Work-related musculoskeletal disorders, particularly back pain, are a significant issue for healthcare workers, with patient handling being the most frequently reported risk factor. Patient handling is often performed without assistive devices or equipment, which can cause healthcare staff to maintain awkward postures or experience high loads. This review aimed to comprehensively map the literature surrounding manual patient handling (without assistive devices) by healthcare practitioners to identify the current evidence-base on moving and handling of patients and explore what primary research had been conducted. JBI methodology for scoping reviews and an a priori registered protocol (DOI 10.17605/OSF.IO/8PR7A) was followed and AMED, CINAHL, MEDLINE, SPORTDiscus and EMBASE databases were searched. Literature published in English between 2002 and 2021 was included. Forty-nine records were included: 36 primary research studies, 1 systematic review and 12 ‘other’ including narrative and government reports. Primary research predominantly used observational cross-sectional designs (n = 21 studies). Most studies took place in hospitals (n = 13) and laboratories (n = 12). Nurses formed the largest population group (n = 13), with very little research on physiotherapists and other allied health professionals.Purpose and background
Methods and results
The aim of this scoping review is to understand the extent and type of evidence in relation to the use of guided growth for correcting rotational deformities of long bones. Guided growth is routinely used to correct angular deformities in long bones in children. It has also been proven to be a viable method to correct rotational deformities, but the concept is not yet fully examined. Databases searched include Medline, Embase, Cochrane Library, Web of Science and Google Scholar. All identified citations were uploaded into Rayyan.ai and screened by at least two reviewers. The search resulted in 3569 hits. 14 studies were included: 1 review, 3 clinical trials and 10 pre-clinical trials. Clinical trials: a total of 21 children (32 femurs and 5 tibiae) were included. Surgical methods were 2 canulated screws connected by cable, PediPlates obliquely oriented, and separated Hinge Plates connected by FiberTape. Rotation was achieved in all but 1 child. Adverse effects reported include limb length discrepancy (LLD), knee stiffness and rebound of rotation after removal of tethers. 2 pre-clinical studies were ex-vivo studies, 1 using 8-plates on Sawbones and 1 using a novel z-shaped plates on human cadaver femurs. There were 5 lapine studies (2 using femoral plates, 2 using tibial plates and 1 using an external device on tibia), 1 ovine (external device on tibia), 1 bovine (screws and cable on metacarp) and a case-report on a dog that had an external device spanning from femur to tibia. Rotation was achieved in all studies. Adverse effects reported include implant extrusions, LLD, articular deformities, joint stiffness and rebound. All included studies conclude that guided growth is a viable treatment for rotational deformities of long bones, but there is great variation in models and surgical methods used, and in reported adverse effects.
This scoping review aims to identify patient-related factors associated with a poorer outcome following total ankle arthroplasty (TAA). A scoping review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. A computer-based literature search was performed in PubMed, Embase, Cochrane trials, and Web of Science. Two reviewers independently performed title/abstract and full-text screening according to predetermined selection criteria. English-language original research studies reporting patient-related factors associated with a poorer outcome following TAA were included. Outcomes were defined as patient-reported outcome measures (PROMs), perioperative complications, and failure.Aims
Methods
The number of women entering medical school has been steadily increasing over the past two decades; however, the number of women pursuing careers in orthopaedic surgery has not increased at the same rate. One of the suggested reasons for this discrepancy is the perceived incompatibility of having a family while upholding the demands of a surgical career in orthopaedics. A growing body of scientific literature has also outlined the increased rate of infertility and pregnancy complications in women surgeons. The extent to which these factors play a role in the recruitment and retention of women in orthopaedic surgery is unknown. Understanding pregnancy and parenthood in orthopaedic surgery is a critical first step in addressing this issue. A scoping review was conducted to identify literature pertaining to the perceptions and experiences of pregnancy and/or parenthood of women in orthopaedic surgery. Embase, MEDLINE and PsychINFO were searched on June 7th, 2021 with Boolean operators to combine the following terms: orthop?e*, pregnancy, maternity, motherhood, parenthood, parental, and parenting. Studies pertaining to orthopaedic surgery residents, fellows and staff were included. The Arksey and O'Malley framework for scoping studies was followed. Descriptive statistics were used to quantify the included studies while thematic analysis as described by Braun and Clarke was used to analyze the qualitative data. A total of 17 studies from 2006 to 2021 met inclusion criteria. Over half of the available research was conducted within the last two years (n=9, 53%). The majority of studies were conducted in the United States (n=15, 88%) and the United Kingdom (n=2, 12%). The most commonly used study design was survey-based research (n=13, 76%), followed by review studies (n=3, 18%), and case series (n=1, 6%). Thematic analysis revealed five key themes contributing to the women's experiences of pregnancy and/or parenthood in orthopaedics: (1) women are subtly or blatantly discouraged from becoming pregnant by their colleagues and superiors, (2) women delay childbearing to preserve their professional reputation, (3) there are higher rates of infertility and preterm labor in orthopaedic surgeons than in the general population, (4) the orthopaedic work environment can be hazardous and challenging for the pregnant woman, but accommodations are possible to mitigate risks, and (5) overall, there is limited support for pregnant and/or parenting women in orthopaedics throughout their career. The first woman to be board-certified in orthopaedic surgery in the United States was Ruth Jackson in 1937. Eighty-four years later, orthopaedic surgery has the lowest number of women of the surgical specialties. The barriers related to pregnancy and/or parenthood during a woman's career in orthopaedics may be one cause. This study identified five themes related to pregnancy and parenthood that warrant further investigation. Qualitative research approaches can be used to elucidate the details of women's experiences and to provide suggestions for structural changes in the orthopaedic work environment.
