Total knee arthroplasty (TKA) is considered as one of the most successful and cost-effective medical interventions yet it is consistently reported that up to 20% of patients are dissatisfied with their outcomes. Patient satisfaction is correlated with the fulfillment of expectations and an important aspect of this involves good surgeon-patient communication, which itself is a contributor to TKA satisfaction. The purpose of this study was to develop and test a checklist intended to enhance the quality of surgeon-patient communication by optimizing the surgeon's role in helping patients set (or reset) and manage post-TKA expectations that are realistic, achievable, and most importantly, patient-specific. In this prospective mixed methods study, a communication checklist was developed from the analysis of interviews with patients who were between six weeks and six months post-TKA. Four orthopaedic surgeons then used the checklist to guide discussions with patients about post-operative expectations and outcomes during follow-up visits between six weeks and six months. A visual analogue scale was used to survey two groups of patients on five measures of satisfaction: the standard of care communication group and the intervention group who had received the checklist. The mean scores of the two groups were compared using independent t-tests. The duration of follow-up visits was also tracked to determine if the checklist took significantly more time in practice. Themes from the qualitative analysis of eight patient interviews incorporated into the checklist included pain management, medication, physiotherapy, and general concerns and questions. The quantitative study comprised 127 participants, 67 in the standard of care communication group and 60 in the checklist group. There were no significant group differences in gender, BMI, comorbidities, post-operative complications, marital or occupational status, however the standard of care group was older by six years (p < .001). The checklist group reported significantly greater satisfaction on four of the five measures of satisfaction: TKA satisfaction and expectations met (p = .017), care and concern shown by the surgeons (p = .011), surgeons' communication ability (p = .008), and satisfaction with time surgeons spent with patients during follow-up visits (p < .001). Satisfaction with the TKA for relieving pain and restoring function was not significant (p = .064). Although the checklist increased the average clinic visit time by only 1 minute, 51 seconds, it was significantly greater (p = .001). The impact of age and gender on satisfaction was explored using a two-way analysis of variance. No significant effects or interactions were observed. Checklists have been shown to decrease medical errors and improve overall standards of patient care but no published research to date has used a communication checklist to enhance orthopaedic surgeon-patient communication. The present findings indicate that this simple tool can significantly increase patient satisfaction. This has practical significance because patient satisfaction is a metric that is increasingly used as a key performance indicator for surgeons and health care institutions alike. Increased TKA satisfaction will benefit patients, surgeons, and the health care system overall

Osteoarthritis (OA) leads to articular cartilage degradation, following complex dysregulation of chondrocyte's metabolism towards a catabolic state. Mechanical and biochemical signals are involved and need to be considered to understand the condition. Regulatory network-based models (RNM) successfully simulated the biological activity of the chondrocyte and the transduction of mechanical signals at the molecular and cell levels. However, the knowledge gap between single-cell regulation and intercellular communication in tissue volumes hinders the interpretability of such models at larger scales. Accordingly, a novel tissue-level biochemical model is proposed. We hypothesise that it is possible to simulate interacting network effects through the transport of diluted species in a finite-element model, to grasp relevant dynamics of cell and tissue regulation in OA. Chondrocyte RNM equations were translated into a reaction term of 18 multi-species diffusion model (e.g., 3 anti-inflammatory and 8 pro-inflammatory interleukins, 3 pro-anabolic and 1 pro-catabolic growth factors, 2 nociceptive factors and 2 pro-inflammatory cytokines). Elements with RNM reaction terms represented the chondrocytes and were distributed randomly through the model, according to known cellular density in the knee cartilage, and could both react to and produce diffusive entities through the pericellular matrix, associated with reduced diffusion coefficients. The model was constructed over a 2D square of 0.47 mm sides considered to be in the middle of the cartilage, so boundary conditions were settled as periodic. Different simulations were initialised with initial concentrations of either healthy or pro-OA mediators. Preliminary results showed that, independently of the initial conditions, the chondrocytes successfully evolved into anabolic states, in absence of sustained pro-catabolic external stimulations, in contrast to single-cell RNM [2]. Our intercellular model suggests that paracrine communication may increase robustness towards cartilage maintenance, and future tests shall reveal new OA dynamics. Acknowledgements: Funding was provided by the European Commission (ERC-2021-CoG-O-Health-101044828)

