This prospective multicentre study was undertaken to determine segmental movement, disc height and sagittal alignment after total disc replacement (TDR) in the lumbosacral spine and to assess the correlation of biomechanical properties to clinical outcomes. A total of 173 patients with degenerative disc disease and low back pain for more than one year were randomised to receive either TDR or multidisciplinary rehabilitation (MDR). Segmental movement in the sagittal plane and disc height were measured using distortion compensated roentgen analysis (DCRA) comparing radiographs in active flexion and extension. Correlation analysis between the range of movement or disc height and patient-reported outcomes was performed in both groups. After two years, no significant change in movement in the sagittal plane was found in segments with TDR or between the two treatment groups. It remained the same or increased slightly in untreated segments in the TDR group and in this group there was a significant increase in disc height in the operated segments. There was no correlation between segmental movement or disc height and patient-reported outcomes in either group. In this study, insertion of an intervertebral disc prosthesis TDR did not increase movement in the sagittal plane and segmental movement did not correlate with patient-reported outcomes. This suggests that in the lumbar spine the movement preserving properties of TDR are not major determinants of clinical outcomes. Cite this article: Bone Joint J 2013;95-B:81–9

Background and Purpose. Non-specific chronic low back pain (NSCLBP) poses a significant disability and economic burden worldwide. Fear avoidance is suggested to contribute to its chronicity and reduced treatment effect. National guidelines recommend exercise as a component of multidisciplinary rehabilitation but its interaction with fear avoidance is ambiguous. This systematic review examined the effect of exercise-based interventions (EBIs) on fear avoidance NSCLBP. Methods and Results. RCTs comparing EBIs to usual care in adults with NSCLBP were included. A systematic search of CINAHL, Medline, EMBASE, Web of Science, Scopus and Cochrane Library (up to January 2019) revealed 10 eligible trials. Following risk of bias assessment, 6 studies were included for data extraction and narrative synthesis. EBIs were not found superior to usual care in reducing fear avoidance at any follow-up. There was evidence that reducing fear avoidance is probably not the mechanism through which EBIs affect pain and disability. In adherent patients, EBIs did not result in greater clinically relevant improvements in pain or disability than usual care, in the short- or intermediate-term. Conclusion. Addition of EBIs as part of multidisciplinary rehabilitation is not more beneficial than that of usual care in reducing fear avoidance in NSCLBP patients. However, the findings of this review are based on heterogenous studies presenting with methodological limitations. Further high-quality research is required to examine the review's findings and investigate current physiotherapy management of fear avoidance in NSCLBP. No conflicts of interest. No funding obtained

The October 2014 Spine Roundup. 360 . looks at: microdiscectomy is not exactly a hands-down winner; lumbar spinal stenosis unpicked; Wallis implant helpful in lumbosacral decompression; multidisciplinary rehabilitation is good for back pain; and understanding the sciatic stretch test

Background. Chronic pain is a complex condition that demonstrates better outcomes in multidisciplinary rehabilitation, typically delivered to groups of patients by tertiary healthcare teams. An inter-disciplinary pain management course for individual patients was developed to increase the scope of physical therapists working in primary care by integrating osteopathic manual therapy with psychological interventions from Acceptance and Commitment Therapy (ACT), a form of ‘3rd wave’ Cognitive Behaviour Therapy. Method and Results. A single cohort study with pre-course (n=180) and post-course (n=79) self-report measures (44% response rate) evaluated six week interventions which combined individual manual therapy with self-management, delivered by teams of qualified and student osteopaths. Data included: quality of life (European Quality of Life Questionnaire); pain, mood and coping (Bournemouth Questionnaire); psychological flexibility (Revised Acceptance and Action Questionnaire); and mindfulness (Freiburg Mindfulness Inventory). Participants were predominantly female (68%), unemployed (59%), with an average age of 49 and pain duration of more than 12 months (86%). Commonly reported symptoms were low back pain (82%), neck pain (60%) and multiple sites (86%). At six months, there were statistically significant improvements in all four outcome measures (p<0.0005), with promising effect sizes in quality of life and pain coping (r=0.52) which appeared to be mediated by changes in psychological flexibility. Conclusions. This innovative, integrated, patient-centred chronic pain management course demonstrated promising outcomes when delivered by osteopaths with varying experience. Randomised clinical trials are now needed to assess outcomes in comparison with standard care, and optimal ways of training physical therapists to deliver effective psychological interventions. Conflicts of interest: No conflicts of interest. Sources of funding: A Department of Health ‘Innovation, Excellence and Strategic Development’ (IESD) grant for the Voluntary Sector Investment Programme (AIMS Ref: 2527190; ISRCTN: 04892266). The results of this study are being submitted for publication in the International Journal of Osteopathic Medicine and will be presented at the COME Collaboration Osteopathic Conference in Barcelona on September 30th 2017 and at the Therapy Expo 2017 at the NEC in Birmingham on November 22nd 2017

