Aims. An objective technological solution for tracking adherence to at-home shoulder
Aims. A pragmatic multicentre randomized controlled trial, UK FROzen Shoulder Trial (UK FROST), was conducted in the UK NHS comparing the cost-effectiveness of commonly used treatments for adults with primary frozen shoulder in secondary care. Methods. A cost utility analysis from the NHS perspective was performed. Differences between manipulation under anaesthesia (MUA), arthroscopic capsular release (ACR), and early structured
Aims. This feasibility study investigates the utilization and cost of health resources related to formal and informal care, home adaptations, and
Aims. The aim of this study was to evaluate the cost-effectiveness of arthroscopic partial meniscectomy versus
Background: Neck pain is a common problem accounting for up to 22% of the workload of physiotherapists. Many different approaches are used and the evidence for these is unclear. Purpose: To evaluate the effectiveness of a brief
Abstract. 20% of patients are severely dis-satisfied following total knee arthroplasty (TKA). Arthrofibrosis is a devastating complication preventing normal knee range of motion (ROM), severely impacting patient's daily living activities. A previous RCT demonstrated superiority of a high intensity stretching programme using a novel device the STAK tool compared with standard
Purpose of the study. The purpose of this project was to evaluate whether OHEIs could facilitate student
Access to health care, including
The primary treatment goal for patients with femoroacetabular impingement syndrome, a common hip condition in athletes, is to improve pain and function. In selected patients, in the short term following intervention, arthroscopic hip surgery is superior to a pragmatic NHS- type
Introduction. Traditionally, limb reconstruction
Purpose of the study. To investigate the feasibility of undertaking a definitive Randomised Controlled Trial (RCT) to determine the effectiveness of early
Aims. There remains a lack of consensus regarding the management of chronic anterior sternoclavicular joint (SCJ) instability. This study aimed to assess whether a standardized treatment algorithm (incorporating
Purpose/Background. Health inequalities are defined as unfair and avoidable differences in health across the population. People belonging to inclusion health groups are most at risk of experiencing these inequalities and tackling them is an NHS priority. Inclusion health groups include ‘people in contact with the justice system’ and BCHC NHS FT is commissioned to provide
Introduction. Legg-Calve-Perthes (Perthes Disease) was first recognised by three physicians, Arthur Legg (1874–1939), Jacqui Calve (1875–1954) and George Perthes (1869 – 1927) in 1910. Perthes disease is a rare childhood condition that affects the hip. It occurs when the blood supply to the femoral head is disrupted. Without this blood supply, the bone cells die and avascular necrosis can occur. The Herring classification is used to diagnose the stages of Perthes Disease. It is an important prognostic factor. There are three classifications, Herring A, B and C. Herring A has no involvement of the lateral pillar with no density changes noted on x-ray. Herring B has at least 50% of the lateral pillar height maintained on x-ray. Herring C has less than 50% of the lateral pillar height on x-ray (Herring et al, 1992). Children with Perthes disease require specialist Limb Reconstruction team throughout their treatment journey, this includes Orthopaedic surgery and therapy (Physiotherapy and Occupational Therapy). The National Limb Reconstruction Therapy Team is based at the National Orthopaedic Hospital, Cappagh. The therapy team consists of 1 Clinical Specialist Physiotherapist, 1 Senior Physiotherapist and 1 Senior Occupational Therapist who provide input to this cohort. This study aims to analyse the importance of a comprehensive pre-operative assessment by the therapy team (Physiotherapist and Occupational Therapist) to maximise patient outcomes post operatively. Methodology. This is a quantitative research study conducted by the National Limb Reconstructive Therapy Service of the National Orthopaedic Hospital in Cappagh, Dublin. The inclusion criteria for this study consisted of:. Age – Patient must be part of the Paediatric Service, i.e., under the age of 16. Diagnosis – Patient must have a diagnosis of Perthes Disease with a Herring Classification documented. Application of a Hip Distractor Frame formed part of the patient's surgical management. Surgery was completed by Mr Connor Green. Surgery was completed between January 2021 and December 2022. Patient were required to have their external hip distractor frame removed by December 2022. Exclusion Criteria: Those not meeting the above inclusion criteria. Following the inclusion criteria, a number of cases were identified of which 10 cases were selected at random. A retrospective analysis of these samples was completed. The medical charts were reviewed as well as patient electronic healthcare records. Microsoft Excel was utilised to analyse the data and capture results. Results. From analysing the data, the following results were identified:. 80% of the sample cohort had a length of stay of 5 days following surgery. There were two outliers due to infection who had a length of stay of 14 days. 90% of the sample received a pre-operative
