Advertisement for orthosearch.org.uk
Results 1 - 8 of 8
Results per page:
Orthopaedic Proceedings
Vol. 105-B, Issue SUPP_8 | Pages 117 - 117
11 Apr 2023
Roser M Izatt M Labrom R Askin G Little P
Full Access

Anterior vertebral body tethering (AVBT) is a growth modulating procedure used to manage idiopathic scoliosis by applying a flexible tether to the convex surface of the spine in skeletally immature patients. The purpose of this study is to determine the preliminary clinical outcomes for an adolescent patient cohort.

18 patients with scoliosis were selected using a narrow selection criteria to undergo AVBT. Of this cohort, 11 had reached a minimum follow up of 2 years, 4 had reached 18 months, and 3 had reached 6 months. These patients all demonstrated a primary thoracic deformity that was too severe for bracing, were skeletally immature, and were analysed in this preliminary study of coronal plane deformity correction.

Using open-source image analysis software (ImageJ, NIH) PA radiographs taken pre-operatively and at regular follow-up visits post-operatively were used to measure the coronal plane deformity of the major and compensatory curves.

Pre-operatively, the mean age was 12.0 years (S.D. 10.7 – 13.3), mean Sanders score 2.6 (S.D. 1.8-3.4), all Risser 0 and pre-menarchal, with mean main thoracic Cobb angle of 52° (S.D. 44.2-59.8°). Post-operatively the mean angle decreased to 26.4° (S.D. 18.4-32°) at 1 week, 30.4° (S.D. 21.3-39.6°) at 2 months, 25.7° (S.D. 18.7-32.8°) at 6 months, 27.9° (S.D. 16.2-39.6°) at 12 months, and 36.8° (S.D. 22.6– 51.0°) at 18 months and 38.2° (S.D. 27.6-48.7°) at 2 years. The change in curve at 2 years post-operative was statistically significant (P=0.004).

There were 4 tether breakages identified that did not require return to theatre as yet, one patient underwent a posterior spinal instrumented fusion due to curve progression.

AVBT is a promising new growth modulation technique for skeletally immature patients with progressive idiopathic scoliosis. This study has demonstrated a reduction in scoliosis severity.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 3 - 3
1 Oct 2022
Birkinshaw H Chew-Graham CA Shivji N Geraghty AWA Johnson H Moore M Little P Stuart B Pincus T
Full Access

Background and study purpose

Low back pain with no identified underlying cause is categorised as primary musculoskeletal pain by the International Association for the Study of Pain. In April 2021, the National Institute for Care and Excellence (NICE) published updated guidance for the management of primary chronic pain conditions in England. As part of the De-STRESS pain study, we explored the perspectives of GPs on the updated guideline and impact upon clinical practice.

Methods and results

Semi-structured interviews were conducted with 21 GPs in England. Data were analysed using thematic analysis and constant comparison techniques. GPs agreed with the recommendations restricting pharmacological options for pain management and reflected that they now had an expert reference to back-up their decision-making and could use the guidance in potentially difficult conversations with patients. Frustration was expressed by GPs about the lack of alternative options to medication, as the non-pharmacological recommendations were difficult to implement, had lengthy waiting lists, or were unavailable in their locality.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 25 - 25
1 Oct 2022
Geraghty A Roberts L Hill J Foster N Stuart B Yardley L Hay E Turner D Griffiths G Webley F Durcan L Morgan A Hughes S Bathers S Butler-Walley S Wathall S Mansell G Leigh L Little P
Full Access

Background

Internet delivered interventions may provide a route to rapid support for behavioural self-management for low back pain (LBP) that could be widely applied within primary care. Although evidence is emerging that more complex technologies (mobile apps linked to digital wristbands) can have some impact on LBP-related disability, there is a need to determine the effectiveness of highly accessible, web-based support for self-management for LBP.