The purpose of the this survey study was twofold: 1) to examine different aspects of satisfaction with post-operative care in injured workers who have undergone rotator cuff surgery and 2) to examine the relationship between receiving a newly implemented summary report and the overall satisfaction with surgery and recovery. The clinical communication summary report was given to injured workers following their review assessment to share with the family doctor or other health care providers. The form indicated a need for further assessments or investigations and return to work recommendations. The study involved using a satisfaction survey that examined different aspects of follow-up visit and workers’ opinion about their understanding of the nature of surgery, their progress, clinical management, and usefulness of the newly implemented summery report. Eighty patients completed the questionnaire (mean age: 54 (8), 62(78%) males, of whom 26 (34%) had a rotator cuff decompression and 31 (40%) had a rotator cuff repair with 20 (26%) having both procedures and three missing data. There were no statistically significant relationships between the patient demographics (age, sex or type of surgery) and satisfaction. However, there was a significant correlation between how patients perceived the summary report in terms of helpfulness and the overall satisfaction with surgery (FTE<0.0004, p=0.001) and the satisfaction with recovery (FTE<0.0001, p=0.001). This may indicate that improvement in worker's understanding of their treatment recommendations and restrictions is associated with higher levels of overall satisfaction in this population. Our results indicate a positive linear relationship between expressing a high satisfaction and the helpfulness of the summary report. As part of improving care, adding a summary report may facilitate sharing information with the injured workers, their care providers and their workplace

Background and purpose of study: Communication between clinicians and patients forms an integral part of any treatment session. To promote positive treatment outcomes, this communication must be effective. To date, research into back pain management has tended to focus on the nature of interventions, neglecting the vital communication that co-exists. This study aimed to measure verbal communication between clinicians and patients and identify trends in non-verbal communication. With a clearer understanding of how clinicians and patients interact, it is anticipated that this knowledge can be used to maximise health gain in subsequent treatments. Methods: Following an assessment, the first follow-up treatment session was video recorded for 21 patients (aged 17–65 years), attending a hospital outpatient physiotherapy clinic. Patients with serious spinal pathology or those, whose first language was not English, were excluded. Verbal communication during the interaction was measured using the validated Medical Communication Behaviour System (MCBS). Trends in non-verbal behaviour were analysed at 40-second intervals, using Heintzman’s classification (smiling, forward leaning, affirmative head nodding, touching and eye gaze). A brief semi-structured interview was undertaken with clinicians to determine the perceived effect of the presence of the video camera. Results: In 21 treatment sessions, 2055 statements were observed, with clinicians spending approximately twice as long talking as patients. Using the MCBS categories, the majority of clinician and patient interaction related to ‘content’ behaviours (52% and 26% respectively). For the clinician, this includes history-taking, advice etc. The highest frequency of clinicians’ non-verbal behaviour was touch (n=352) and for patients, was eye gaze (n=36). In a secondary analysis, age, gender and experience of the clinician were all shown to influence the communication that occurred. Conclusion: Validated outcome measures can be used to analyse the complex communication that occurs between clinicians and patients with back pain. Video recording clinical sessions can provide valuable feedback for clinicians and students on their communication skills

Aims. The Bracing Adolescent Idiopathic Scoliosis (BASIS) study is a randomized controlled non-inferiority pragmatic trial of ‘full-time bracing’ (FTB) compared to ‘night-time bracing’ (NTB) for the treatment of adolescent idiopathic scoliosis (AIS). We anticipated that recruiting patients to BASIS would be challenging, as it is a paediatric trial comparing two markedly different bracing pathways. No previous studies have compared the experiences of AIS patients treated with FTB to those treated with NTB. This qualitative study was embedded in BASIS to explore families’ perspectives of BASIS, to inform trial communication, and to identify strategies to support patients treated in a brace. Methods. Semi-structured interviews were conducted with parents (n = 26) and young people (n = 21) who had been invited to participate in BASIS at ten of the 22 UK paediatric spine services in hospitals recruiting to BASIS. Audio-recorded interviews were transcribed and analyzed thematically. Results. Families viewed their interactions with BASIS recruiters positively, but were often confused about core aspects of BASIS, such as the aims, expectations of bracing, and the process of randomization. Participants typically expressed a preference for NTB, but recruiters may have framed NTB more favourably. Patients and parents reported challenges wearing a brace, such as physical discomfort, feelings of self-consciousness, difficulty participating in physical activities, and strain on financial resources to support brace use. Patients in FTB reported more pronounced challenges. While families valued health professional support, they felt there was a lack of social, emotional, and school support, and relied on online resources, as well private counselling services to address this need. Conclusion. The findings informed the development of resources and strategies, including guidance for schools and the recommendations in this paper, to support patients to wear NTB and FTB as prescribed. The results indicated opportunities for recruiters to enhance trial communication in ways that could improve informed consent and recruitment to BASIS, and inform future trials of bracing. Cite this article: Bone Jt Open 2025;6(2):135–146