Background: The main aim of this study was to compare the effectiveness of a brief intervention based on cognitive-behavioural principles (Solution Finding Approach – SFA) with the McKenzie approach (McK). A secondary aim was to determine if there were any clinical characteristics that distinguished patients who responded best to the McKenzie method. Methods: Eligible patients who were referred by GPs to
Participation in a
Aims. Ankle fractures are common, mainly affecting adults aged 50 years and over. To aid recovery, some patients are referred to
The present study was conducted to evaluate the cost of
Research into the treatment of Femoro-Acetabular Impingement (FAI) has focussed on surgical correction of structural abnormalities and tended to overlook the dynamic process of impingement. The role of
Aim: To assess the value of
Introduction. The number of hip fracture admissions is rising; with reduced hospital bed capacity and increasing patient numbers, care pathways must be optimised to maximise inpatient bed efficiency. There is currently significant interest in improving healthcare services across all 7 days in the United Kingdom. It is unclear whether lack of allied healthcare professional review at the weekend is detrimental to hip fracture patient care. This study aims to examine whether providing 7-day
An Extended Scope Practitoner Physiotherapist (ESP) developed a problem shoulder clinic to support the
Purpose: to determine the effect of
Introduction: Tibialis posterior tendon dysfunction is a common cause of foot pain and dysfunction in the middle aged patients. Initially, it presents as medial ankle pain and swelling, with or without a flexible flat foot, later progressing on to a fixed deformity. Operative management for the early stages of tendon dysfunction poses a significant workload on hospitals and physical burden on patients. We have evaluated non-operative management of early tibialis posterior tendon dysfunction (. 1. ). Methods: This is a prospective study on patients with stage I and II tibialis posterior tendon dysfunction treated with a structured
OBJECTIVE. Post TKR manipulation under anesthesia is required when post operatively patients don't achieve desired range of motion. The rates quoted in various western literature ranges from 1 to 2 %. A knee is considered to be stiff when the patient fails to achieve 60 degrees of flexion. The objective of the study was to find out the differentiating factor responsible for low rate of MUA in Indian post TKR patients as compared to Anglo-Saxon population. MATERIAL & METHODS. We studied 100 consecutive patients operated from January 2016. The following parameters of these 100 patients were recorded. Pre-op ROM. Age and Sex of the TKR patient. Duration of home
Objective. To investigate, through a randomised, single blind, Quasi-experimental trial, whether immediate
Background and purpose of the study. Dropped Head Syndrome (DHS) is characterized by a chin on chest flexion neck deformity that is passively correctible. The condition is rare and literature on surgical and conservative management is focused on case studies and theoretical evidence. Purpose of the study. The purpose of this study was to investigate the value of
Adolescent Idiopathic Scoliosis (AIS) patients were subjected to four weeks of
There is a lack of evidence as to the best way to deliver rehabilitation following TKA. Previous work has suggested that postoperative physiotherapy applied to all patients is not effective at improving one-year post-surgical outcomes. The aim of this study was to target
We performed a prospective, randomised trial on 106 patients to compare the effects of local corticosteroid injections with
Study Design. Randomized, single blind, Quasi-experimental trial. Objective. To investigate whether immediate
To assess the value of
The purpose of this study was to assess the value of
The availability of seven-day NHS services for patients is currently receiving widespread national attention. Rehabilitation services including
Objectives. To investigate the views and experiences of patients with sciatica who have undergone a bespoke
Aims. Meniscal allograft transplantation is undertaken to improve pain
and function in patients with a symptomatic meniscal deficient knee
compartment. While case series have shown improvements in patient
reported outcome measures (PROMs), its efficacy has not been rigorously
evaluated. This study aimed to compare PROMs in patients having
meniscal transplantation with those having personalized physiotherapy
