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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 13 - 13
1 Oct 2022
Webber R Reddington M Arris S Mawson S
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Background

Advice and education are considered vital components of back pain care within national guidelines. However, a recent systematic review only found low grade evidence for a small average effect. They also reported wide heterogeneity in intervention design and delivery. This review aimed to understand why intervention design varied and what limited effectiveness by examining the underlying theoretical foundations of the studies from that review.

Method

Population, context, selection criteria, intervention(s), control, outcome measures, how the intervention was hypothesised to produce outcomes and author recommendations based on results of the study were extracted from text records. The extent to which the advice included matched a published international consensus statement on evidence-based advice for back pain was recorded. Whether interventions or settings were complex was determined using the Medical Research Council complex intervention development and evaluation guidance and the extent to which they met complexity reporting criteria was recorded.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 17 - 17
1 Sep 2019
Reddington M Walters S Cohen J Baxter S Cole A
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Purpose of the study

To investigate the feasibility of undertaking a definitive Randomised Controlled Trial (RCT) to determine the effectiveness of early physiotherapy for sciatica.

Methods

Patients over 18 presenting to their G.P with sciatica were eligible to participate in the study, those without a clear understanding of English or had co-morbidities preventing rehabilitation were ineligible. Process and patient reported outcomes including self-rated disability, pain and general health, were collected at baseline, 6,12 and 26 weeks post randomisation.

Participants were randomised into either early physiotherapy, receiving treatment within 2 weeks after randomisation or usual care with physiotherapy commencing 6 weeks post randomisation. Both groups received up to 6 treatment sessions of a patient-centred, goal orientated physiotherapy programme specific to their needs.


Orthopaedic Proceedings
Vol. 101-B, Issue SUPP_9 | Pages 18 - 18
1 Sep 2019
Reddington M Walters S Cohen J Baxter S Cole A
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Purpose of the study

The aims of the study were to explore the experiences of sciatica sufferers, their perceptions of physiotherapy and healthcare service provision.

Methods

This was the qualitative element of a mixed methods study investigating the feasibility of early physiotherapy for sciatica. Participants in the pilot trial consented to take part in semi-structured interviews before and after they had undertaken an individualised physiotherapy programme. Data from the interviews was examined line by line using a thematic analysis approach with key themes and sub-themes emerging.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 28 - 28
1 Feb 2014
Newsome R Reddington M Breakwell L Chiverton N Cole A Michael A Boote J Dimairo M
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Purpose of study and background

The primary aim of the study was to test the feasibility of conducting a full RCT with economic analysis and help to inform the provision of physiotherapy in a specific sub-group of patients with sciatica

Methods

60 patients waiting for primary, unilateral, single level, lumbar micro-discectomy surgery were recruited and randomised into two groups. The intervention group received a new spinal physiotherapy regimen. Primary outcome measure was the number of patients who did not require surgery at the time of consent clinic. Secondary measures were the Visual Analogue Scale (VAS) Oswestry Disability Index (ODI) and EQ5DL, taken at recruitment, 1 week before surgery and 2 weeks and 3 months after surgery.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 6 - 6
1 Feb 2014
Newsome R Reddington M Boote J Breakwell L Chiverton N Michael A Cole A Dimairo M
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Objectives

To investigate the views and experiences of patients with sciatica who have undergone a bespoke physiotherapy programme whilst awaiting primary lumbar microdiscectomy.

Methods

This is a qualitative study, nested within a preliminary RCT. All patients were listed for primary, single-level microdiscectomy surgery. In the experimental arm of the study 29 patients had up to 6 sessions of physiotherapy over an 8 week period while on the waiting list for lumbar microdiscectomy. After surgery, they were invited to participate in an in-depth semi-structured interview. At this time patients had either decided not to have the surgery, or had undergone surgery. Interviews were audio-recorded, transcribed, and thematically analysed. Two researchers were involved in the analysis of the data to ensure the interpretation of the findings was robust, credible and trustworhy.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 60 - 60
1 Jun 2012
Newsome R Reddington M Breakwell L Chiverton N Cole A Michael A
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Purpose

To question the reliability of Thoracic Spine pain as a red flag and symptoms of a possible cause of Serious Spinal Pathology (SSP).

Methods

The clinical notes and Magnetic Resonance Imaging (MRI) results of patients presenting to the Sheffield Spinal Service with Thoracic spine symptoms but no signs were retrospectively reviewed over the period of 2 year (September 2008-August 2010).