Aims. Gap junction intercellular communication (GJIC) in osteocytes is impaired by oxidative stress, which is associated with age-related bone loss. Ageing is accompanied by the accumulation of advanced oxidation protein products (AOPPs). However, it is still unknown whether AOPP accumulation is involved in the impairment of osteocytes’ GJIC. This study aims to investigate the effect of AOPP accumulation on osteocytes’ GJIC in aged male mice and its mechanism. Methods. Changes in AOPP levels, expression of connexin43 (Cx43), osteocyte network, and bone mass were detected in 18-month-old and three-month-old male mice. Cx43 expression, GJIC function, mitochondria membrane potential, reactive oxygen species (ROS) levels, and nicotinamide adenine dinucleotide phosphate (NADPH) oxidase activation were detected in murine osteocyte-like cells (MLOY4 cells) treated with AOPPs. The Cx43 expression, osteocyte network, bone mass, and mechanical properties were detected in three-month-old mice treated with AOPPs for 12 weeks. Results. The AOPP levels were increased in aged mice and correlated with degeneration of osteocyte network, loss of bone mass, and decreased Cx43 expression. AOPP intervention induced NADPH oxidase activation and mitochondrial dysfunction, triggered ROS generation, reduced Cx43 expression, and ultimately impaired osteocytes’ GJIC, which were ameliorated by NADPH oxidase inhibitor apocynin, mitochondria-targeted superoxide dismutase mimetic (mito-TEMPO), and ROS scavenger N-acetyl cysteine. Chronic AOPP loading accelerated the degradation of osteocyte networks and decreased Cx43 expression, resulting in deterioration of bone mass and mechanical properties in vivo. Conclusion. Our study suggests that AOPP accumulation contributes to age-related impairment of GJIC in osteocytes of male mice, which may be part of the pathogenic mechanism responsible for bone loss during ageing. Cite this article: Bone Joint Res 2022;11(7):413–425

Few doctors answer their bleep by stating who they are. Answering the phone in a formal manner is of utmost importance in the hospital setting especially by on-call teams who are normally referred patients by other specialties, general practitioners and in some cases by other hospitals. An audit to evaluate the internal hospital communication was completed. In the first part of this audit, junior doctors within the orthopaedic department at the RAH were bleeped. Doctors were expected to answer by initiating the conversation by stating (1) name, (2) department, (3) grade and (4) a greeting. A list of omissions was recorded. If the call went through switchboard, it was expected that the hospital name was stated. The second part of the audit extended to other specialties in the RAH as well as orthopaedic departments in hospitals within the Greater Glasgow and Clyde health board (NHS GGC). Forty-three bleeps were made to doctors of various grades over a period of two months. Nine bleeps (two from other hospitals) were not answered. Five doctors answered their bleep in full. Only twenty-one doctors stated their name whilst eleven stated their grade. In both instances the department was not necessarily stated. The results were similar between the different departments as well as between the seven hospitals offering an orthopaedic service within NHS GGC. Of the thirteen on-call doctors that were bleeped as an external call through switchboard, only one doctor stated the hospital name. This has implications since most hospitals within NHS GGC share a common switchboard. These results emphasise the need for a protocol within NHS GGC for a standard etiquette for intra and inter hospital communication to ensure that patient safety and confidentiality is safeguarded