Multiligament knee injuries (MLKI) are devastating injuries that can result in significant morbidity and time away from sport. There remains considerable variation in strategies employed for investigation, indications for operative intervention, outcome reporting, and rehabilitation following these injuries. At present no study has yet provided a comprehensive overview evaluating the extent, range, and overall summary of the published literature pertaining to MLKI. Our aim is to perform a methodologically rigorous scoping review, mapping the literature evaluating the diagnosis and management of MLKI. This scoping review will address three aims: firstly, to map the current extent and nature of evidence for diagnosis and management of MLKI; secondly, to summarize and disseminate existing research findings to practitioners; and thirdly, to highlight gaps in current literature. A three-step search strategy as described by accepted methodology will be employed to identify peer-reviewed literature including reviews, technical notes, opinion pieces, and original research. An initial limited search will be performed to determine suitable search terms, followed by an expanded search of four electronic databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, and Web of Science). Two reviewers will independently screen identified studies for final inclusion.Aims
Methods
Chronic osteomyelitis reflects a progressive inflammatory process of destruction and necrosis affecting bone architecture. It presents a challenge to manage, requiring multi-stage multidisciplinary interventions, and the literature reports a wide variety of treatment strategies. This systematic scoping review aims to map and summarise existing literature on treatment of chronic osteomyelitis of the femur and tibia and investigates the full range of treatments reported in order to enhance the reader's understanding of how to manage this complex condition. A comprehensive computer-based search was conducted in PubMed, EMBASE, MEDLINE, Emcare and CINAHL for articles reporting treatment of chronic tibial/femoral osteomyelitis. Two reviewers independently performed a two-stage title/abstract and full-text screening, followed by data collection. Studies were included if they described any treatment strategy including at least one surgical intervention. Key information extracted included causative pathogens, treatment protocol and outcome i.e. both success rate, defined as remission achieved following initial treatment with no recurrence during followup, and recurrence rate.Aim
Method
Recent reports show that spinopelvic mobility influences outcome following total hip arthroplasty. This scoping review investigates the relationship between spinopelvic parameters (SPPs) and symptomatic femoroacetabular impingement (FAI). A systematic search of EMBASE, PubMed and Cochrane for literature related to SPPs and FAI was undertaken as per PRISMA guidelines. Clinical outcome studies and prospective/retrospective studies investigating the role of SPPs in symptomatic FAI were included. Review articles, case reports and book chapters were excluded. Information extracted pertained to symptomatic cam deformities, pelvic tilt, acetabular version, biomechanics of dynamic movements and radiological FAI signs.Abstract
Introduction
Methods
Achilles tendon ruptures are common in the UK, with data demonstrating a significant rise in incidence over the past years. Chronic Achilles ruptures have been less well defined in literature, and repair techniques vary significantly. A surge in publications reporting various management options for chronic Achilles ruptures has necessitated a review that systematically maps and summarises current evidence regarding treatments and identifies areas for future research. This scoping review aims to improve knowledge of various treatment strategies and their associated outcomes, thereby aiding clinicians in optimising treatment protocols. The Arksey and O'Malley, Levac and Peters frameworks were used. A computer-based search in PubMed, Embase, Emcare, Cinahl, ISI Web of Science and Scopus was performed for articles reporting the treatment of chronic Achilles ruptures. Two reviewers independently performed title/abstract and full text screening according to a pre-defined selection criteria.Abstract
Objectives
Methods