at 12 months. Patients and Methods. A single-centre assessor-blinded, comprehensive cohort study,
incorporating a pilot randomized controlled trial (RCT) was performed
on patients with a symptomatic compartment of the knee in which
a (sub)total meniscectomy had previously been performed. They were
randomized to be treated either with a meniscal allograft transplantation
or personalized
Introduction. Chronic mid body Achilles tendinopathy is a common problem. There is no consensus on treatment. The aim of this review was to assess the effectiveness of
The capacity for
In order to compare the outcome from surgical repair and
Purpose and Background. Traditional
An audit of general practitioner (GP) Paediatric orthopaedic referrals to our hospital (1996) revealed that the average waiting time was 84 weeks for non-urgent simple conditions. A
Aim. To develop a clinical core set of outcome measures that is accepted for relevance, feasibility and validity by stakeholders and useful for a) interaction between patient and professional, b) internal quality improvement, and c) external transparency in patients with NSLBP in primary care
Aims. This systematic review places a recently completed multicentre randomized controlled trial (RCT), UK FROST, in the context of existing randomized evidence for the management of primary frozen shoulder. UK FROST compared the effectiveness of pre-specified
ECSWT has been on the medical horizon for last 30 years mainly in urology for urolithiasis and has found a parallel use in orthopaedics for various chronic soft tissue conditions like Tendoachilles tendinoses and plantar fasciitis etc. ECSWT acts a piezoelectric device releasing acoustic energy and causing micro-trauma activating cytokine mediated response stimulating local angiogenesis and tissue repair. Methodology. 56 patients were recruited for the trial after ethics approval was achieved. The diagnosis was confirmed with ultrasound scan and measuring the width of the swelling and the local hypervascularity. The cohort of the patients was randomised in groups for
Background: It is universally acknowledged that psychological distress in chronic low back pain (LBP) is commonplace and the early identification of such distress is increasingly being advocated as an important aspect of LBP assessment. The Distress and Risk Assessment Method (DRAM) is a screening tool, using the Modified Zung (MZ) and Modified Somatic Perception Questionnaires (MSPQ), developed to provide a simple classification of patients with LBP. Patients are classified as normal, at risk of developing distress, and those who are distressed (Distressed Depressive {DD} and Distressed-Somatic {DS}). The DRAM was used to screen LBP patients for entrance to an RCT examining different
Background. The
Background &
Objectives: The
Objectives: The current study evaluates the effectiveness of a direct access
Background and purpose. Sleep disturbance is a prevalent symptom in people with chronic low back pain (CLBP >12 weeks), but there is currently no knowledge of the effectiveness of
We present a review of our Specialist
Background: In the Republic of Ireland,
Objective: To examine the effectiveness of a specific
Purpose: The purpose of this study was to compare treatment benefits from surgical repair and from
The aim of this study was to examine GP’s and PT’s views of a
A pilot study of a
Objectives: The current study evaluates the effectiveness of a direct access
It has been suggested that minimal incision surgery for hip arthroplasty allows earlier mobilisation and reduces hospital stay. Intensive post-op
There are a multitude of studies internationally that have considered the rates of redislocation of shoulders, where, after first time anterior dislocation, initial management has consisted of an internal rotation sling immobiliser or no immobility. The majority of these have indicated poor results. This is in comparison with recurrence rates of dislocation, post shoulder stabilisation (arthroscopic or open), after first time anterior dislocation, which have demonstrated excellent results. The question remains, is there a non-operative alternative that will give similarly good results for these patients. A selection criteria was set up for use of the external rotation brace for first time anterior dislocators. Thirty-five patients were used that fit the criteria and were able to be followed over time. A
Background: There is some evidence for the effectiveness of exercise therapy and clearer evidence for encouraging physical activity. The Back to Fitness programme was developed with this in mind. It is a simple and inexpensive treatment aimed at increasing normal use of the spine. Objective: To compare the effects of a group exercise programme with individual
Aim: Assessment of a new protocol, were acute soft tissue knee injuries are referred initially to a
There are longstanding debates regarding surgical versus conservative management of Achilles tendon ruptures, however there is limited focus on rehabilitation. A specific rehabilitation programme was initiated in 2008 to unify management and improve patient outcomes. We present the results at three and a half years. In October 2008 management was streamlined under the foot and ankle surgeons and a dedicated
Purpose of study and background. The primary aim of the study was to test the feasibility of conducting a full RCT with economic analysis and help to inform the provision of
We report a prospective, randomised, controlled trial of the effect of either a non-steroidal anti-inflammatory drug (diclofenac sodium) or
Background:. The aim of this study was to investigate the outcome after ACL reconstruction between a group of patients receiving a standardized supervised
The purpose of this study was to assess the efficacy of
Background &
Purpose: This pragmatic randomised clinical trial (RCT) investigated differences in the clinical outcomes of
The purpose of this study was to discover if student led clinics (SLC) are feasible delivery mechanisms for Low back pain (LBP) self-management support and to develop a service model. LBP is the most commonly reported musculoskeletal disorder worldwide. The increasing service and workforce demands of LBP are challenging for providers and policy makers. self-management is appropriate for many people living with LBP yet guidance for self-management is lacking. One potential delivery mechanism is through SLC. These are ‘clinics’ run by students, supervised by clinicians.Purpose
Background
Background: Growing demands upon orthopaedic services in the United Kingdom have resulted in increasing waiting times for orthopaedic consultations. The increasing pressure of new government targets has led to role delegation within the NHS. Magnetic Resonance Imaging (MRI) is a limited resource that requires judicious and validated use. We evaluated the use of MRI in the assessment of patients presenting with back pain to a service managed by an
1312 patients with idiopathic scoliosis completed the ScolioGold Body Image Questionnaire (SBIQ) before and after a course of intensive PSSE treatment. A paired T-test compared the patient's perception of Body image. Mean age was 24.7 with a range of 6 to 83 years old (<18 = 687; >18 = 625), female = 1061, male = 251). Pre-treatment average was 5.3 (SD=2.07), which improved to 2.8 after treatment (SD=1.8). The difference of 2.6 was statistically significant (p<0.005). Pre-treatment, the patients in the children group scored 4.67, which was significantly lower than the adult group score of 6.32. On average, the children improved their scores by 2.48 to 2.19 which was statistically significant (p=0.000). The adults improved their scores by 2.81 to 3.51 which was statistically significant (p=0.000). On average patients with mild (11° to 25° Cobb angles) and moderate (26° to 50° Cobb angles) curvatures achieved a larger improvement compared to patients with severe curvatures (>50° Cobb angles). This difference of 0.35 was statistically significant (n=641, p<0.05). There were significant improvements in the total SBIQ scores before and after treatment in both the child and adult groups with mild to severe curvatures after an intensive course of PSSE treatment. This shows that intensive PSSE treatment can improve scoliotic patients' self-image, therefore addressing aspects of their psychosocial well-being.
When talking to patients about pain, it has been shown that practitioners can positively or negatively influence health beliefs and treatment outcomes. Multidisciplinary physical and psychological interventions have demonstrated better outcomes for patients with long-term pain. Acceptance and Commitment Therapy (ACT) is a form of ‘third wave’ Cognitive Behavioural Therapy (CBT) that has been shown to promote resilience and wellbeing. A qualitative auto-ethnographic case study design was used to explore the communication processes and therapeutic outcomes associated with developing an innovative course integrating ACT interventions with osteopathic treatment, delivered by a single practitioner. Six individual consultations with four patients were audio-recorded, transcribed verbatim and coded. Linguistic Ethnography was used to identify pain discourses and analyse links with clinical decisions and patient responses. Transcript extracts were analysed at three levels; micro-level Conversation Analysis of communication processes; Interactional Sociolinguistic Analysis of changes in patient-practitioner roles; and macro-level Discourse Analysis of the wider biomedical and biopsychosocial context.Purpose and background of the study
Methods
More than 20 million UK citizens have MSK conditions, and post-pandemic the backlog awaiting access to MSK services has increased. The most prevalent MSK condition is low back pain (LBP), and getUBetter has been recommended by NICE as one of five digital health technologies for helping manage LBP. Purpose: Evaluate impact of getUBetter on a community MSK waiting list. Mixed methods approach used. All patients on community MSK waiting list sent a postal invite for getUBetter. Number of downloads and frequency of use recorded, and users emailed questionnaire exploring outcomes and satisfaction. Rate users removed themselves from the waiting list compared with non-users. Of 14,500 invitations, 657(4.5%) patients downloaded getUBetter, 395(60.1%) used it once and 138(21%) ≥3 times. Seventeen (7%) of 239 patients canvassed responded to questionnaire, 17% reported improved pain, 21% reported improved confidence and had been helped back to work. Twenty-five percent better understood their condition and 43% needed no other treatment. Seventy-five percent were critical of limited content, with chronic osteoarthritis mentioned. 69.6% of users removed themselves from the waiting list. This was 29.6% above the rate for non-users.Purpose/Background
Methods/Results
Aims. Femoroacetabular Junction Impingement (FAI) describes abnormalities
in the shape of the femoral head–neck junction, or abnormalities
in the orientation of the acetabulum. In the short term, FAI can
give rise to pain and disability, and in the long-term it significantly increases
the risk of developing osteoarthritis. The Femoroacetabular Impingement
Trial (FAIT) aims to determine whether operative or non-operative
intervention is more effective at improving symptoms and preventing
the development and progression of osteoarthritis. . Methods. FAIT is a multicentre superiority parallel two-arm randomised
controlled trial comparing
This study examined the effect of seven vs. five day
We performed a prospective, double-blind, randomised, clinical trial to investigate the efficacy of two regimes of rehabilitation for knees with anterior cruciate ligament deficiency (ACLD). Fifty ACLD patients were randomly allocated to one of two treatment groups: a programme of muscle strengthening (T) or a programme designed to enhance proprioception and improve hamstring contraction reflexes (P). An indirect measure of proprioception, the reflex hamstring contraction latency (RHCL), and a functional scoring system were used to record the status of the knee before and after the 12-week course of
The aim of this study was to produce clinical consensus recommendations about the non-surgical treatment of children with Perthes’ disease. The recommendations are intended to support clinical practice in a condition for which there is no robust evidence to guide optimal care. A two-round, modified Delphi study was conducted online. An advisory group of children’s orthopaedic specialists consisting of physiotherapists, surgeons, and clinical nurse specialists designed a survey. In the first round, participants also had the opportunity to suggest new statements. The survey included statements related to ‘Exercises’, ‘Physical activity’, ‘Education/information sharing’, ‘Input from other services’, and ‘Monitoring assessments’. The survey was shared with clinicians who regularly treat children with Perthes’ disease in the UK using clinically relevant specialist groups and social media. A predetermined threshold of ≥ 75% for consensus was used for recommendation, with a threshold of between 70% and 75% being considered as ‘points to consider’.Aims
Methods
Introduction Non-specific low back pain (NSLBP) is an extremely heterogeneous condition with many attempts at sub-classification having been made over the years. Background and Purpose of the Study This study developed UK
Background: This pragmatic randomised controlled trial aimed to investigate any differences in the clinical outcomes of patients with low back pain (LBP) receiving
Objective: To determine the factor structure of the Coping Strategies Questionnaire (CSQ). 1. in chronic low back pain patients (CLBP) presenting for
In 2008 The Christie was chosen by Manchester United Football Club to form a unique partnership. This funded a specialist Physiotherapist and Occupational Therapist to work exclusively on the Young Oncology Unit, creating the first posts of their kind in the UK. The YOU treats patients between 16–24 years old with a diagnosis of cancer, sarcoma being one of the most common in this age group. All patients attending the YOU now receive a fully comprehensive
Introduction. The advent of ambulatory total joint replacements has called for measures to reduce postoperative length of stay, while improving patient function and postoperative satisfaction. This prospective, randomized trial evaluated the efficacy of one-on-one preoperative
Purpose: Currently, clubfoot is initially treated with non-operative methods including Ponseti casting and the French
Objective: To determine the extent to which coping strategies mediate chronic low back pain (CLBP) disability in patients presenting for
