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. 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
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
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
Participation in a
Aims. This feasibility study investigates the utilization and cost of health resources related to formal and informal care, home adaptations, and
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
Aims. Ankle fractures are common, mainly affecting adults aged 50 years and over. To aid recovery, some patients are referred to
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
Aims. Is it feasible to conduct a definitive multicentre trial in community settings of corticosteroid injections (CSI) and hydrodilation (HD) compared to CSI for patients with frozen shoulder? An adequately powered definitive randomized controlled trial (RCT) delivered in primary care will inform clinicians and the public whether hydrodilation is a clinically and cost-effective intervention. In this study, prior to a full RCT, we propose a feasibility trial to evaluate recruitment and retention by patient and clinician willingness of randomization; rates of withdrawal, crossover and attrition; and feasibility of outcome data collection from routine primary and secondary care data. Methods. In the UK, the National Institute for Health and Care Excellence (NICE) advises that prompt early management of frozen shoulder is initiated in primary care settings with analgesia,
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
Aims. Frozen shoulder is a common, painful condition that results in impairment of function. Corticosteroid injections are commonly used for frozen shoulder and can be given as glenohumeral joint (GHJ) injection or suprascapular nerve block (SSNB). Both injection types have been shown to significantly improve shoulder pain and range of motion. It is not currently known which is superior in terms of relieving patients’ symptoms. This is the protocol for a randomized clinical trial to investigate the clinical effectiveness of corticosteroid injection given as either a GHJ injection or SSNB. Methods. The Therapeutic Injections For Frozen Shoulder (TIFFS) study is a single centre, parallel, two-arm, randomized clinical trial. Participants will be allocated on a 1:1 basis to either a GHJ corticosteroid injection or SSNB. Participants in both trial arms will then receive
Aims. Perthes’ disease is a condition which leads to necrosis of the femoral head. It is most commonly reported in children aged four to nine years, with recent statistics suggesting it affects around five per 100,000 children in the UK. Current treatment for the condition aims to maintain the best possible environment for the disease process to run its natural course. Management typically includes
Aims. To achieve expert clinical consensus in the delivery of hydrodilatation for the treatment of primary frozen shoulder to inform clinical practice and the design of an intervention for evaluation. Methods. We conducted a two-stage, electronic questionnaire-based, modified Delphi survey of shoulder experts in the UK NHS. Round one required positive, negative, or neutral ratings about hydrodilatation. In round two, each participant was reminded of their round one responses and the modal (or ‘group’) response from all participants. This allowed participants to modify their responses in round two. We proposed respectively mandating or encouraging elements of hydrodilatation with 100% and 90% positive consensus, and respectively disallowing or discouraging with 90% and 80% negative consensus. Other elements would be optional. Results. Between 4 August 2020 and 4 August 2021, shoulder experts from 47 hospitals in the UK completed the study. There were 106 participants (consultant upper limb orthopaedic surgeons, n = 50; consultant radiologists, n = 52; consultant physiotherapist, n = 1; extended scope physiotherapists, n = 3) who completed round one, of whom 97 (92%) completed round two. No elements of hydrodilatation were “mandated” (100% positive rating). Elements that were “encouraged” (≥ 80% positive rating) were the use of image guidance, local anaesthetic, normal saline, and steroids to deliver the injection. Injecting according to patient tolerance,
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
The anterior cruciate ligament (ACL) is frequently injured in elite athletes, with females up to eight times more likely to suffer an ACL tear than males. Biomechanical and hormonal factors have been thoroughly investigated; however, there remain unknown factors that need investigation. The mechanism of injury differs between males and females, and anatomical differences contribute significantly to the increased risk in females. Hormonal factors, both endogenous and exogenous, play a role in ACL laxity and may modify the risk of injury. However, data are still limited, and research involving oral contraceptives is potentially associated with methodological and ethical problems. Such characteristics can also influence the outcome after ACL reconstruction, with higher failure rates in females linked to a smaller diameter of the graft, especially in athletes aged < 21 years. The addition of a lateral extra-articular tenodesis can improve the outcomes after ACL reconstruction and reduce the risk of failure, and it should be routinely considered in young elite athletes. Sex-specific environmental differences can also contribute to the increased risk of injury, with more limited access to and availablility of advanced training facilities for female athletes. In addition, football kits are designed for male players, and increased attention should be focused on improving the quality of pitches, as female leagues usually play the day after male leagues. The kit, including boots, the length of studs, and the footballs themselves, should be tailored to the needs and body shapes of female athletes. Specific
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
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