The requirement for the peer support groups were born out of concern for the psychological wellbeing of the paediatric patients and to assess if this would improve their wellbeing during their treatment. Groupwork is a method of Social Work which is recognised as a powerful tool to allow people meet their need for belonging while also creating the forum for group members to empower one another. Social Work meet with all paediatric patients attending the limb reconstruction service in the hospital. The focus of the Medical Social Worker (MSW) is to provide practical and emotional support to the patient and their parent/guardian regarding coping with the frame. Some of the challenges identified through this direct work include patient's struggling with the appearance of the frame and allowing peers to see the frame.

The peer support group aims to offer its attendees the opportunities to engage with fellow paediatric patients in the same position. It allowed them to visually identify with one another. We wanted to create a safe space to discuss the emotional impact of treatment and the frames. It normalises the common problems paediatric patients face during treatment. We assisted our participants to identify new coping techniques and actions they can take to make their journey through limb reconstruction treatment more manageable. Finally, we aimed to offer the parents space to similarly seek peer support with regard to caring for a child in treatment. All paediatric patients were under the care of the Paediatric Orthopaedic Consultant and were actively engaging with the limb reconstruction multi-disciplinary team (MDT). The patient selection was completed by the MDT; based on age, required to be in active treatment, or their frames were removed within one month prior to the group's commencement. Qualitative data was collected through written questionnaires and reflection from participants in MSW sessions. We also used observational data from direct verbal feedback from the MDT. In the first group, parents gave feedback due to participants age and completed written feedback forms. For our second group, initial feedback was collated from the participants after the first session to get an understanding of group expectations. Upon completion, we collected data from both the participants and the parents. Qualitative and scaling questions gathered feedback on their experience of participating in the group.

We held two peer support groups in 2022:One group for patients aged between 3–6 years in January 2022 across two sessions, which was attended by four patients. The second group for young teenage patients aged between 11–15 years in April 2022 across four sessions, which was attended by five patients. The written feedback received from group one focused on eliciting the participant's experience of the groupwork. 100% of participants identified the shared experience as the main benefit of the groupwork. 100% of participants agreed they would attend a peer support group again, and no participant had suggestions for improvement to the group. Feedback did indicate that group work at the beginning of treatment could be more beneficial. In relation to the second group, 60% of the paediatric patients and their parents returned the questionnaires. All of the parent's feedback identified that it was beneficial for their child to meet peers in a similar situation. They agreed that it was beneficial to meet other parents, so they could get support and advice from one another. On a scale between 1 and 5, 5 being the highest score, the participants scored high on the group work meeting their expectations, enjoyment of the sessions, and the group work was a beneficial aspect of their treatment. All respondents would strongly recommend groupwork to other paediatric patients attending for limb reconstruction treatment.

Overall, the MDT limb reconstruction team, found the peer support group work of great benefit to the participants and their parents. The MSW team identified that during a period on the limb reconstruction team, when a high number of patients were in active treatment, the workload of the MSW also increased reflecting this activity. Common issues and concerns were raised directly to MSW (particularly from group two) regarding numerous difficulties they experienced trying to cope with the frame. The group work facilitators created a space where the participants could get peer support, share issues caused by the frame, hear directly from others, and that they too experience similar feelings or issues. Collectively, they identified ways of coping and promoting their own wellbeing while in treatment. The participants in group two, subsequently created a group on social media, to be able to continue their newly formed friendships and to continue to update one another on their treatment journeys. The participants self-requested another group in the future. This was facilitated in November 2023, the facilitators sought more feedback from all participants and their parents after this session. These findings will contribute towards the analysis for the presentation. Peer support groupwork was presented at the hospital's foundation day and has been well received by senior management in the hospital, as a positive addition to the limb reconstruction service. The focus of the MDT in 2024, is to further develop and facilitate more peer support groups for our paediatric patients.

Back pain is extremely common in soldiers undergoing training¹. There is no data worldwide with regards to incidence, prevalence and impact of back pain in a deployed military population. This study was undertaken to evaluate these issues.