Cauda Equina Syndrome (CES) is a surgical emergency. With Physiotherapists increasingly taking on first-contact and spinal triage roles, screening for CES must be as thorough and effective as possible. This study explores whether Physiotherapists are asking the correct questions, in the correct way and investigates their experiences when screening for this serious condition. Thirty physiotherapists working in a community musculoskeletal service were purposively invited to participate in semi-structured interviews. Data was transcribed and thematically analysed.Purpose of study
Background
Anterior knee instability associated with rupture of ACL is a disabling clinical problem, especially in the athletic individual. The gracilis and semitendinosus tendon (T4) represent an alternative autograft donor material for reconstruction of the ACL. The aim of our study was to elaborate a CPG to assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with ACL reconstruction with T4. The CPG was developed according to international methods of guideline development. To identify “best evidence” a structured search was performed. When no evidence was available, consensus between experts (physiotherapist and orthopaedic surgeons) was achieved to develop the guideline. To identify “best clinical experience” and “physiopathology reasoning” focus group of practicing physiotherapists was used. They reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it. CPG include three phases determined from the evidence, physiopathology reasoning and the biological process of autograft (weeks after the surgery: 2. a. –6. a. , 6. a. –10. a. and 10. a. –16. a. ). The recommendations included: In postoperative weeks (2. a. –6. a. )
People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians’ views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial). An online cross-sectional survey was piloted by the multidisciplinary research team, then shared with clinical professional groups in the UK who are involved in the management of adults with severe, persistent LBP. The survey had seven sections that covered the demographic details of the clinician, five hypothetical case vignettes of patients with varying presentations, a series of questions regarding the preferred management, and whether or not each clinician would be willing to recruit the example patients into future clinical trials.Aims
Methods
We have compared three different methods of treating
symptomatic non-traumatic tears of the supraspinatus tendon in patients
above 55 years of age. A total of 180 shoulders (173 patients) with
supraspinatus tendon tears were randomly allocated into one of three
groups (each of 60 shoulders);
Following cast removal for nonoperatively treated distal radius fractures, rehabilitation facilitated by advice leaflet and advice video were compared to a course of face-to-face therapy. Adults with an isolated, nonoperatively treated distal radius fracture were included at six weeks post-cast removal. Participants were randomized to delivery of rehabilitation interventions in one of three ways: an advice leaflet; an advice video; or face-to-face therapy session(s). The primary outcome measure was the Disabilities of the Arm, Shoulder and Hand (DASH) score at six weeks post intervention and secondary outcome measures included DASH at one year, DASH work subscale, grip strength, and range of motion at six weeks and one year.Aims
Methods
With many stakeholders, healthcare decisions are complex. However, patient interests should be prioritized. This maximizes healthcare value (quality divided by cost), simultaneously minimizing costs (objective) and maximizing quality (subjective). Unfortunately, even ‘high value’ procedures like total knee arthroplasty (TKA) suffer from recovery assessment subjectivity (i.e. high assessment variability) and increasing costs. High TKA costs and utilization yield high annual expenditures (∼$22B), including postoperative physical therapy (PT) accounting for ∼10% of total costs (∼$2.3B annually). Post-TKA PT is typically homogenous across subjects ensuring most recover, however recent work shows outcomes unimpacted by PT. Accordingly, opportunities exist improving healthcare value by simultaneously reducing unnecessary PT expenditures and improving outcomes. However, discerning recovery completion relies on discrete ROM measures captured clinically and subjective clinician experience (i.e. intuition about recovery). Accordingly, our goal was developing objective post-TKA performance assessment methods utilizing gait knee ROM and statistical analyses to categorize patient recovery (‘accelerated,’ ‘delayed,’ or ‘normal’). We first established statistical reasons for current post-TKA rehabilitation including risk-reward tradeoffs between incorrectly ascribing ‘poor recovery’ to well-recovering patients (T1 error) or ‘good recovery’ to poorly-recovering patients (T2 error) using methods described by Mudge et al. and known TKA volumes/rehabilitation costs. Next, previously captured gait ROM data from well-healed patients was utilized establishing standard recovery curves. These were then utilized to assess newly captured patient recovery. Following IRB approval, we prospectively captured gait ROM from 10 TKA patients (3M, 69±13 years) 1-week pre-TKA and 6-weeks immediately post-TKA. Performance was compared to recovery curves via control charts/Shewhart rules (daily performance) as well as standard deviation thresholds (weekly performance) establishing recovery as ‘accelerated,’ ‘delayed,’ or ‘normal.’ The categorization was extrapolated to US TKA population and savings/expenses quantified. Statistical analyses were performed in Minitab with statistical significance set to α<0.05.Introduction