The aim of this study was to prepare a scoping review to investigate the use of biologic therapies in the treatment of musculoskeletal injuries in professional and Olympic athletes. Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) extension for scoping reviews and Arksey and O’Malley frameworks were followed. A three-step search strategy identified relevant published primary and secondary studies, as well as grey literature. The identified studies were screened with criteria for inclusion comprising clinical studies evaluating the use of biologic therapies in professional and Olympic athletes, systematic reviews, consensus statements, and conference proceedings. Data were extracted using a standardized tool to form a descriptive analysis and a thematic summary.Aims
Methods
Introduction
Materials and Methods
The use of biologics in the treatment of musculoskeletal injuries in Olympic and professional athletes appears to be increasing. There are no studies which currently map the extent, range, and nature of existing literature concerning the use and efficacy of such therapies in this arena. The objective of this scoping review is to map the available evidence regarding the use of biologics in the treatment of musculoskeletal injuries in Olympic and professional sport. Best-practice methodological frameworks suggested by Arksey and O’Malley, Levac et al, and the Joanna Briggs Institute will be used. This scoping review will aim to firstly map the current extent, range, and nature of evidence for biologic strategies to treat injuries in professional and Olympic sport; secondly, to summarize and disseminate existing research findings; and thirdly, to identify gaps in existing literature. A three-step search strategy will identify peer reviewed and non-peer reviewed literature, including reviews, original research, and both published and unpublished (‘grey’) literature. An initial limited search will identify suitable search terms, followed by a search of five electronic databases (MEDLINE, EMBASE, Cochrane Database of Systematic Reviews, Web of Science, and Google Scholar) using keyword and index terms. Studies will be screened independently by two reviewers for final inclusion.Aims
Methods
Chronic postsurgical pain (CPSP) can occur after elective mid/hindfoot and ankle surgery. Effective treatment approaches for CPSP in this population have not been extensively investigated. The impact of multimodal strategies on CPSP following elective mid/hindfoot surgery is unknown due to both the heterogeneity of acute pain management and the lack of a recognized definition specific to this type of surgery. This study aimed to identify and evaluate current pain management strategies after elective mid/hindfoot and ankle surgery. We conducted a systematic review under Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. Three databases (MEDLINE, Embase and Cochrane Library) were electronically searched for English studies published between 1990 and July 2017. Reference lists of relevant systematic reviews were also manually searched. Comparative studies of adults undergoing elective mid/hindfoot and ankle surgery were included. Two reviewers independently reviewed studies and assessed their methodological quality. Of 1,159 studies, seven high-quality randomized controlled trials met our inclusion criteria. Though all studies examined regional anesthesia techniques, intervention heterogeneity precluded meta-analysis. Participants were typically followed up to 48 hours post-operatively. Interventions effective at reducing postoperative pain and/or opioid consumption included inserting popliteal catheters under ultrasound instead of nerve stimulation guidance, infusing perineural dexamethasone, bupivacaine, or ropivacaine perioperatively, and adding a femoral catheter infusion to a popliteal catheter infusion. Only one study assessed pain six months following elective mid/hindfoot and ankle surgery, demonstrating significant pain reduction with activity with the addition of a femoral to popliteal catheter infusion. There is an overwhelming lack of evidence regarding CPSP and its management for patients undergoing elective mid/hindfoot and ankle surgery. Although specific regional anesthesia techniques and adjuncts may be effective at reducing in-hospital pain and opioid consumption after elective mid/hindfoot and ankle surgery, our systematic review identified only seven studies addressing multimodal pain management in this population. Further comparative studies with longer-term follow-up are required.