Stress fractures of the pars interarticularis of the lumbar spine in professional fast bowlers have become commonplace in recent times. Should conservative measures in their treatment fail, surgery can give good results. Postoperative rehabilitation is of the utmost importance following surgery and a suggested programme is outlined. Post operatively, exercises and rehabilitation should proceed at a rate that is proportional to graft incorporation at the surgical site. Our rehabilitation programme has been fine tuned over several years giving much clearer guidance regarding that bowlers’ progress. We have rehabilitated 12 fast bowlers subsequent to Bucks repair of the pars interarticularis stress fracture in the lumbar spine. We have identified 7 stages in this process to rehabilitate the bowler to the highest level. We emphasise that the process of rehabilitation involves a team approach, the most important members being surgeon, physiotherapist, bowling coach and trainer. Surgery to the fast bowler with a stress fracture of the pars interarticularis can give good results. However it is necessary to have a multidisciplinary rehabilitation programme that proceeds in a stepwise manner to enable a return to full sport

Purposes and Background. Musculoskeletal disorders including as back and neck pain are leading causes of work disability. Effective interventions exist (i.e. functional restoration, multidisciplinary biopsychosocial rehabilitation, workplace-based interventions, etc.), but it is difficult to select the optimal intervention for specific patients. The Work Assessment Triage Tool (WATT) is a clinical decision support tool developed using machine learning to help select interventions. The WATT algorithm categorizes patients based on individual, occupational, and clinical characteristics according to likelihood of successful return-to-work following rehabilitation. Internal validation showed acceptable classification accuracy, but WATT has not been tested beyond the original development sample. Our purpose was to externally validate the WATT. Methods and Results. A population-based cohort design was used, with administrative and clinical data extracted from a Canadian provincial compensation database. Data were available on workers being considered for rehabilitation between January 2013 and December 2016. Data was obtained on patient characteristics (ie. age, sex, education level), clinical factors (ie. diagnosis, part of body affected, pain and disability ratings), occupational factors (ie. occupation, employment status, modified work availability), type of rehabilitation program undertaken, and return-to-work outcomes (receipt of wage replacement benefits 30 days after assessment). Analysis included classification accuracy statistics of WATT recommendations for selecting interventions that lead to successful RTW outcomes. The sample included 5296 workers of which 33% had spinal conditions. Sensitivity of the WATT was 0.35 while specificity was 0.83. Overall accuracy was 73%. Conclusion. Accuracy of the WATT for selecting successful rehabilitation programs was modest. Algorithm revision and further validation is needed. No conflicts of interest. Sources of funding: Funding was provided by the Workers' Compensation Board of Alberta

Rehabilitation as a concept, and the practice of rehabilitation, have changed remarkably during the preceding years. Modern rehabilitation is multidisciplinary and multi-professional. The development and research of rehabilitation has also grown international. The contents of modern rehabilitation include medical, social and psychological aspects, and in vocational rehabilitation, the working conditions and organisational questions are dealt with as well (Jager 1999). Traditional methods in vocational rehabilitation and guidance include medical and psychological assessment, and work clinics assessment (which includes practical work assessment in the work place). Presently, the methods, have advanced and rehabilitation is not seen merely as a specific method for handicapped people. Various rehabilitation measures are flexibly applied, and rehabilitation includes elements of adult education, training of working skills, and ideas of on-the-job training and career advancement. The concepts, targets and contexts of rehabilitation and prevention can be described as follows:. Primary Prevention: health education and ergonomic advice for general, non-disabled population. Secondary Prevention: early rehabilitation for groups at risk with early signs of disability. Tertiary Prevention: rehabilitation and habilitation of severely disabled to secure social integration. The outcome of rehabilitation has been studied extensively, but the number of randomised controlled trials (RCT) is not large in any of the major target groups of rehabilitation. Among musculoskeletal disorders, the best evidence for the efficacy of multidisciplinary rehabilitation is for sub-acute and chronic low back pain disorders. Systematic reviews have been performed in various other musculoskeletal disorders as well, e.g. in fibromyalgia and multilocational pain syndromes, where no clear evidence has yet been demonstrated. It should be noted though that RCT’s are not the only way to get information about the outcome, efficacy or effectiveness of rehabilitation, and vocational rehabilitation in particular. The outcome of vocational rehabilitation, i.e. the success of occupational integration, depends a great deal on the general employment outlook. This is generally known but often ignored. Various forms of supported employments have become more important than earlier. The European Social Fund’s Employment Horizon initiative has launched many projects in Europe. As a result, new training and employment approaches have been developed for disabled persons, including co-operatives, social enterprises and distance work. In practice, supported employment takes the form of individual training at the workplace and consists of finding suitable supported work, redesigning job requirements in co-operation with both employer and employee to fit the employee’s abilities, and ongoing support as long as it is needed. These programmes reflect the important values of the society. It is a valuable goal to help disabled people to integrate into society, which involves participation into working life. This makes it possible for them to preserve their dignity as well. In fact, how Society deals with its disabled people enables it to discover most clearly its basic values