Methods
Physical therapy(PT) is an integral component in the management of musculoskeletal conditions. On the other hand, there have been few reports exclusively dedicated to studying PT interventions on the same day of total hip arthroplasty(THA). In this study, we investigate the role of rehabilitation in the early postoperative period on length of stay (LOS), total medical cost, and physical recovery following total hip arthroplasty. A prospective cohort study was carried out 104 consecutive patients who underwent 107 primary THA performed by two surgeons. Data were gathered on all patients who underwent operative management from June2016 to June 2017. Institutional review board approval was obtained before performing this study. Patient demographic, physical, and clinical dates were collected for all patients, including age, gender, body mass index (BMI), diagnosis, Japan Orthopedic Association (JOA) hip score, Japanese Orthopedic Association Hip-Disease Evaluation Questionnaire (JHEQ) score, 3min walk test, and Timed up and go (TUG) test. The patient population consisted of 5men and 99women, with an average age of 66.0 years (range, 50–84 years). There were no statistically significant differences between patients who did and did not receive PT with regard to demographic, medical, and surgical data, including gender, age, BMI, JOA hip score, JHEQ score, preoperative 3min walk test, preoperative TUG test(Table 1). All patients underwent direct anterior approach THA through navigation system. Postoperative day (POD) 0 was defined as the same day of surgery. There were no standardized criteria by which patients were selected for participation in rehabilitation with physical therapists. Patient selection for POD 0 rehabilitation was based on the end of surgery time. For instance, when the end of surgery time was in the forenoon, the patients were received POD 0 PT. In contrast, patients who ended operation in the afternoon were classified POD 1 PT. Rehabilitation protocol was adjusted based on surgical approach, and all patients were weight bearing as tolerated. TUG test and 3min walk test was done by a physiotherapist on the seventh day postoperatively.INTRODUCTION
METHODS
Numerous approaches are recommended for the management of non-specific neck pain (NS-NP). However, the extent to which approaches are used is unclear. This survey investigated current UK physiotherapists' measurement and management of patients with NS-NP. Physiotherapists were invited to participate in an online survey if they were practicing in the UK and had experience of managing NS-NP. 2101 responses were received. Analysis of the results indicated the overall popularity of active treatment approaches with 84% and 61% of respondents employing exercise and patient education respectively. 48% of respondents reported using a multimodal approach (that is, combination of exercise and manual therapy with/without patient education). Over a third of respondents reported not using outcome measures (OMs) for NS-NP. Of the two-thirds who reported using OMs, the majority reported using pain and range of motion measures. Physical and functional limitations, psychological distress, and quality of life constructs, which are frequently associated with NS-NP, were rarely measured.Background and objectives
Methods and results
To evaluate the patient experience of patients referred to the ESP Orthopaedic Triage Service. To identify the demographic data of the patients To evaluate patients' expectations and satisfaction of the service A prospective audit of 50 new patients to the ESP service in Mountain Ash General Hospital and Prince Charles Hospital The audit was carried out over a 3 month period between December 2008 and February 2009. Patients were asked to anonymously complete a survey following their appointment. Data was collated independently and analysed with descriptive statistics. Patients referred to ESP service Self administered satisfaction survey. Mean age range 40-59 yrs (range 20 -70yrs). 50% >1 year duration of symptoms. 94% of patient's surveyed rated the service provided as good - excellent. 88% of patient's reported that they were happy to be assessed by the ESP. 96% of patients surveyed agreed they were able to discuss their treatment openly with only 10% preferring to see a Doctor. The ESP service in Cwm Taff Health board achieves a high level of patient satisfaction.