Methods and results

We conducted a multi-centre pragmatic randomised controlled trial, testing ‘SupportBack’, an accessible internet intervention developed specifically for primary care. We aimed to determine the effectiveness of the SupportBack interventions in reducing LBP-related physical disability in primary care patients. Participants were randomised to 1 of 3 arms: 1) Usual care + internet intervention + physiotherapy telephone support, 2) Usual care + internet intervention, 3) Usual care alone. Utilising a repeated measures design, the primary outcome for the trial was disability over 12 months using the Roland Morris Disability Questionnaire (RMDQ) at 6 weeks, 3, 6 and 12 months. Results: 826 were randomised, with follow-up rates: 6 weeks = 83%; 3 months = 72%; 6 months = 70%; 12 months = 79%. Analysis is ongoing, comparing each intervention arm versus usual care alone. The key results will be presented at the conference.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 17 - 17
1 Oct 2022
Shivji N Geraghty A Birkinshaw H Pincus T Johnson H Little P Moore M Stuart B Chew-Graham C
Full Access

Background and study purpose

Low mood and distress are commonly reported with by people with persistent musculoskeletal pain and may be mislabelled as ‘depression’. In order to understand how pain-related distress is conceptualised and managed in primary care consultations, we explored understanding of pain-related distress and depression from the perspectives of people with persistent musculoskeletal pain and general practitioners (GPs).

Method and results

Semi-structured interviews with 21 GPs and 21 people with persistent musculoskeletal pain were conducted. The majority of people with pain had back pain (15/21). Data were analysed thematically using constant comparison techniques. Participants described challenges distinguishing between distress and depression in the context of persistent pain but described strategies to make this distinction. Some people with pain described how acceptance of their situation was key, involving optimism about the future and creation of a new identity. Some GPs expressed ‘therapeutic nihilism’, with uncertainty about the cause of pain and thus how to manage people with both pain and distress, whilst GPs who could identify and build on optimism with patients described how this could help the patient to move forwards.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 4 - 4
1 Feb 2016
Geraghty A Stanford R Roberts L Little P Hill J Foster N Hay E Yardley L
Full Access

Background:

Internet interventions provide an opportunity to encourage patients with LBP to self-manage and remain active, by tailoring advice and providing evidence-based support for increasing physical activity. This paper reports the development of the ‘SupportBack’ internet intervention, designed for use with usual primary care, as the first stage of a feasibility RCT currently underway comparing: usual primary care alone; usual care plus the internet intervention; usual care plus the internet intervention with physiotherapist telephone support.

Methods:

The internet intervention delivers a 6-week, tailored programme focused on graded goal setting, self-monitoring, and provision of tailored feedback to encourage physical activity/exercise increases or maintenance. 22 patients with back pain from primary care took part in ‘think aloud’ interviews, to qualitatively explore the intervention, provide feedback on its relevance and quality and identify any extraneous content or omissions.


Orthopaedic Proceedings
Vol. 98-B, Issue SUPP_6 | Pages 31 - 31
1 Feb 2016
Bishop F Dima A Ngui J Little P Moss-Morris R Foster N Lewith G
Full Access

A statement of the purposes of the study and background:

Merely publishing clinical guidelines is insufficient to ensure their implementation in clinical practice. We aimed to clarify the decision-making processes that result in the delivery of particular treatments to patients with low back pain (LBP) in primary care and to examine clinicians' perspectives on the National Institute for Health and Care Excellence (NICE) clinical guidelines for managing LBP in primary care.

A summary of the methods used and the results:

We conducted semi-structured interviews with 53 purposively-sampled clinicians from south-west England. Participants were: 16 General Practitioners (GPs), 10 chiropractors, 8 acupuncturists, 8 physiotherapists, 7 osteopaths, and 4 nurses. Thematic analysis showed that official guidelines comprised just one of many inputs to clinical decision-making. Clinicians drew on personal experience and inter-professional networks and were constrained by organisational factors when deciding which treatment to prescribe, refer for, or deliver to an individual patient with LBP. Some found the guideline terminology - “non-specific LBP” - unfamiliar and of limited relevance to practice. They were frustrated by disparities between recommendations in the guidelines and the real-world situation of short consultation times, difficult-to-access specialist services and sparse commissioning of guideline-recommended treatments.