The clinical reason for request of Thoracic MRIs were noted and the patient notes were reviewed to determine their presentation, length of time of symptoms, age and also it was noted whether any other recognized red flag symptoms were present. Exclusion criteria consisted of patients referred with known SSP or myelopathic symptoms.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 84 - 84
1 Jun 2012
Newsome R Reddington M Breakwell L Chiverton N Cole A Michael A
Full Access

Purpose

To evaluate the competencies of spinal extended scope physiotherapists (ESP) following the introduction of requesting rights for magnetic resonance imaging (MRI) one year later.

Methods

From September 2009 to August 2010 each MRI scan requested by the 2 spinal ESPs within the orthopaedic clinic was recorded along with their clinical diagnosis to ascertain why the scan was requested. This was indicated on a four point scale of likelihood of pathology which had been introduced to give evidence for MRI requesting rights. This was then audited to determine the total number of scans requested along with the accuracy or justification of the request.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 378 - 378
1 Jul 2010
Newsome R Reddington M Breakwell L Chiverton N Cole A
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Purpose: To investigate whether patients who present with Lumbar radicular signs and symptoms and who have MRI scans reported as showing no nerve root compression, improve following Nerve Root Injection (NRI).

Methods: The clinic notes and MRI results of 127 patients who underwent NRI under the care of two spinal surgeons were reviewed retrospectively. Those patients with radicular pain and MRI scans reported as showing no nerve root compression were evaluated further. All patients had a selective NRI using a standard image intensifier guided oblique approach with 40 mg Kenalog and 1 ml 0.25% bupivacaine injected around the nerve root. The patients’ symptoms and signs were noted at the follow up appointment six weeks later.

Results: 43 of the 127 patients who underwent selective NRI had MRI scan reports suggesting no nerve root compression. Of the 47 patients 30 (69%) reported a significant improvement (p=0.0009) in their leg pain following the NRI, the remaining 13 patients reported no relief.

Conclusions: Clinicians treating patients presenting with lumbar radicular signs and symptoms should not rely on MRI report alone in the diagnosis and management of the patient. The results show that patients who exhibit lumbar radicular signs and symptoms who have non-concordant MRI results may still benefit from treatment (NRI).

Ethics approval: None required

Statement of interest: None


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 381 - 381
1 Jul 2010
Reddington M Chiverton N
Full Access

Aims: To establish whether self rated disability and physical function in people with Chronic Low Back Pain (CLBP) are correlated.

Design/Methods: The study was observational/correlational in design. One hundred patients attending orthopaedic surgical clinics or for physiotherapy at the Northern General Hospital (NGH) site of Sheffield Teaching Hospitals (STH) were recruited for the study. Once consent was obtained patients were asked to complete the Oswestry Disability Index (ODI) and undertake the Harding battery of physical performance.

Results: The Pearson product moment correlation coefficients were calculated for the group using SPSS v.13. The results show low negative correlations for the whole group with low to moderate negative correlations for the male group. There were no statistically significant correlations for the physical performance measures and ODI in the female sub-group.

Pearson correlation Co-efficient results for all participant

Conclusions: The lack of correlation between self-rated disability and physical performance suggests that the two constructs are un-related and as such should be measured separately. There were significant differences between the physical performance parameters between genders. This enhances the findings of previous studies which, together with this study suggest that the level of physical performance should not be extrapolated from self-rated disability questionnaires.

Ethics Approval: The study was approved by the North Sheffield ethics committee (ref: 07/H1308/120) and Sheffield Teaching Hospitals NHS Foundation Trust (ref: STH 14280)

Statement of interest: None


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 489 - 489
1 Sep 2009
Newsome R Reddington M Breakwell L Chiverton N Cole A
Full Access

Objective: To determine whether extended scope physiotherapists (ESP’s) in spinal clinics are able to accurately assess and diagnose patient pathology as verified by MRI findings.

Methods: This is a prospective study of 318 new spinal outpatients assessed and examined by one of two spinal ESP’s. 76 patients (24%) were referred for an MRI scan. At the time of request for MRI scan the likelihood of specific spinal pathology correlating with the MRI scan was noted on a four point scale dividing the patients into 4 groups:

Group 4 = Very high suspicion of pathology (n=41)

Group 3 = Moderate suspicion of pathology (n=21)

Group 2 = Some suspicion of pathology (n=10)

Group 1 = Pathology unlikely but scan indicated eg thoracic pain (n=4).

Results: Of the 76 patients referred for an MRI scan, 54 (71%) had an MRI scan result that would correlate with the clinical picture. Looking at the percentage of scans correlating with the clinical picture for each of the 4 groups:

Group 4: 88%

Group 3: 67%

Group 2: 40%

Group 1: 0%

Conclusion: Dividing the patients into groups by clinical suspicion is essential for evaluating a clinician’s ability in spinal assessment. Further evaluation of Consultants, Fellows and Specialist Registrars is on going. This type of study could form a basis for competency measures for staff development and training if they are undertaking extended roles.