activity (PA) and fitness level are considered key factors in public health promotion, and as such, healthcare workers (HCW) need to be physically well because they are not only responsible for themselves, but of their clients as well. Therefore, we aim to determine the PA and health-related fitness (HRF) level of HCW in a tertiary hospital, disaggregated to age, sex, work assignments, and job tenure.

METHODS

A cross-sectional research design was utilized to assess HCW from the administrative, medical, nursing, and paramedical cohorts. ALPHA-FIT Test Battery was used to assess cardiorespiratory fitness, muscular strength, lower extremity power and strength, upper body muscle endurance, balance, and body composition.

RESULTS

Our study concurred with the results of previous studies on HCW yielding lower PA levels compared with the general population. We tested 282 participants (administrative: 97; medical: 36; nursing: 55; paramedical: 94), mean age 37.4 years, 64.54% females, 52.13% perceived average health status. Ninety percent of the HCW had PA levels below the World Health Organization’s recommended levels. The ALPHA-FIT mean score per category revealed: one-legged stance, 2.67/3; figure-of-8 run, 2.45/3; shoulder-neck mobility, 4.58/5; modified push-up, 2.05/4; hand-grip strength, 2.5/5; jump and reach, 4/4; dynamic sit-up, 2.62/3; six-minute walk test, 475.38 meters covered. There were no significant differences in PA and HRF levels across cohorts except for modified sit-ups (p < 0.001) and figure-of-8 run (p = 0.012). The results showed significant inverse correlation between balance and shoulder-neck mobility and age (p < 0.001), and modified push ups (p = 0.004). Males had significantly higher sit-up scores (p < 0.001), one-legged stance scores (p = 0.001), and faster figure-of-8 run (p = 0.011), while females had better jump and reach scores (p < 0.001).

CONCLUSION

Physical activity levels of HCW did not meet the World Health Organization’s recommended PA levels. Healthcare professionals who are expected to be aware of the benefits of PA and HRF have shown low to midfit levels of grip strength, upper extremity endurance, core strength, and cardiorespiratory endurance. Information on PA and HRF may aid in policy making on employee wellness that could highly impact health service delivery.

Human ; Physical Activity ; Exercise ; Health Personnel ; Healthcare Workers ; Health Promotion

Introduction: The coronavirus disease 2019 (COVID-19) pandemic prompted a shift from standard in-person consultation to non-patient contact methods such as telemedicine. To our knowledge, there was no published a priori evaluation of the telemedicine readiness and acceptance among the medical staff of the Philippine General Hospital (PGH) before implementing the institution’s telemedicine program. The lack of this vital pre-implementation step is understandable given the unprecedented crisis. However, if telemedicine programs will continue in the post-quarantine period, it is crucial to determine the facilitators and barriers to the use of telemedicine. Objective: This study determined the level of readiness and acceptance for telemedicine as an alternative method for patient consultation during the COVID-19 pandemic and post-enhanced community quarantine period among PGH medical staff (consultants, residents, fellows). Methods: The cross-sectional study was conducted from October 2020 to July 2021. Medical staff from the 16 clinical departments of the PGH were selected by systematic random sampling. Inclusion criteria included appointment as medical staff in PGH or University of the Philippines College of Medicine (UPCM), voluntary informed consent, internet access, and technical capacity to access e-mail and SurveyMonkey™. The online survey consisted of two questionnaires. It collected data on the demographic profile and outcomes of interest (e.g., telemedicine readiness and acceptance). Technological readiness was determined through the 16-item modified version of Technological Readiness Index (TRI) version 2.0, while telemedicine acceptance was determined through the modified version of the 19-item Unified Theory of Acceptance and Use of Technology (UTAUT) questionnaire. Descriptive and analytical statistics were performed at a 95% confidence interval. Results: The study had an 87% response rate with 205 respondents, 62% of whom were physicians in training (resident physicians and fellows). The respondents had a median age of 33 years and were mostly males. Only 19% had telemedicine experience before the pandemic. The majority (51%) learned telemedicine on their own. The most common devices used for telemedicine were mobile or smartphones (53%) and laptops (38%). The primary source of internet for telemedicine was mobile broadband (e.g., cellular data) (40%). The majority practiced telemedicine at their home or residence (51%), followed closely by the hospital or clinic (47%). The mean score of the respondents on TRI was 3.56 (very good technological readiness), and 4.00 (very good telemedicine acceptance) on UTAUT (behavioral intention to use the system). Performance expectancy (p = 0.02), effort expectancy (p = 0.03), and self-efficacy (p = 0.02) were significantly directly related to telemedicine adoption, while anxiety (p = 0.03) was significantly inversely related. Conclusion The PGH medical staff were found to have very good telemedicine readiness and acceptance. This suggests a willingness to use telemedicine during the pandemic. Further studies on the organization and technical support system of the telemedicine program in the PGH are strongly recommended. The quality and efficiency of the program will strongly influence the continued use of telemedicine by the medical staff even after the pandemic.
Health Services Administration ; Telemedicine ; Telecommunications ; Remote Consultation ; COVID-19

In April 2020, the Department of Rehabilitation Medicine (DRM) of the University of the Philippines - Philippine General Hospital (UP-PGH) transitioned to a telerehabilitation program called ITAWAG, an acronym for Introducing Telerehab As a Way to Access General rehabilitation medicine services. This was in response to the designation of UP-PGH as a COVID-19 referral center and the abrupt closure of all its in-patient and out-patient rehabilitation services. Eleven previous in-patients and out-patients with musculoskeletal and neurologic impairments continued their rehabilitation programs remotely, either through a phone call or video call. Their clinical outcomes and the implementation of the ITAWAG program were monitored to determine the effectiveness of an offsite continuing care program. Using the Clinical Global Impressions-Severity (CGI-S) scale, eight patients had a reduction in the severity of their illness, while the remaining three clients had no change. Feedback surveys showed that most clients and caregivers (68%) and health providers (77%) were satisfied with the program's implementation and its outcome. A frequent complaint was the poor phone reception and internet connection. As threats of a COVID-19 outbreak continue, telerehabilitation gives patients a safe, affordable, and convenient alternative for follow-up and continuity of care in medical rehabilitation. Integrating the ITAWAG program into the initial facility-based rehabilitation management can enhance its value in optimizing functional gains and resolving its shortcomings.
Telerehabilitation ; COVID-19 ; Continuity of Patient Care

OBJECTIVES: Data is necessary for a hospital-wide cerebral palsy (CP) profile, this being the leading pediatric diagnosis at the PGH Rehabilitation Medicine Out Patient clinic. This study aims to identify clinical features, severity of disability and common interventions in pediatric CP patients.

METHODS: CP profile data collection forms were accomplished from September 2014 to December 2015.

PRIMARY RESULTS: Among 125 participants: 55% were < 5 years old, 47% were delivered vaginally, 42% had perinatal onset of condition, 34% had normal birth weight and 23% were moderately preterm. Most were quadriplegic (36%) and spastic (50%). Primary caregivers were mostly mothers (45%) and

CONCLUSION: A hospital-wide cerebral palsy profile should be established to monitor CP, given its multifactorial cause and complex functional impact. Trends should be correlated with maternal and patient factors, healthcare provision and socioeconomics

Human ; Male ; Female ; Cerebral Palsy ; Motor Skills ; Patient-generated Health Data