This study evaluates forty-four consecutive autopsy specimens of the senior author’s own patients in attempt to locate and measure periacetabular bone defects and correlate this information with their communication pathways with the joint space. The purpose of this study was to evaluate autopsy retrieved hemipelves of previously well-functioning total hip arthroplasties (THAs) with computed tomography (CT) to better understand patterns of osteolysis around modular uncemented acetabular components. Forty-four hemipelves containing titanium porous-coated modular acetabular components were retrieved at autopsy, imaged with CT, and analyzed to determine the location and volume of osteolytic lesions. The mean age of the patients at the time of surgery was seventy years. The mean time in situ for the implants was eight years. A total of forty-six osteolytic lesions were identified in twenty-eight of the forty-four cases (64%). Thirty-one of forty-six lesions (67%) had one or more apparent communications with the joint space. We identified four types of communication pathways between osteolytic lesions and the joint space: around the rim, through a central dome hole, in association with a screw or screw hole, or around a non-ingrown interface. The mean volume of lesions that had a clear communication pathway was significantly larger than those lesions that did not have a clear communication pathway (p=0.012). Thirteen of the fifteen lesions that did not have a clear communication with the joint space represented bone defects that had existed prior to total hip arthroplasty. Osteolysis was commonly observed at early time intervals around modular uncemented acetabular components. The communication with the joint space is important for developing osteolysis, as well as in the detection of true osteolytic lesions

Abstract. Introduction. Transforming outpatient services is a key commitment set out in the NHS Long Term Plan, with particular emphasis on digital solutions to reduce outpatient follow-up (FU) by 25%. This study looks at the potential for removing knee arthroscopy FU by providing a bespoke multimedia report for each individual patient, generated using the Synergy™ Surgeon App (Arthrex). Methodology. Single District Hospital using a 3 Phase study. Phase 1 – Assessment of cost and environmental impact of outpatient follow up appointments. Phase 2 – Bench marking of existing pathways and patient experience. Phase 3 – Qualitative assessment of multimedia report feedback of 30 patients. Results. Phase 1 – Impact per year for Trust in released clinician time 135hrs. Cost avoidance £40-£60k. Reduction of the carbon footprint from reduced FU of 3132 KgCo2e2. Phase 2 – Deep dive on 2019 n. 353 procedures. 1206 outpatient appointments required. Average 1.2 post-operative appointments. Phase 3 – 87% of patients who received the e-op report needed no further FU. This compares to only 25% using a traditional post op discussion after surgery. 94% of patients felt the report aided their recovery. Conclusions. Reducing patient FU appointments is crucial to the future of the NHS. Achieving this whilst simultaneously improving the quality of patient communication is achievable as this study has demonstrated. The potential scalability of this project to be applied other arthroscopic procedures is enormous. The study has demonstrated patients are comfortable with modern technology and feel it enhances their understanding whilst decreasing the need for routine post-op FU

Multiple myeloma (MM) is an incurable hematological tumor stemming from malignant plasma cells. MM cells accumulate in the bone marrow (BM) and shape the BM niche by establishing complex interactions with normal BM cells, boosting osteoclasts (OCLs) differentiation and causing bone disease. This unbalance in bone resorption promotes tumor survival and the development of drug resistance. The communication between tumor cells and stromal cells may be mediated by: 1) direct cell-cell contact; 2) secretion of soluble factors, i.e. chemokines and growth factors; 3) release of extracellular vesicles/exosomes (EVs) which are able to deliver mRNAs, miRNAs, proteins and metabolites in different body district. Primary CD138+ MM cells were isolated from patients BM aspirates. MM cell lines were cultured alone in complete RPMI-1640 medium or co-cultured with murine (NIH3T3) or human (HS5) BMSC cell lines or murine Raw264.7 monocytes in DMEM medium supplemented with 10% V/V FBS. Silencing of Jagged1 and Jagged2 was obtained by transient expression of specific siRNAs or by lentiviral transduction using a Dox-inducible system (pTRIPZ). EVs were isolated using differential ultracentrifugation. EVs concentration and size were analyzed using Nano Track Analysis (NTA) system. The uptake of PKH26-labelled MM-derived EVs by HS5 or Raw264.7 was measured after 48 hours by confocal microscopy and flow cytometry. Osteoclast (OCL) differentiation of Raw264.7 cells was induced by 50ng/ml mRANKL, co-culturing with MM cells, CM or EVs. OCLs were stained by TRAP Kit and counted. Bone resorption was assessed by Osteo Assay Surface plates. Flow cytometric detection of apoptotic cells was performed after staining with Annexin V. Gene expression was analyzed by qRT-PCR, while protein levels were determined using flow cytometry ELISA or WB. Notch oncogenic signaling is dysregulated in several hematological and solid malignancies. Notch receptors and ligands are key players in the crosstalk between tumor cells and BM cells. We have demonstrated that: 1) the dysregulated Jagged ligands on MM cells trigger the activation of Notch receptors in the nearby stromal cells by cell-cell contact. This results in the release of anti-apoptotic and growth stimulating factors, i.e. IL6 and SDF1; 2) MM cells promote the development of bone lesions boosting osteoclast differentiation by secreting soluble factors (i.e. RANKL) and by the activation of Notch signaling mediated by direct contact with osteoclast precursors; 3) Finally, we present evidences that EVs play a crucial role in the dysregulated interactions of MM cells with the microenvironment and that Notch signaling regulates their release and participate in this cross-talk. These evidences supports the hypothesis that Jagged targeting on MM cells may interrupt the communication between tumor cells and the surrounding milieu, blocking the activation of the oncogenic Notch pathway and finally resulting in the a reduction of MM-associated bone disease and drug resistance