The optimal management of rotationally-unstable ankle fractures involving the posterior malleolus remains controversial. Standard practice involves trans-syndesmotic fixation (TSF), however, recent attention has been paid to the indirect reduction of the syndesmosis by repairing small posterior malleolar fracture avulsion fragments, if present, using open reduction internal fixation. Posterior malleolus fixation (PMF) may obviate the need for TSF. Given the limited evidence and diversity in surgical treatment options for rotationally-unstable ankle fractures with ankle syndesmosis and posterior malleolar involvement, we sought to assess the research landscape and identify knowledge gaps to address with future clinical trials. We performed a scoping review to investigate rotational ankle fractures with posterior malleolar involvement, utilizing the framework originally described by Arksey and O'Malley. We searched the English language literature using the Ovid Medline and Embase databases. All study types investigating rotationally-unstable ankle fractures with posterior malleolus involvement were categorized into defined themes and descriptive statistics were used to summarize methods and results of each study. A total of 279 articles published from 1988 to 2018 were reviewed, and 70 articles were included in the final analysis. The literature consists of studies examining the surgical treatment strategies for PMF (n=21 studies, 30%), prognosis of rotational ankle fractures with posterior malleolar involvement (n=16 studies, 23%), biomechanics and fracture pattern of these injuries (n=13 studies, 19%), surgical approach and pertinent anatomy for fixation of posterior malleolus fractures (n=12 studies, 17%), and lastly surgical treatment of syndesmotic injuries with PMF compared to TSF (n=4 studies, 6%). Uncontrolled case series of single treatment made up the majority of all clinical studies (n=44 studies, 63%), whereas controlled study designs were the next most common (n=16 studies, 23%). Majority of research in this field has been conducted in the past eight years (n=52 studies, 74%). Despite increasing concern and debate among the global orthopaedic community regarding rotationally-unstable ankle fractures with syndesmosis and posterior malleolar involvement, and an increasing trend towards PMF, optimal treatment remains unclear when comparing TSF to PMF. Current research priorities are to (1) define the specific injury pattern for which PMF adequately stabilizes the syndesmosis, and (2) conduct a randomized clinical trial comparing PMF to TSF with the assistance of the orthopaedic community at large with well-defined clinical outcomes.
Chronic postoperative pain (CPP) can occur in elective mid/hindfoot and ankle surgery patients. Multimodal pain management has been reported to reduce postoperative pain and opioid use, which may prevent the development of CPP. However, few studies have examined the impact of multimodal pain management strategies on CPP following complex elective mid/hindfoot and ankle surgery. The purpose of this study was to 1) evaluate current pain management strategies and 2) determine current definitions, incidence, and prevalence of CPP after elective mid/hindfoot and ankle surgery. Three databases (MEDLINE, Embase and Cochrane Library) were manually and electronically searched for English language studies published between 1990 and July 2017. For the first aim, we included comparative studies of adults undergoing elective mid/hindfoot and ankle surgery that investigated pre-, peri- or postoperative pain management. For the second aim, we included observational studies examining CPP definition, incidence, and prevalence. Two reviewers independently screened titles and abstracts, followed by full texts. Conflicts were resolved through discussion with a third reviewer. Reviewers also independently assessed the quality of studies meeting inclusion criteria using the Joanna Briggs Institute Critical Appraisal Checklist. For the first aim, 1159 studies were identified by the primary search, and seven high quality randomized controlled trials were included. Ankle arthroplasty or fusion and calcaneal osteotomy were the most common procedures performed. The heterogeneity of study interventions, though all regional anesthesia techniques, precluded meta-analysis. Most investigated continuous popliteal, sciatic and/or femoral nerve blockade. Participants were typically followed up to 48 hours postoperatively to examine postoperative pain levels and morphine consumption in hospital. Interventions effective at reducing postoperative pain and/or morphine consumption included inserting popliteal catheters using ultrasound instead of nerve stimulation guidance, perineural dexamethasone, and adding continuous femoral blockade to continuous popliteal blockade. Using more than one analgesic was generally more effective than using a single agent. Only two studies examined longer term pain management. One found no difference in pain levels and opioid consumption at two weeks with perineural or systemic dexamethasone use. The other found that pain with activity was significantly reduced at six months postoperatively with the addition of a femoral catheter infusion to a popliteal catheter infusion. For the second aim, only two studies of the 747 identified were selected. One prospective observational study defined CPP as moderate-to-severe pain at one year after foot and ankle surgery, and reported 21% and 43% of patients as meeting their definition at rest and with activity, respectively. The other study was a systematic review that reported 23–60% of patients experienced residual pain after total ankle arthroplasty. There is no standardized definition of CPP in this population, and incidence and prevalence are rarely reported and vary largely based on definition. Although regional anesthesia may be effective at reducing in-hospital pain and opioid consumption, evidence is very limited regarding longer-term pain management and associated outcomes following elective mid/hindfoot and ankle surgery.
Low back pain (LBP) is the most common symptom encountered by osteopaths in the UK and affects a third of the UK population each year. Guidelines recommend using the biopsychosocial (BPS) model for non-specific LBP but it remains unclear what the BPS model actually is and how it applies in osteopathy. The aim of this study was to define the factors included in a BPS approach for non-specific LBP in a manual therapy using a systematic search and scoping review. An online search was performed on seven electronic databases. Guidelines and systematic reviews published after 2004 were included. 10% of the articles randomly selected were analysed by second reviewer to assess consistency of information extraction. Disagreements were discussed between the two reviewers. Mediation from the third author was not required.Background:
Methods:
