Aims

Patient engagement in adaptive health behaviours and interactions with their healthcare ecosystem can be measured using self-reported instruments, such as the Patient Activation Measure (PAM-13) and the Effective Consumer Scale (ECS-17). Few studies have investigated the influence of patient engagement on limitations (patient-reported outcome measures (PROMs)) and patient-reported experience measures (PREMs). First, we assessed whether patient engagement (PAM-13, ECS-17) within two to four weeks of an upper limb fracture was associated with limitations (the Quick Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH), and Patient-Reported Outcome Measurement Information System Upper Extremity Physical Function computer adaptive test (PROMIS UE PF) scores) measured six to nine months after fracture, accounting for demographic, clinical, and psychosocial factors. Secondly, we assessed the association between patient engagement and experience (numerical rating scale for satisfaction with care (NRS-C) and satisfaction with services (NRS-S) six to nine months after fracture.

Aims

Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS.

The purpose of this study was to evaluate any differences in quadriceps activation during functional activity between patients with patellofemoral problems and normal subjects. 24 patients and 11 controls were assessed. Surface EMG amplitudes were recorded from three parts of the quadriceps, vastus medialis obliquus (VMO), lower fibres of vastus lateralis (VLO) and rectus femoris (RF), whilst subjects stepped on and off a stool. These amplitudes were normalised to those from a maximal isometric voluntary contraction at 90° of knee flexion. The patients activated their VMO significantly less effectively than controls (mean + SEM normalised peak amplitude was 1.06 + 0.09 in patients, compared to 1.41 + 0.12 in the control subjects). In the controls, most of the activity was seen with the knee in flexion, with very little activity with the knee in extension. In comparison, patients recorded less activity with the knee in flexion and more when the knee approached extension. EMG amplitudes in isometric contractions at 60° of knee flexion were compared with those at 90°. VMO and VLO showed less activation at 60° in both groups of subjects, but in RF there was no difference in the EMG, between these two angles. This suggests that the motor control of VMO/VLO may be different from the bulk of the quadriceps. We have shown that high activity in the VMO and VLO parts of the quadriceps appears to be important in an exercise that involved taking the body weight on one knee at around 90° of flexion. This high activity is likely to have two effects: it is important for the stability of the knee itself, and by increasing the area of contact, it reduces contact pressures. Patients with patellofemoral problems were unable to produce this needed activity in VMO. The VMO and VLO may have a different motor control from the bulk of the quadriceps, and in normal function, work synchronously. The loss of this synchronicity in patients with patellofemoral problems, could well help to explain the retropatellar pain that these patients experience

Previous research has suggested that when subjected to painful lumbar stimulation, chronic low back pain (CLBP) patients with illness behaviour (IB) are unable to effectively engage a sensory modulation system utilised by patients without IB. 1. Furthermore, reduced insular cortex volume in CLBP patients with IB, may compound this problem. 2. . Pain Management Programs (PMP) has demonstrated reductions in IB and disability associated with chronic pain conditions. This current study aims to assess whether the pattern of cerebral response to pain in IB patients could be normalised by participation in a PMP. 12 patients with CLBP and IB (>4/5 Waddell signs present) were recruited prior to attending a 16-day PMP. FMRI scanning occurred prior to (PrePMP) and upon completion of the PMP (PostPMP). 8 healthy volunteers (HC) were scanned once. As in previous research, painful stimuli consisted of intense electrical stimulation delivered bilaterally to the lower back. The presentation of 3 colours indicated the likelihood of receiving 10second stimulation to the lower back (Always, Never and Maybe). IB scores were significantly reduced PostPMP (p <0.05). FMRI group activation maps for the Always condition revealed PostPMP patients increased activation in posterior regions, areas similarly activated by HC. For the Maybe condition, compared to PrePMP group, HC demonstrated greater activation in precuneus and middle and inferior frontal regions. Compared to their pre-treatment selves, PostPMP patients demonstrated increased activation in posterior and frontal regions. The results demonstrate that completion of a 16-day PMP leads to alteration in the brain's response to painful low back stimulation in CLBP patients with IB. Increased activation is seen in regions associated with the top-down modulation of pain. The response is similar to that seen in HC, and greater than before PMP confirming that the PMP process facilitates the utilisation of more normal coping pathways in response to CLBP

The October 2015 Research Roundup360 looks at: Wasted implants; Biofilms revisited; Peri-operative anticoagulation not required in atrial fibrillation; Determinants in outcome following orthopaedic surgery; Patient ‘activation’ and outcomes; Neuroplasticity and nerve repair; KOOS Score in predicting injury?

The October 2013 Trauma Roundup³⁶⁰ looks at: Radiological, electromagnetic or just leave it out altogether?: distal locking in intramedullary nailing; Internal fixation of radiation-induced pathological fractures of the femur has a high rate of failure; Obesity and trauma; Short and sweet?: antibiotics in open fractures; Extremity injuries more important than previously thought?; Cement nails tiptop for osteomyelitis; Oxygen measurements for compartment syndrome?