Fractures were classified according to the Vancouver classification system. The mechanism of injury, the ambulatory status prior to the fracture and the loosening zones (according to Gruen) were studied.
Patients with a periprosthetic fracture around a hemiarthroplasty had better results compared to those with a fracture around a total hip replacement. Poorer outcomes were noticed in patients with a periprosthetic fracture around a revised total hip replacement.
Patients with mechanical back pain have been treated in a nurse-led spinal clinic. They attend two one-on-one sessions with a nurse, the second session usually between three and 12 months after the first. Between these visits, they also attended two sets of classes in the spinal assessment clinic to help them improve and manage their back pain. A questionnaire is completed at presentation and at review. The questionnaires include three scores: The low back outcome Score, MSPQ and the Zung Depression Scale. Since 1995, approximately 2250 patients have been treated. The influence of smoking, gender, age, occupation and marital status on recovery has been studied.
The aim of this study was to compare implementation of RCGP guidelines in patients in Primary Care with acute low back pain between GP and Nurse Practitioner. This report presents preliminary results. The intention was to recruit 200 patients presenting to GP with new episode of back pain. 50% randomised to NP care, 50% to GP care. Outcome measured by documentation audit and patient feedback. Individuals complete a questionnaire which includes a Low Back Outcome Score (LBOS) at 14 weeks, 6,12 and 24 months. All patients in NP arm given back book and advised against bed rest.
Initial results suggest no significant difference in outcome between GP and Nurse Practitioner patients. Of interest is that 10% and 13% of patients failed to recall important features of management. This implies that audit of healthcare processes by patient questionnaire may be unsatisfactory.
The aim of this study was to test the effectiveness of a nurse practitioner-led clinic for managing the pre and postoperative care of patients undergoing lumbar spine surgery, against traditional clinic treatment. Ninety patients were randomised- 46 (Group 1) attended a nurse practitioner run pre-operative class and post-operative follow-up clinic and 44 (Group 2) were seen by the surgeon before and after the operation. All patients completed the Low Back Outcome Score, MSPQ and Zung score, pre-operatively and at six months post-op. There were 46 male and 44 female patients, and mean age was 45.4 years (range 20–77). The two groups were demographically similar (p = 0.418). The mean pre-op outcome score was 23.49 in group 1 and 17.41 in group 2 (p = 0.038) and the mean post-op scores were 44.67 and 35.38 for group 1 and 2 respectively (p = 0.021). Intra-group comparison showed an improvement in post-op outcome score for all patients (p = 0.001), but those in group 1 were significantly more satisfied (p = 0.008). Four theatre slots were lost in group 2 but none in group 1. A nurse practitioner-led pre-op counselling and post-op follow-up is more effective than the traditional clinic attendance for patients undergoing lumbar spine surgery and prevented waste of theatre time.