Orthopaedic Proceedings
Vol. 96-B, Issue SUPP_4 | Pages 23 - 23
1 Feb 2014
Jones L Roberts L Little P Wiles R Mullee M Cleland J Cooper C
Full Access

Purpose of the Study and Background

With a strong political agenda for change towards patient-centred healthcare, the notion of shared decision-making is reported to substantially improve patient experience, adherence to treatment and health outcomes. In clinical practice however, observational studies have shown shared decision-making is rarely implemented and patient preferences are seldom met.

The aim of this study was to measure the extent of shared decision-making in clinical encounters involving physiotherapists and patients with low back pain.

Methods and Results

Eighty outpatient encounters (from 12 clinicians) were observed, audio-recorded, transcribed verbatim and analysed using the OPTION instrument. This measures 12 decision-making items, rated on a scale 0–4, which are summated and scaled to give a percentage: The higher the score, the greater the shared decision-making competency.

The mean OPTION score was 24.0% (range 10.4%–43.8%). Providing patients with a list of treatment options was the only behaviour exhibited by every clinician, however in 73.8%, this was not demonstrated beyond a perfunctory level. Failure to offer the choice of doing nothing, or deferring the decision precluded clinicians from attaining a higher OPTION score.


Orthopaedic Proceedings
Vol. 84-B, Issue SUPP_II | Pages 142 - 142
1 Jul 2002
Roberts L Little P Cantrell E Chapman J Langridge J Pickering R
Full Access

Purpose of study: General practitioners (GPs) are often asked to recruit patients for research studies. However, a mismatch exists between the numbers of potential patients (estimated from pilot work and reported literature) and actual patients recruited. The purpose of this study was to establish GPs’ perceptions of the reasons for this mismatch.

Background: An OCPS survey reported that 16% of adults consulted their GP with back pain per year. Thus a GP, serving an average population of ~1900 patients, might expect to see around 300 patients with back pain every year, although this estimate includes all causes of back pain. Nevertheless, this represents a significant proportion of a GP’s workload.

In the ‘Back Home’ study, which was a randomised controlled trial of a patient information leaflet for people with acute low back pain (previously presented to this Society), recruitment of patients was problematic. A total of 28/97 GPs in the New Forest area agreed to recruit patients for the study, but in 22 weeks, only 8 patients emerged. Despite extending the catchment area of the study, and having 51 participating GPs, in 2_ years, only 64 patients were entered from 19 of these GPs. Therefore, we decided to investigate GPs’ perceptions of the reasons for such poor recruitment.

Methods: The challenge for this research was identifying how best to gain information from GPs about poor recruitment, recognising that requests for information about poor response rates may yield a limited response! The least intrusive means of accessing information was considered to be a brief questionnaire containing an open question that asked GPs to list any reasons that they thought may have contributed to the slow recruitment of patients into the study. GPs were then asked to rate 12 factors, identified by GPs who had withdrawn from the study. The factors were rated using a Likert scale from 1–4 (1=‘not at all’, 2=‘mildy’, 3=‘moderately’ and 4=‘very significantly’).

Results: Of the initial 51 participating GPs, 11 did not complete the study: 1 left the practice; 2 retired; 7 withdrew (3 of these due to pressure of work); and 1 was asked to leave the study by the research team due to issues of non-conformity with the study protocol.

Forty GPs were sent a questionnaire and 24 responded (60%). They gave 47 unprompted reasons for poor recruitment of patients – the most popular being: pressure of work (n=12); difficulty remembering (n=10); feeling ‘over-researched’ (n=4); and few patients fitted the inclusion criteria (n=4). When GPs rated the 12 listed factors, the maximum score for each item = 96 (24x4). According to the GPs, the top 4 factors were: pressure of work (score=60); forgetting to include suitable patients (52); time-consuming process of entering patients (39); GPs are ‘over-researched’ (31).

Conclusion: Research studies that necessitate GPs accessing patients from their routine surgeries are likely to experience difficulties with recruitment. It is vital that researchers and funding agencies address this issue if research within primary care is to survive.