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FD in Rehabilitation patients has not been reported in thePM&R literature.Keywords: Rehabilitation, Gait, Drop foot, Walking.
Poster 210
Functional Anesthetic Diskography to ConfirmDiskogenic Back Pain in a Patient withEquivocal Results on Provocation DiskographyTesting: A Case Report.Shivani Shah, D.O (Emory University, Atlanta, GA);Michael K. Schaufele, MD.
Disclosures: S. Shah, None.Patients or Programs: A 45-year-old woman withchronic low back pain and well controlled depression.Program Description: Academic spine center.Setting: Emory Orthopedics and Spine Center, Emory Uni-versity, Atlanta Georgia.Results: The patient presents with a 6-year history of pro-gressive low back pain that is exacerbated by axial loadingand improved with lying supine which has not significantlyimproved with conservative therapy. Her physical examina-tion shows moderate pain on extension and decreased flex-ion. Her recent MRI revealed moderate-severe lumbar degen-erative disk disease at L4-L5, a possible L5-S1 annular tear,and normal at the levels above. To determine if the patientmay be a candidate for surgical intervention, she underwentprovocation diskography (PD) which showed a normal con-trol of L5-S1. PD of L4-5 revealed severe degenerative disko-gram pattern with severe 9/10 non-concordant pain. PDinjection of L3-4 showed a small annular tear with moderate6/10 non-concordant pain at high pressure only. The resultswere felt to be inconclusive and it was recommended that thepatient undergo functional anesthetic diskography (FAD)L4-5. On a separate day, an intradiskal catheter was insertedinto the L4-5 disk. The patient was brought to the recoveryarea and asked to perform functional activities with VASscoring of each activity. Next, with the patient blinded, thedisk was injected with 0.7cc of 4% lidocaine and after 20minutes the patient performed the same activities. Afterinjection of the local anesthetic, she experienced more than80% pain relief of her usually painful activities. Therefore,the study was felt to be consistent with diskogenic pain atL4-5.Discussion: There is no definitive test to prove diskogenicback pain. Currently PD, the controversial standard, hasmany inherent limitations. An agreement between PD andAD would be ideal however this may be difficult to achieve.In patients with inconclusive PD testing and no other struc-tural abnormalities except annular tears, confirmation by ADmay be considered when one is planning surgical treatment.Conclusions: Currently FAD could be used as an addi-tional test to PD in indeterminate cases, pending furtherresearch on FAD.Keywords: Diskogenic, Functional anesthetic diskogra-phy, Provocative diskography.
Poster 211
General Practitioners’ Understanding ofRehabilitation Physician Skills and Relation toReferrals in the Australian Capital Territoryand Surrounding New South Wales Area.Keith K. Chan, MB, BCh (The Canberra Hospital,Woden, ACT, Australia).
Disclosures: K. K. Chan, None.Objective: To study what general practitioners (GPs)/fam-ily physicians in the Australian Capital Territory (ACT) andsurrounding New South Wales (NSW) area understandabout rehabilitation physician skills and the relationshipbetween their understanding and other factors on referrals torehabilitation physicians.Design: Survey questionnaire.Setting: Regional survey, Australia.Participants: 470 general practitioners in the ACT Divisionof General Practice database, with 170 (36%) respondents.Interventions: Not applicable.Main Outcome Measures: Respondents were given 11referral scenarios (8 appropriate and 3 inappropriate refer-rals) and asked to indicate how likely they were to make thesereferrals to rehabilitation physicians. They were also assessedon their understanding of 6 skills of rehabilitation physicians.Demographic and professional data were requested.Results: Respondents’ average age was 49 years (� 10years). 54% were women. 77% were graduates of Australian/New Zealand medical schools. Most respondents workedmore than 6 sessions a week and had been in practice for least5 years. 35% of respondents had exposure to rehabilitationmedicine in medical school and 25% had previously workedin a rehabilitation medicine setting. 86% of respondents hadpreviously referred patients to rehabilitation medicine phy-sicians. On average, 7 out of 11 referral scenarios werecorrectly selected. There was a significant relationship be-tween selection of appropriate referrals and understanding ofrehabilitation physician skills (P�.05), but not with GPdemographics and professional characteristics.Conclusions: This survey suggests that appropriate GPreferrals to rehabilitation physicians in the ACT/surroundingNSW area is significantly correlated with their understandingof rehabilitation physician skills. Improving GPs’ knowledgeof rehabilitation physician skills may increase the number ofappropriate referrals to the specialty.Keywords: Rehabilitation, Physicians, Family, Referraland consultation, Australia.
Poster 212
Guillain-Barre Syndrome—One-Year Follow-upin Neurological Rehabilitation Unit: FunctionalRecovery and Residual Deficits.Anupam Gupta, MD (National Institute of MentalHealth & Neuro Sciences, Bangalore, India);Thyloth Murali, MD (Psychiatry); AbhishekSrivastava, MD (PM&R); Arun Taly, DM (Neurology).
S195PM&R Vol. 1, Iss. 9S, 2009