Purpose of the study and background. The CONNECT trial evaluated a theory-based intervention to increase low back pain patients' adherence to treatment recommendations through physiotherapists' communication behaviour. Bridging the gap between evidence and evidence-based practice, we aimed to develop an implementation intervention to support physiotherapists in translating the CONNECT communication training into practice. Methods and results. A systematic approach was used to develop this intervention. 1. Focus groups underpinned by the Theoretical Domains Framework were conducted to assess CONNECT trained physiotherapists' (n = 9) perceptions of the barriers and enablers to implementing these strategies in practice; the results of which yielded four main domains; two related to factors outside the individual (i.e. social influences and environmental resources), and two related to individuals' motivation and capabilities (i.e. self –efficacy and behavioural regulation). 2. Intervention components (i.e., behavior change techniques (BCT) and mode of delivery) were chosen. BCTs were mapped to the identified domains (e.g., the BCT of self-monitoring mapped to the self-efficacy domain) and audit and feedback focused coaching was selected as the main mode of delivery based on empirical evidence and feasibility. 3. Outcome measures were selected to evaluate the proposed changes in physiotherapist practice (i.e., Health Care Climate Questionnaire). This intervention was trialed with physiotherapists (n = 2) using a case-study design. Results from patient consultation audio-recordings and follow-up interviews revealed this intervention supported the translation of evidence-based training into practice and is considered feasible and acceptable to physiotherapists. Conclusion. Findings provide support for the systematic development and implementation of an intervention to translate evidence-based communication training into practice

Elastic energy-storing tendons including the equine superficial digital flexor tendon (SDFT) and human Achilles tendon significantly increase locomotor efficiency, but suffer high injury rates and experience increased core temperatures during exercise. Tenocytes are linked by gap junctions (GJ) comprised of connexin (Cx) proteins that mediate intercellular communication and are necessary for strain-induced collagen synthesis. The effects of hyperthermia on gap junction intercellular communication (GJIC) are unknown. We investigated the hypothesis that there is a down regulation in GJIC and Cx protein by tenocytes in response to hyperthermic episodes similar to those experienced in the SDFT of galloping horses. Monolayers of equine SDFT-derived cells were heated to 45°C for 10 minutes. GJIC, Cx43 and Cx32 protein expression and cell viability were measured by fluorescence recovery after photobleaching (FRAP) and immunofluorescent labelling respectively. There was a marked reduction in GJIC (p=< 0.0001) compared with controls (37oC) at 30min and 1h post-heating, with significant recovery by 2h (p=< 0.0001). The number of Cx43 plaques/cell also decreased significantly at 30mins (p=< 0.05), 1h (p=< 0.0001) and 2h (p=< 0.0001). There was however a 3-fold increase in the number of Cx32 plaques/cell at 1h (p=< 0.0001) that returned to normal by 2h. There was little change in cell viability up to 2h, however by 24h post-heating there was an 80% decrease in cell number indicating significant levels of cell death (p=< 0.0001). Reductions in GJIC following exercise-induced hyperthermia may inhibit tenocyte collagen synthesis. Connexin isotypes may differentially modulate tenocyte collagen synthesis, therefore the dissimilar alterations in Cx43 and Cx32 following heating could have functional importance. The return of GJIC a few hours post-heating might facilitate spread of apoptotic death signals, killing neighbouring cells which would have otherwise escaped death. Understanding the responses of GJ to increased temperature, and the effects of this on viability and collagen synthetic capacity is likely to increase our knowledge of how exercise-induced SDFT core degeneration accumulates

