Extracapsular Hip Fractures (EHF's) are a significant health burden on healthcare services. Optimal treatment is controversial with conflicting evidence being reported. Currently treatment is undertaken with Intramedullary Nail (IMN) or Dynamic Hip Screw (DHS) constructs with a recent increase in IMN use (1). This study aims to conduct a systematic review of Randomised Control Trials published between 2020 and 2023 with particular focus on patient demographics and holistic patient outcomes.

Using a unified search-protocol, RCT's published between 2020 and 2023 were collected from CENTRAL, PubMed, MEDLINE and EMBASE. Rayyan software screened duplicates. Using the CASP and Cochrane Risk of Bias Tool papers were critically examined twice, and Blood Loss, Infection and Mobility described the patient journey. Patient demographics were recorded and were contrasted with geographically diverse cohort studies to compare population differences. Parametric tests were used to determine significance levels between population demographics, namely Age and Sex.

Eleven papers were included, representing 908 patients (436 Male). The mean age for patients was 64.39. There was considerable risk of bias in 7/11 studies owing to the randomization process and the recording of data. Four Cohort studies were selected for comparison representing 14314 patients. Mean age was significantly different between Cohort Studies and RCT's (Independent T-Test, df 13, t=7.8, p = <0.001, mean difference = 19.251, 95% CI = 13.888, 24.613). This was also true for sex ratios included in the studies (df 13, t = -2.268, p = 0.024, Mean Difference = -0.4884, 95% CI = -0.9702, -0.0066).

To conclude, RCT's published in the post COVID-19 era are not representative of patient demographics. This has the potential to provide inaccurate information for implant selection. Additionally further research must be conducted in how to better improve RCT patient inclusion so as to be more representative of patients whilst balancing the risks of operations.

Background

Farming is regarded as a high-risk work sector for LBP.

Background: The UK guidelines for the management of low back pain (LBP) in the workplace were published in 2000 but studies exploring their implementation are limited. As part of a larger implementation strategy which combined changes in organisational structures with a health promotion campaign, managers at a major Dublin teaching hospital were surveyed.

The aim of this study was to establish the efficacy of a health promotion campaign in changing managers’ attitudes towards the guidelines.

Methods: A questionnaire survey of hospital managers was conducted in 2004. As part of this survey, managers were asked to indicate their level of agreement with a series of guideline based statements. The results of this survey were used to guide the development of a health promotion campaign which included a series of workshops combined with provision of written materials.

In 2006 a repeat survey of the managers (n=92) was conducted to measure the efficacy of the health promotion campaign. Survey data were entered onto SPSS (V.11) for analysis using descriptive statistics and chi square tests.

Results: A 63% (n=58) response rate was achieved. Positive changes occurred in relation to all the guidelines including a 28% increase (p< 0.05) in the proportion of managers who believe that most LBP is self limiting and a 38% increase (p< 0.05) in the proportion of managers who believe that remaining active and returning to work even if there is some pain is appropriate.

Conclusion: A health promotion campaign targeting hospital managers was successful in changing managers’ attitudes towards the occupational LBP guidelines.

Background: Most research regarding low back pain (LBP) amongst health service workers has tended to focus on single occupational groups rather than conducting occupational group comparisons.

Purpose: This study aims to compare the prevalence of LBP, associated sick leave and the proportion of LBP attributed to a work incident between various subgroups of workers in the Irish health service.

Methods: Hospital employees (n=2237) were stratified according to the five Department of Health and Children occupational clusters (Administration, Medical, General Support, Nursing and Professionals). A disproportional stratified sample (n=400) of employees was taken. Postal questionnaires and subsequent reminders were administered.

Data were analysed using descriptive statistics. Subgroup comparisons were made using chi square tests.

Results: A response rate of 61.5% (n=246) was achieved of whom 52% (n=128) had experienced LBP. There was no significant difference in lifetime prevalence between groups (χ² = 3.874, p= 0.423). However, the difference, between groups, in the proportion of staff with LBP who had taken sick leave in the previous year was significant (χ² =12.070, p=0.017) with the highest level of sick leave among nursing staff ( 57%) and the lowest level among medical staff (14%). The proportion of staff attributing LBP onset to a work incident was no different between groups (χ² = 6.551, p= 0.586).

Conclusions: While no difference in LBP prevalence or attribution of LBP onset to work was found between the occupational groups, the variance in LBP related sick leave suggests that occupation specific factors influence back related work loss.

Background: Current evidence emphasises the need for workplace managers to become more involved in the case management of the worker with low back pain (UK Guidelines , 2000).

Purpose: To establish health service managers’ needs in relation to the management of the worker with low back pain (LBP).

Methods: A self administered questionnaire was distributed to all departmental managers (n =63) at a major Irish teaching hospital. The questionnaire comprised of a series of quantitative and qualitative questions relating to aspects of management of the worker with LBP including facilitation of return to work and organisational support for managers.

Quantitative data were summarised using descriptive statistics. Qualitative data were transcribed, coded and analysed using the qualitative data analysis approach of Miles and Huberman (1994).

Results: A response rate of 76% (n =48) was achieved. Of these 63%(n=30) had experience of managing LBP related sick leave among staff. Common themes which emerged from the qualitative data included lack of staff resources to accommodate return to work of a worker at less than full physical work capacity, lack of specific guidance from the occupational health department regarding expected work capacity of the worker with LBP and difficulty dealing with attitudes of colleagues towards the worker with LBP.

Conclusion: Strategies aimed at improving the management of the worker with LBP and facilitating earlier return to work need to give consideration to improving staff resources, provision of clear guidelines from occupational health departments and guidance for managers regarding ways of supporting both the worker with LBP and his/her colleagues.