ObjectiveTo expand access to comprehensive rehabilitation services among veterans with cancer by increasing cancer rehabilitation referrals in a Veterans Affairs (VA) hospital.DesignA rapid cycle improvement approach based on the Institute of Healthcare Improvement's Model for Improvement was used to assess and optimize the cancer rehabilitation referral process. In this quality improvement project, our cancer rehabilitation workgroup developed an electronic screening tool within the VA electronic patient record system to streamline cancer rehabilitation referrals. Providers could complete an optional Cancer Rehabilitation (CaRe) Screen that consisted of 12 questions related to patient symptoms and function. If the screen was positive, a nonvisit electronic consult was automatically generated and sent to a physiatrist for review. The physiatrist would then triage patients to appropriate services including physiatry, physical therapy, occupational therapy, speech therapy, rehab psychology, and other rehabilitation services.ResultsA total of 90 referrals were placed between 2019–2021. A total of 84% of the patients referred were male, 73% were white. The top cancer types referred were lung (27%), blood (23%), gastrointestinal (12%), and prostate (10%). There were 19 referrals in 2019, 13 in 2020, and 58 in 2021. The electronic screening tool was implemented in mid‐2021. Advanced practice providers placed 48% of consults. Of the referrals placed in 2021, 13% of consults were initiated through the electronic screening tool. The most common rehabilitation‐related referrals placed after initial cancer rehabilitation triage included physical therapy (n = 47, 35.1%), physiatry (n = 28, 20.9%), and occupational therapy (n = 24, 17.9%).ConclusionsImplementing an electronic screening tool can streamline cancer rehabilitation referrals and increase access to cancer rehabilitation services for Veterans with cancer. Ongoing work is required to refine the referral process and educate providers and patients on the importance of cancer rehabilitation in the cancer care continuum.

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IntroductionRoutinely assessing exercise levels during clinical visits may be a starting point for clinicians to support physical activity in persons with multiple sclerosis (MS).ObjectiveTo evaluate the feasibility and findings of routinely implementing a self‐reported physical activity vital sign during clinical visits.DesignRetrospective database review.SettingOutpatient academic MS center.PatientsAll adult patients of our MS center with confirmed MS presenting for an in‐person or telemedicine clinic visit with a physician or nurse practitioner.InterventionsNone.Main Measure(s)A standard physical activity vital sign representing minutes per week of moderate‐to‐vigorous exercise was collected. Percentage of persons with MS with a recorded physical activity vital sign was retrospectively evaluated along with demographic characteristics and key findings.ResultsNinety‐three percent of patients with MS at our center had a physical activity vital sign recorded in at least one visit, and 86% at the most recent visit. Of 1560 patients with a recorded physical activity vital sign, 24.3% of patients were consistently active (≥150 min/week of exercise), 20.8% were consistently inactive (0 min/week), and the remaining 54.9% were inconsistently active. The physical activity vital sign was inversely associated with BMI (p < .001) and 25‐foot walk test times (p < .001), but not associated with biological sex or age.ConclusionsApproximately a quarter of patients with MS with a documented physical activity vital sign met national aerobic exercise guidelines of 150 min/week per the U.S. Department of Health and Human Services. Routine implementation of the physical activity vital sign at our MS center was feasible and helped identify inactive patients who may benefit from physical activity counseling.

The first metatarsal-phalangeal joint plays a key role for athletes of various disciplines. When an athlete presents for evaluation of pain at this joint, there are several causes that should be considered. The purpose of this article is to review common injuries including turf toe, sand toe, extensor and flexor hallucis longus tendinopathy, sesamoiditis, and metatarsalgia and provide current evidence-based recommendations for diagnosis, management, and return to play considerations. Conditions not specific to athletes like gout and hallux rigidus also are discussed. Mechanism of injury, physical examination, and imaging such as weight-bearing radiographs and point-of-care ultrasound can help with diagnosis. Treatment of many of these injuries begins with nonsurgical management strategies including footwear or activity modification, physical therapy, and select interventions.