Wireless technologies and their use in the medical field have become much more widespread and important in the last decade. Whether it is a doctor carrying a personal digital assistant, the hospital WLAN, RFID asset tracking systems, telemetry-based Point-of-Care systems, or implanted wireless devices, wireless systems play an important role in the underlying technologies utilized by a hospital. Conversely, wireless technologies are not widely used in computer assisted orthopaedic surgery (CAOS), mainly due to their poor performance in the operating room (OR). The large amount of metallic interference found in the OR can severely degrade wireless signals. This can cause failure in wireless digital communication and large errors in 3-D tracking when using wireless signals for 3-D positioning. We have developed a wireless positioning system based on ultra wideband (UWB) technology which achieves mm-range 3-D dynamic accuracy and can be used for intraoperative tracking in CAOS systems. This system can be used to track smart surgical tools in the OR and also for registration of bones and conventional (non-smart) surgical tools. UWB technology also has the potential for high data rate digital communication. The potential of highly accurate 3-D tracking combined with high data rate digital communication make UWB an attractive wireless technology for future CAOS systems and provides a strong backbone for smart surgical tools. We have run various experiments with our UWB system in an OR both during orthopaedic surgeries and when the OR was empty. We have obtained time domain and frequency domain data, which has been analyzed to show the effects of transmitting UWB wireless signals in the OR. The implications of the OR environment on 3-D positioning accuracy and also high data rate digital communication will be presented. The final conclusions show the potential of UWB for wireless smart surgical tools which can be tracked in real-time with mm-range and even sub-mm range 3-D accuracy

The risk of venous thromboembolism following surgery, with its associated morbidity and mortality, means it forms an important part of informed consent for a surgical procedure. The risk of thrombo embolic complications extends beyond the post-operative hospital stay. Patients suffering such a complication after discharge are generally not re-admitted under the care of the operating surgeon. A retrospective opening loop audit was undertaken to investigate the communication of post-operative thrombo embolic complications between specialities in a large district general hospital. The operating surgeon was unaware of 87% of cases of pulmonary embolism and 20% of cases of deep vein thrombosis affecting patients in their post-operative period. The inter-specialty communication of post-operative complications is important to maintain a high standard of patient care and allow surgeons to make informed decisions about clinical practice

Patient satisfaction is an important measure of patient-centered outcomes and physician performance. Given the continued growth of the population undergoing surgical intervention for osteoarthritis (OA), and the concomitant growth in the associated direct costs, understanding what factors drive satisfaction in this population is critical. A potentially important driver not previously considered is satisfaction with pre-surgical consultation. We investigated the influence of pre-surgical consultation satisfaction on overall satisfaction following surgery for OA. Study data are from 1263 patients who underwent surgery for hip (n=480), knee (n=597), and spine (n=186) OA at a large teaching hospital in Toronto, Canada. Before surgery, patient-reported satisfaction with information received and degree of input in decision-making during the pre-surgical consultation was assessed, along with expectations of surgery (regarding pain, activity limitation, expected time to full recovery and likelihood of complete success). Pre- and post-surgery (6 weeks, and 3, 6, and 12 months) patients reported their average pain level in the past week (0–10, 10 is worst). At each follow-up time-point, two pain variables were defined, pain improvement (minimal clinically important difference from baseline ≥2 points) and ‘acceptable’ pain (pain score ≤ 3). Patients also completed a question on satisfaction with the results of the surgery (very dissatisfied/dissatisfied/somewhat satisfied/very satisfied) at each follow-up time point. We used multilevel ordinal logistic regression to examine the influence of pre-surgery satisfaction with consultation on the trajectory of satisfaction over the year of recovery controlling for expectations of surgery, pain improvement, acceptable pain, socio-demographic factors (age, sex, and education), body mass index, comorbidity, and depressive symptoms (Hospital Anxiety and Depression Scale). Mean age of the sample was 65.5 years, and over half (54.3%) were women. Overall, 74% and 78.9% of patients were satisfied with the information received and with the decision-making in the pre-surgical consultation, respectively, no significant differences were found by surgical joint (p=0.22). Post-surgery, levels of satisfaction varied very little over time (6 weeks: 92.5% were satisfied and 66.4% were very satisfied, 1 year: 91.1% were satisfied and 65.6% were very satisfied). Results from a model including time, surgical joint, satisfaction with consultation and control factors indicated that being satisfied with the information received in the pre-surgical consultation was associated with higher odds of being more satisfied after surgery (OR: 1.2, 95% CI: 1–1.4). Additionally, spine and knee patients were more likely to be dissatisfied than hip patients (OR: 3.2, 95% CI: 2.1–4.9 and OR: 2.5, 95% CI: 1.8–3.4 for spine and knee patients respectively). Achieving pain improvement (OR: 1.7, 95% CI: 1.3–2.4) and acceptable pain (OR: 2.5, 95% CI: 1.6–3.9) were both significantly associated with greater satisfaction. Pre-operative expectations were not significantly associated with post-surgery satisfaction. Findings highlight the important role of pre-surgery physician-patient communication and information on post-surgery satisfaction. This points to the need to ensure organizational provisions that foster supportive and interactive relationships between surgeons and their patients to improve patients' satisfaction. Findings also highlight that early post-recovery period (i.e. <= 3 months) as a key driver of longer-term satisfaction

Aims. COVID-19 has compounded a growing waiting list problem, with over 4.5 million patients now waiting for planned elective care in the UK. Views of patients on waiting lists are rarely considered in prioritization. Our primary aim was to understand how to support patients on waiting lists by hearing their experiences, concerns, and expectations. The secondary aim was to capture objective change in disability and coping mechanisms. Methods. A minimum representative sample of 824 patients was required for quantitative analysis to provide a 3% margin of error. Sampling was stratified by body region (upper/lower limb, spine) and duration on the waiting list. Questionnaires were sent to a random sample of elective orthopaedic waiting list patients with their planned intervention paused due to COVID-19. Analyzed parameters included baseline health, change in physical/mental health status, challenges and coping strategies, preferences/concerns regarding treatment, and objective quality of life (EuroQol five-dimension questionnaire (EQ-5D), Generalized Anxiety Disorder 2-item scale (GAD-2)). Qualitative analysis was performed via the Normalization Process Theory. Results. A total of 888 patients responded. Better health, pain, and mood scores were reported by upper limb patients. The longest waiters reported better health but poorer mood and anxiety scores. Overall, 82% had tried self-help measures to ease symptoms; 94% wished to proceed with their intervention; and 21% were prepared to tolerate deferral. Qualitative analysis highlighted the overall patient mood to be represented by the terms ‘understandable’, ‘frustrated’, ‘pain’, ‘disappointed’, and ‘not happy/depressed’. COVID-19-mandated health and safety measures and technology solutions were felt to be implemented well. However, patients struggled with access to doctors and pain management, quality of life (physical and psychosocial) deterioration, and delay updates. Conclusion. This is the largest study to hear the views of this ‘hidden’ cohort. Our findings are widely relevant to ensure provision of better ongoing support and communication, mostly within the constraints of current resources. In response, we developed a reproducible local action plan to address highlighted issues. Cite this article: Bone Jt Open 2021;2(8):583–593

Purposes of the study and background. A Qualitative study exploring patient's experience of Cauda Equina Syndrome (CES) was carried out. The aim of this study was to identify how Cauda Equina Syndrome symptoms may be more effectively identified by patients and their clinician. Patient's symptoms and experiences of their condition were explored, including issues associated with bladder, bowel and sexual function. A summary of the methods used and the results. Via in-depth questions, participants were enabled to share their stories within a confidential setting. Narrative analysis of the patient's story allowed symptom progression and recognition to be explored and language used by participants themselves to describe symptoms identified. Seven themes emerged from the study. The findings were used to develop clinical tools to assist in the consultation process of potential CES patients. Finally the tools were validated by CES patients and clinicians prior to use within a clinical setting. Conclusion. The findings of this research have been utilised, working with patients as partners, to establish clear, sensitive and understandable language to use during clinical questioning of potential CES patients. This patient choice of language for sensitive questions has been replicated on a clinical cue card to use during the consultation and on a credit card sized leaflet to give to patients. Working with patients, clear methods of communication have been developed surrounding potentially embarrassing but critical symptoms in order to assist ‘bringing the individual patient and the surgical team together at the earliest practical opportunity’. No conflicts of interest. Source of funding; Physiotherapy Research Foundation (Part of the CSP Charitable Trust registered charity 279882)

Purpose of the study and background. Physical activity and exercise therapy are among the guideline recommendations for the rehabilitation of people with chronic low back pain (CLBP ≥ 3 months); however, patient adherence is often poor. CONNECT is a theory-based communication skills training programme designed to enhance physiotherapists' support of their CLBP patients' psychological needs in order to increase adherence to their home-based rehabilitation programme. Methods and results. The CONNECT trial [Current Controlled Trials ISRCTN63723433] included six Dublin-area public clinics and their physiotherapists (n = 24) who received eight hours of communication skills training from a psychologist [experimental group] and physiotherapists (n = 26) from six equivalent clinics who formed a treatment as usual pragmatic control condition. New patients (n = 255, 54% female) diagnosed with CLBP and receiving physiotherapy at one of these clinics completed ratings of home-based adherence at 1, 4, 12, and 24 weeks after their initial treatment session; 24 weeks was the primary endpoint. Due to the nature of the intervention, physiotherapists were aware of treatment allocation; patients and assessors were blinded. Intention to treat analysis using a linear mixed model approach indicated that patients in the experimental group rated their home-based adherence significantly higher than patients in the control condition across time-points (P = .01), but the difference was not significant at the 24-week follow-up (P > .05). Conclusions. The CONNECT intervention had a positive effect on patients' self-rated adherence to home-based rehabilitation for CLBP, but the impact was not maintained over 24 weeks. Further analysis from the CONNECT trial will investigate its effects on pain and function, as well as hypothesised mediators of change

Purpose. The purpose was to compare the accuracy of the method using 3D printing model with the method using picture archiving and communication system (PACS) images in high tibial osteotomy (HTO). Materials and methods. This study analyzed 40 patients with varus deformity and medial osteoarthritis. From 2012 to 2016, patients underwent HTO using either 3D printing model (20 knees) or method based on a PACS image (20 knees). After obtaining the correction angle for the target point (62.5% point of the mediolateral tibial plateau width), in the 3D printing method, the wedge-shaped 3D-printed model was designed with the measured angle and osteotomy section and was produced by the 3D printer. The PACS method used preoperative radiographs to shift the weight bearing axis. The accuracy of the HTO and the proportion of acceptable range (62.5 ± 5%) at each method was compared using the full-length lower limb radiographs at the sixth postoperative week. The pre and postoperative posterior tibial slope angle was also compared at each method. Results. The weight bearing line on the tibial plateau was corrected from a preoperative 21.1 ± 11.8% to a postoperative 61.6 ± 3.4% in the 3D group and from 19.5 ± 12.3% to 61.4 ± 8.0% in the PACS group. The patients in an acceptable range were more in 3D printing group (80%) than in PACS group (60%) (p=0.028). The mean of absolute difference with the target point was less in 3D printing groups (2.4 ± 2.5) than PACS group (6.2 ± 5.1) (p=0.006). The posterior tibial slope was not significantly different in 3D printing group (8.6° to 8.9°, p=0.073), whereas different in PACS group (9.9° to 10.5°, p=0.042). Conclusions. In HTO, correction based on the 3D printing method was more accurate than correction using the PACS method

Sixteen observers measured eight anatomic parameters on digitalised images of six acute distal radial fractures using the Patient Archiving Communication System (PACS) software and repeated the measurements two weeks later. Inter and intra observer variability for each parameter was calculated using intraclass correlation coefficients (ICC) and tolerance limits (TL). Highest inter-observer agreement was demonstrated in dorsal tilt (ICC 0.858; TL ± 14.2°) with poor agreement on the size of the gap and step. When compared with the results of a similar study published 10 years ago looking at observer variability in x-ray measurement of healed distal radial fractures, the reliability of computerized measurements is not significantly different to those achieved by manual techniques (dorsal tilt inter-observer TL on PACS ± 16° compared with TL ± 15° using ruler and protractor). These results suggest the current guidelines in the literature for acceptable radiological reduction limits based on < 10° change in palmar tilt, < 2mm radial shortening, < 5° change in radial angle and < 1–2mm articular step for acute distal radius fractures cannot be reliably measured