Objectives. Aged trauma patients are at high risk for various comorbidities and loss of function following hip fracture. Consequently a multidisciplinary approach for the treatment of these patients has become more famous in order to maintain the patients” activity level and health status prior to trauma. This study evaluates the effect of a multidisciplinary inpatient rehabilitation on the short- and long-term functional status of geriatric patients following hip fracture surgery. Methods. A collective of 158 hip fracture patients (> 80 years) who underwent surgery were included in this study. An initial Barthel Index lower than 30 points was a criteria to exclude patients from this study. Two subgroups, depending on the availability of treatment spots at the rehabilitation center were made. No other item was used to discriminated between the groups. Group A (n=95) stayed an average of 21 days at an inpatient rehabilitation center specialized in geriatric patients. Group B (n=63) underwent the standard postoperative treatment. As main outcome parameter we used the Barthel Index, which was evaluated for every patient on the day of discharge and checkups after three, six and twelve months. Results. After three months, the average Barthel Index was 82,27 points for group A and 74,68 points for group B (p=0,015). In the six-months-checkup group A”s average Barthel Index was 84,05 points and group B”s was 74,76 points (p=0,004). After twelve months, patients from group A had an average Barthel Index of 81,05 while patients from group B had an average Barthel Index of 71,51 (p=0,010). Conclusion. This study reveals a significant better outcome in both, the short-term and the long-term functional status for geriatric hip-fracture patients, who underwent an inpatient treatment in a rehabilitation center following the initial surgical therapy. This is shown at the timepoints three, six and twelve month after discharge. To maintain quality of life and mobility as well as the patient”s independence in daily life, a treatment in a rehabilitation center specialized in geriatric patients is highly recommendable

Aims

The aim of this study was to investigate the association between the type of operation used to treat a trochanteric fracture of the hip and 30-day mortality.

Aims

Chronic conditions of the wrist may be difficult to manage because pain and psychiatric conditions are correlated with abnormal function of the hand. Additionally, intra-articular inflammatory cytokines may cause pain.

We aimed to validate the measurement of inflammatory cytokines in these conditions and identify features associated with symptoms.

The February 2014 Spine Roundup³⁶⁰ looks at: single posterior approach for severe kyphosis; risk factors for recurrent disc herniation; dysphagia and cervical disc replacement or fusion; hang on to your topical antibiotics; cost-effective lumbar disc replacement; anxiolytics no role to play in acute lumbar back pain; and surgery best for lumbar disc herniation.

We live in troubled times. Increased opposition reliance on explosive devices, the widespread use of individual and vehicular body armour, and the improved survival of combat casualties have created many complex musculoskeletal injuries in the wars in Iraq and Afghanistan. Explosive mechanisms of injury account for 75% of all musculoskeletal combat casualties. Throughout all the echelons of care medical staff practice consistent treatment strategies of damage control orthopaedics including tourniquets, antibiotics, external fixation, selective amputations and vacuum-assisted closure. Complications, particularly infection and heterotopic ossification, remain frequent, and re-operations are common. Meanwhile, non-combat musculoskeletal casualties are three times more frequent than those derived from combat and account for nearly 50% of all musculoskeletal casualties requiring evacuation from the combat zone.

With the established success of the National Joint Registry and the emergence of a range of new national initiatives for the capture of electronic data in the National Health Service, orthopaedic surgery in the United Kingdom has found itself thrust to the forefront of an information revolution. In this review we consider the benefits and threats that this revolution poses, and how orthopaedic surgeons should marshal their resources to ensure that this is a force for good.

Previous studies on the timing of surgery for fracture of the hip provide conflicting evidence as to the effect of prolonged delay before operation. We have prospectively reviewed 3628 such fractures in patients older than 60 years of age. Those for whom the delay was for medical reasons were excluded. Patients were followed up for one year or until death. Operation was undertaken within 48 hours in 95.2% and after this in 4.8%. A significant increase in length of stay was found in patients operated on after 48 hours when compared with those in the earlier group (21.6 vs 32.5 days). No increase in hospital stay was found for lesser delays.