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      Beliefs, attitude, and knowledge of the Iranian physiatrists towards neuromusculoskeletal ultrasound and common barriers in its application

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          Abstract

          Background

          Regarding the increasing application of neuromusculoskeletal sonography among medical specialties, specifically physiatrists, this study aims to assess the knowledge and skill level of these specialists in neuromusculoskeletal sonography in Iran.

          Methods

          This descriptive, cross-sectional study was performed in 2018. The utilized questionnaire developed based on previous studies in collaboration with 6 university lecturers of Shaheed Beheshti, Iran, and Tabriz medical universities and a physiatrist from Hacettepe University (Turkey); it included questions entailing demographic data, knowledge, and performance levels. Its validity and reliability were evaluated through face validation, pilot study, and the Cronbach α calculated via SPSS. Data extraction and analysis were also performed by SPSS-25.

          Results

          Of 364 questionnaires distributed, 300 were properly filled and entered into the study, of which, 38% were filled by clinical residents, 10% university lecturers, and 52% other categories (e.g. private sector).

          The average number of musculoskeletal patient visits was 140.6 ± 119 and the mean number of musculoskeletal sonographies requested was 8.2 ± 5.2 per month (the three most common indications reported as the shoulder, carpal tunnel syndrome, and tendon injuries).

          95% of the participants considered the importance of sonography for physiatrists to be “very high” or “high”; with the most valuable applications “as a guide for procedures (90%), its diagnostic utility (68%), and follow up/evaluating the response to treatment (45%). 86% of physiatrists reported they had participated in musculoskeletal sonography courses, 60% during residency, and the rest through workshops.

          Also, the participants mentioned safety (83%), the possibility of performing simultaneous diagnosis and intervention procedures (70%), repeatability (58%), and dynamic imagery (52%) as the major advantages of musculoskeletal ultrasound.

          Conclusion

          a large number of doctors consider musculoskeletal sonography to be essential for physiatrists, though insufficient education on the subject and the low number of ultrasound devices are some of the obstacles in enhancing the use of this technology in PM&R setting. Presenting certified specific training courses during residency, provision of necessary rotations, using the capacities of the PM&R scientific committee, and the private sector for running workshops and professional training courses are suggested for enhancing the knowledge and skills of neuromusculoskeletal sonography.

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          Most cited references22

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          Ultrasound of knee osteoarthritis: interobserver agreement and correlation with Western Ontario and McMaster Universities Osteoarthritis.

          The aim of this work was to assess the reproducibility of ultrasound findings of knee osteoarthritis and to correlate ultrasound findings with Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC). Prospective study was conducted upon 80 patients (56 F, 24 M; mean age 57 years) with primary osteoarthritis of knee joint. All patients underwent clinical assessment with calculation of WOMAC and high-resolution ultrasound of the knee joint. The ultrasound images were analyzed for cartilage thinning, osteophytes, synovial effusion, synovial proliferation, popliteal cyst, and meniscal protrusion. Image analysis was performed by two readers and linear regression analysis was used to determine association of ultrasound findings with WOMAC. There was excellent inter-observer agreement of both readers for cartilage thinning (k = 0.99, P = 0.001), osteophytes (k = 0.94, P = 0.001), synovial effusion (k = 0.98, P = 0.001), synovial thickening (k = 0.96, P = 0.001), popliteal cyst (k = 1.00, P = 0.001), and meniscal protrusion (k = 0.86, P = 0.001). There was significant association of WOMAC with cartilage changes (t = 3.406, 3.302, P = 0.001), osteophytes (t = 3.841, 3.006, P = 0.001), and synovial effusion (t = 4.140 and 2.787, P = 0.05) of both readers. We concluded that ultrasound is a reproducible method for assessment of knee osteoarthritis and well correlated with WOMAC.
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            Nineteen Reasons Why Physiatrists Should Do Musculoskeletal Ultrasound

            This article is an eventual consensus of experts from the European Musculoskeletal Ultrasound Study Group (EURO-MUSCULUS) and the Ultrasound Study Group in Physical and Rehabilitation Medicine (USPRM) pertaining to the use of musculoskeletal ultrasound in physical and rehabilitation medicine. Nineteen important reasons (as regards general advantages, specific conditions in physical and rehabilitation medicine, as well as comparisons with other imaging tools) have been highlighted to consolidate the scenario of how/why the probe of ultrasound needs to become the stethoscope, the extended hand, and the pen of physiatrists.
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              • Article: not found

              Teaching medical students diagnostic sonography.

              The purpose of this pilot project was to train medical students in sonography. Thirty-three medical students participated in a pilot sonography course, which included exposure to ultrasound physics, knobology of a compact ultrasound scanner, training in scanning and anatomy of the aorta and right kidney, and reading assignments in these areas. Pretraining and posttraining examinations were given in these areas to analyze the degree of knowledge gained by these methods. Nearly all of the medical students increased their basic knowledge of sonography and improved their scanning skills. The improvement was statistically significant in all areas. Training in sonography for medical students could be used as a foundation for later, more specialty-specific training to improve the overall medical sonography skills for all physicians.
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                Author and article information

                Contributors
                ahmad_raeissadat@yahoo.com
                Journal
                BMC Musculoskelet Disord
                BMC Musculoskelet Disord
                BMC Musculoskeletal Disorders
                BioMed Central (London )
                1471-2474
                14 October 2020
                14 October 2020
                2020
                : 21
                : 680
                Affiliations
                [1 ]GRID grid.411600.2, Physical Medicine and Rehabilitation Research Center and Department, , Shaheed Beheshti University of Medical Sciences, ; Tehran, Iran
                [2 ]GRID grid.411600.2, Department of Physical Medicine and Rehabilitation, , Shaheed Beheshti University of Medical Sciences, ; Tehran, Iran
                [3 ]GRID grid.411600.2, Physical Medicine and Rehabilitation Research Center, Shohada-e-Tajrish Hospital, , Shaheed Beheshti University of Medical Sciences, ; Tehran, Iran
                [4 ]Neshat Physical Medicine, and Rehabilitation Clinic, Karaj, Iran
                [5 ]GRID grid.411746.1, ISNI 0000 0004 4911 7066, Department of Physical Medicine and Rehabilitation, Neuromusculoskeletal Research Center, School of Medicine, , Iran University of Medical Sciences, ; Tehran, Iran
                [6 ]GRID grid.412888.f, ISNI 0000 0001 2174 8913, Physical Medicine and Rehabilitation Research Center, , Tabriz University of Medical Sciences, ; Tabriz, Iran
                Author information
                http://orcid.org/0000-0003-1512-0921
                Article
                3708
                10.1186/s12891-020-03708-1
                7559464
                a3376cb3-571b-4e49-bbc5-16f4d236723a
                © The Author(s) 2020

                Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.

                History
                : 25 June 2020
                : 9 October 2020
                Funding
                Funded by: Physical Medicine and Rehabilitation Research Center, Shaheed Beheshti University of medical sciences
                Categories
                Research Article
                Custom metadata
                © The Author(s) 2020

                Orthopedics
                neuromusculoskeletal sonography,physical medicine and rehabilitation,knowledge assessment,residency curriculum perspectives

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