1000 back pain questionnaire were distributed over a period of four days at the main military base in Basrah in February 2009 in different locations. The filling out was anonymous and completely voluntary.

UK military personnel

Information was obtained about age, BMI, length of service, rank, incidence, prevalence, onset, admission rate, treatment, aero-medical evacuation, operational effectiveness, pain killers and VAS.

768 (77%, 26% of population at risk) questionnaires were returned Prevalence of back pain was 33.4% (257). A greater prevalence occurred in the combat arms (41.7%, p=0.01) and those of over 12 years service (44%, p=0.004). No statistical difference was found with rank, or BMI. 74 people (9.6%) had developed new onset back pain since deploying. Recurrent pain occurred in 38.9% of the whole sample. VAS showed a normal distribution. 35% of those affected were discharging their duty with mild difficulty but around 6% were having great difficulty. 25% were on regular analgesics. Back pain constituted 23% (137/583) of the physiotherapy dept caseload, 6.6%, (25/378) of ward admissions and 0.04% (5/119) of aero-med patients.

Back pain is a major problem among deployed personnel. However with adequate resources the vast majority can be managed in the field thus reducing attrition rates² and maintaining operational effectiveness. Further studies should be undertaken to assess if back pain persists after deployment.

Back pain is common, with quotes of lifetime prevalence ranging from 50% to 80% and point prevalence of 15% to 30%. There is scarce data within the British Military.

A prospective observational study evaluated the prevalence of back pain and its impact on work in a deployed population on OP TELIC 13. 1000 questionnaires were distributed over 4 days, 768 were returned. Additionally, clinical data was collected from the ward, aero-medical, and physiotherapy dept for the period September 2008- February 2009.

Overall prevalence of back pain was 33.4% (257). A greater prevalence occurred in the combat arms (41.7%, p=0.01) and those of over 12 years service (44%, p=0.004). No statistical difference was found with rank, or BMI. 74 people (9.6%) had developed new onset back pain since deploying. Within the new pain group 10/74, (13%) were experiencing either ‘some’ or ‘great’ difficulty at work. Recurrent pain occurred in 38.9% of the whole sample, with an increased prevalence in those of over 12 years service (58% p< 0.001). Back pain constituted 23% (137/583) of the physiotherapy dept case-load, 6.6%, (25/378) of ward admissions and 0.04% (5/119) of aero-medical patients.

This study shows that back pain is a major problem among deployed personnel, but can be managed with timely medical input, and is rarely the indication for aero-medical evacuation. Adequate resources are required to maintain operational effectiveness. Further studies should be undertaken to assess if back pain persists after deployment.

Fractures of the distal radius are common skeletal injuries. In most practices patients are discharged within few weeks to few months. The aim of this study is to investigate whether there is a difference in outcome between 6 months and 1 year with different treatment methods with special focus on conservative management.

A one-year prospective cohort study of patients with fractures of the distal radius was set in York Hospital. From 204 patients included, 200 (98%), 182 (89%) and 164 (82%) patients were evaluated at 6 weeks, 6 months and 1 year, respectively. Two patients had bilateral fractures. In total 162 fractures were treated conservatively, and 8 fractures were treated operatively following failure of conservative immobilization.

Outcome assessment included Gartland and Werley, DASH and SF-36 scoring systems. Between 6 months and 1 year there was statistically significant improvement in the over-all Gartland and Werley score (p< 0.001) and most of its components such as the subjective evaluation, grip strength, arthritis change, finger function, and the range of motion. There was no significant improvement in pain and deformity.

In the conservatively treated patients a good or excellent result was found after 6 months in 77%, after 1 year in 92%. In the failed conservative group it was 61% (5/7) and 83 % (5/6).

Conclusion: This study has shown that functional improvement occurs up to 1 year following distal radius fractures, therefore a final say in the outcome may not be determined before that time should the need arise for reconstructive surgery or medico legal advice.