Although modern operative intervention for calcaneal fractures has improved the outcome in many patients, there still is no real consensus on treatment, operative technique, or postoperative management. Vira® is a system for reconstruction-arthrodesis of severe calcaneal fractures, consisting in m The aim of our study was to elaborate a CPG to assist physiotherapists in decision making and to improve the efficacy and uniformity of care for patients with severe calcaneal fractures. The CPG was developed according to international methods of guideline development. To identify “best evidence” a structured search was performed. When no evidence was available, consensus between experts (physiotherapist and orthopaedic surgeons) was achieved to develop the guideline. To identify “best clinical experience” and “physiopathology reasoning” focus group of practicing physiotherapists was used. They reviewed the clinical applicability and feasibility of the guideline, and their comments were used to improve it. CPG include three phases determined from the physiopathology and biomechanical reasoning of surgical system (weeks after the surgery: 2a–5a, 5a–14a, 14a–+/−24a). Unfortunately, evidence related to the treatment of severe calcaneal fracture was sparse and often of poor methodologic quality. The recommendations that were included: early onset (2a week after the surgery) with early mobility and loading, program of home exercises, manual therapy (articular and miofascial techniques), walking in swimming pool, continuous electromagnetic fields of 99Hz with an intensity of 99 Gaussian during 30 min/day; electrotherapy of the intrinsic muscles of the feet (80Hz; 8:12, 20 mi), a program of active exercises of the feet (dorsiflexion and plantarflexion, not supination and pronation) and resistive exercises of triceps surae muscle (7a week), criotherapy and anti-inflammatory positions.
To report the five-year results of a randomised controlled trial
examining the effectiveness of arthroscopic acromioplasty in the
treatment of stage II shoulder impingement syndrome. A total of 140 patients were randomly divided into two groups:
1) supervised exercise programme (n = 70, exercise group); and 2)
arthroscopic acromioplasty followed by a similar exercise programme
(n = 70, combined treatment group).Objectives
Methods
We conducted a randomised controlled trial to
determine whether active intense pulsed light (IPL) is an effective treatment
for patients with chronic mid-body Achilles tendinopathy. A total
of 47 patients were randomly assigned to three weekly therapeutic
or placebo IPL treatments. The primary outcome measure was the Victorian
Institute of Sport Assessment – Achilles (VISA-A) score. Secondary
outcomes were a visual analogue scale for pain (VAS) and the Lower
Extremity Functional Scale (LEFS). Outcomes were recorded at baseline,
six weeks and 12 weeks following treatment. Ultrasound assessment
of the thickness of the tendon and neovascularisation were also
recorded before and after treatment. There was no significant difference between the groups for any
of the outcome scores or ultrasound measurements by 12 weeks, showing
no measurable benefit from treatment with IPL in patients with Achilles tendinopathy. Cite this article:
The Ponseti and French taping methods have reduced
the incidence of major surgery in congenital idiopathic clubfoot
but incur a significant burden of care, including heel-cord tenotomy.
We developed a non-operative regime to reduce treatment intensity
without affecting outcome. We treated 402 primary idiopathic clubfeet
in patients aged <
three months who presented between September
1991 and August 2008. Their Harrold and Walker grades were 6.0%
mild, 25.6% moderate and 68.4% severe. All underwent a dynamic outpatient
taping regime over five weeks based on Ponseti manipulation, modified
Jones strapping and home exercises. Feet with residual equinus (six
feet, 1.5%) or relapse within six months (83 feet, 20.9%) underwent
one to three additional tapings. Correction was maintained with
below-knee splints, exercises and shoes. The clinical outcome at
three years of age (385 feet, 95.8% follow-up) showed that taping
alone corrected 357 feet (92.7%, ‘good’). Late relapses or failure
of taping required limited posterior release in 20 feet (5.2%, ‘fair’)
or posteromedial release in eight feet (2.1%, ‘poor’). The long-term
(>
10 years) outcomes in 44 feet (23.8% follow-up) were assessed
by the Laaveg–Ponseti method as excellent (23 feet, 52.3%), good
(17 feet, 38.6%), fair (three feet, 6.8%) or poor (one foot, 2.3%).
These compare favourably with published long-term results of the
Ponseti or French methods. This dynamic taping regime is a simple
non-operative method that delivers improved medium-term and promising
long-term results. Cite this article: