Abstract. Introduction. A spotlight has been placed upon virtual assessment of patients during the coronavirus pandemic. This has been particularly prevalent in the assessment of acute knee injuries. In this study we aim to assess the accuracy of telephone
In current practice in the UK there are three main approaches to investigating suspected scaphoid fractures not seen on initial plain film x-rays. Early MRI of all cases. Review all cases in clinic at two weeks with repeat x-rays. Hybrid model. Virtual Fracture Clinic (VFC)
Three developments in the last 10 to 15 years have made it necessary to review how we ensure rapid access to treatment of patients with disabling low back pain. Firstly, there would appear to be an increase in the numbers of patients seeking medical help for low back pain, whether due to increased patient expectation, or better reporting, or a true increase associated with the increasing sedentary nature of life, is uncertain. Secondly, there is the realisation that amongst the factors that encourage acute back pain to become chronic is being off work, and the sooner a diagnosis and treatment is started the more likely that chronicity will be prevented, so a long waiting time to be seen in a clinic is productive of disability. Thirdly, reorganisation of consultant services has created the spinal surgeon, who in return for being allowed to practice spinal surgery almost exclusively undertakes the load of patients referred with back pain, amongst whom lurk those with a surgically remediable problem. The effect has been that although waiting times for general orthopaedic patients have dropped, as general orthopaedic, or other specialist orthopaedic surgeons no longer see spinal cases, the specialist spinal surgeon is overwhelmed by a large group of patients with back pain for whom there is not a surgical solution. Unfortunately, there is a shortage of spinal surgeons, which is likely in the UK at any rate to get worse. Being overwhelmed with non-surgical back pain interferes with their ability to deal with surgical problems. It also does create a recruitment problem, as back pain is not seen as a rewarding or satisfying problem to treat.
Purpose of the study and background. This audit report outlines a physiotherapy lead spinal
Referral patterns in spine clinic of young patients with suspected scoliosis is suboptimal with 19% of late referrals and 42% of inappropriate referrals. Patients'
The Trauma
In Britain 8 million people consult their general practitioner annually with musculoskeletal conditions leading to referral of 1.5 million patients to Orthopaedics/ Rheumatology. Northern Ireland has the highest waiting lists for outpatients in Britain. The demand on orthopaedics continues to rise despite past attempts to reduce waiting lists. Trauma and orthopaedics accounted for 14% of the excess waiters for outpatients at June 2002. (DHSSPS Sept 2002) Roland et al 1991, etc. demonstrated that 43% of all orthopaedic referrals were inappropriate. In Belfast, G.P.s and Physiotherapists in partnership with the Regional Orthopaedic Service decided to pilot a Primary Care Orthopaedic
Introduction: Mismatch between patient load and out-patient clinic resources in South Australian public sector has resulted in a long waiting list for initial appointment of new patients with shoulder complaints. There is no validated
Background. A retrospective review of all patients transferred by helicopter ambulance to the Great Western Hospital over a 20-month period between January 2003 and September 2004 was undertaken to establish the case-mix of patients (trauma and non-trauma) transferred and the outcome of their admission and length of hospital stay. Methods. Details of all Helicopter Emergency Ambulance Service (HEAS) transfers to this unit in the study time period were obtained from the three HEAS providers in the area and case notes for all patients (where available) were reviewed. Results. 156 trauma patients were transferred (total patients 193). 111 cases were identified for analysis (45 transfers had inadequate information to identify them) with mean age of 33 years (range 1-92 years). Mean Injury Severity Score on admission was 12 (range 1-36). 45 (or 41%) patients were discharged home from the Accident and Emergency Department. 24 cases had operations, 9 patients required ICU care and 2 were pronounced dead on arrival in the A&E Department. Average hospital stay following HEAS transfer was 2.97 in-hospital days (range 0-18). Conclusions. Pre-hospital Helicopter Ambulance transfer in the acute setting is of debatable value. There is no doubt that it can be an extremely valuable service but
Integrated Regional Orthopaedic (MSK) Assessment clinics (ROAC) are now mandated in many provinces for the assessment and
Background Changes in professional boundaries have allowed many of the tasks traditionally undertaken by doctors to be delegated to Nurses and Allied Health professionals. The employment of an appropriately experienced specialist physiotherapist in orthopaedic clinics in the NHS to
Purposes and Background. Musculoskeletal disorders including as back and neck pain are leading causes of work disability. Effective interventions exist (i.e. functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment
Purpose: Uncertainty around back pain management results in large volumes of patients with back related complaints being referred to orthopaedic surgeons for direction. The vast majority of these referrals are non surgical leading to unacceptable wait times (T1) across Canada. This reservoir delays not only those who are disabled with problems requiring a surgical remedy but also those who only require direction to appropriate conservative care. Physiotherapists with advanced training in orthopaedics possess skills in musculoskeletal interview, exam and Orthopaedic residents on the other hand must acquire spine specific skills in interview and exam, interpretation of radiographic exams, surgical decision making as well as surgical technique in a 2–3 month residency rotation. Our question was „Can an Experienced Physiotherapist Become Proficient in Triaging for Surgically Appropriate Patients After a 2–3 month „Residency „. Method: Following a 3 month clinical residency an experienced physiotherapist and a spine surgeon independently interviewed, physically examined and reviewed diagnostic imaging of 31 patients. It was then independently concluded whether the patients were candidates for surgical treatment, required conservative management or whether further investigations were necessary to make the final determination. The level of agreement was calculated using Chance Corrected Agreement or Kappa values. Operational definitions were reviewed and a second group of 29 patients were assessed. Results: The initial Kappa score was .68 (considered good clinical agreement) and the final Kappa score was 0.84 (considered virtually interchangeable). Conclusion: A 3 month period can prepare an experienced orthopaedic physiotherapist to
Study Design: Prospective cohort study. Objective: To assess the ‘red flag’ symptom of night pain as an indicator for serious disease in patients attending a back pain
Virtual encounters have experienced an exponential rise amid the current COVID-19 crisis. This abrupt change, seen in response to unprecedented medical and environmental challenges, has been forced upon the orthopaedic community. However, such changes to adopting virtual care and technology were already in the evolution forecast, albeit in an unpredictable timetable impeded by regulatory and financial barriers. This adoption is not meant to replace, but rather augment established, traditional models of care while ensuring patient/provider safety, especially during the pandemic. While our department, like those of other institutions, has performed virtual care for several years, it represented a small fraction of daily care. The pandemic required an accelerated and comprehensive approach to the new reality. Contemporary literature has already shown equivalent safety and patient satisfaction, as well as superior efficiency and reduced expenses with musculoskeletal virtual care (MSKVC) versus traditional models. Nevertheless, current literature detailing operational models of MSKVC is scarce. The current review describes our pre-pandemic MSKVC model and the shift to a MSKVC pandemic workflow that enumerates the conceptual workflow organization (patient
Background: Patients assessed at the clinic are classified and managed according to the guidelines from The Royal College of General Practitioners. The purpose of this study was to evaluate the differences in initial assessment findings between patients with ‘simple’ LBP and those with probable ‘Nerve Root Pain’ (NRP). Methods: All 1949 new patients attending over two years were assessed using a range of valid and reliable questionnaires to establish generic health status (Short-Form 36; SF36), self reported disability (Oswestry Disability Index; ODI) and psychological status (Hospital Anxiety and Depression Scale; HADS). The spinal examination was carried out by a Senior Physiotherapist and patients were
Background: This study tested the null hypothesis that computed tomography (CT) and magnetic resonance imaging (MRI) have the same diagnostic performance characteristics for
To evaluate the patient experience of patients referred to the ESP Orthopaedic
Knee pain is common, representing a significant socioeconomic burden. Caused by a variety of pathologies, its evaluation in primary-care is challenging. Subsequently, an over-reliance on magnetic resonance imaging (MRI) exists. Prior to orthopaedic surgeon referral, many patients receive no, or incorrect, imaging. Electronic-triage (e-triage) tools represent an innovative solution to address this problem. The primary aim of this study was to ascertain whether an e-triage tool is capable of outperforming existing clinical pathways to determine the correct pre-hospital imaging based on knee pain diagnosis. Patients ≥18 years with a new presentation of knee pain were retrospectively identified. The timing and appropriateness of imaging was assessed. A symptom-based e-triage tool was developed, using the Amazon LEXbotplatform, and piloted to predict five common knee pathologies and suggest appropriate imaging. 1462 patients were identified. 17% of arthroplasty patients received an ‘unnecessary MRI’, whilst 28% of arthroscopy patients did not have a ‘necessary MRI’, thus requiring a follow-up appointment, with a mean delay of three months (SD 2.6, range 0.2-20.2). Using NHS tariffs, a wasted cost through unnecessary/necessary MRIs and subsequent follow-up appointments was estimated at £45,816. The e-triage pilot was trialled with 41 patients (mean age:58.4 years, 58.5% female). Preliminary diagnoses were available for 34 patients. Using the highest proportion of reported symptoms in the corresponding group, the e-triage tool correctly identified three of the four knee pathologies. The e-triage tool did not correctly identify anterior cruciate ligament injuries (n=3). 79.2% of participants would use the tool again. A significant number of knee pathology patients received incorrect imaging prior to their initial hospital appointment, incurring delays and unnecessary costs. A symptom-based e-triage tool was developed, with promising pilot data and user feedback. With refinement, this tool has the potential to improve wait-times and referral quality, whilst reducing costs.
The management of mid-shaft clavicle fractures (MSCFs) has evolved over the last three decades. Controversy exists over which specific fracture patterns to treat and when. This review aims to synthesize the literature in order to formulate an appropriate management algorithm for these injuries in both adolescents and adults. This is a systematic review of clinical studies comparing the outcomes of operative and nonoperative treatments for MSCFs in the past 15 years. The literature was searched using, PubMed, Google scholar, OVID Medline, and Embase. All databases were searched with identical search terms: mid-shaft clavicle fractures (± fixation) (± nonoperative).Aims
Methods