Weightbearing instructions after musculoskeletal injury or orthopaedic surgery are a key aspect of the rehabilitation pathway and prescription. The terminology used to describe the weightbearing status of the patient is variable; many different terms are used, and there is recognition and evidence that the lack of standardized terminology contributes to confusion in practice. A consensus exercise was conducted involving all the major stakeholders in the patient journey for those with musculoskeletal injury. The consensus exercise primary aim was to seek agreement on a standardized set of terminology for weightbearing instructions.Aims
Methods
A Physiotherapist-led Joint Replacement Surgery (JRS) Clinic was pioneered at the Royal Melbourne Hospital (RMH) Australia to improve the efficiency of the review process following hip and knee arthroplasty surgery and improve outpatient access to orthopaedic consultation. A credentialed physiotherapist conducted specified post-operative reviews in place of orthopaedic surgeons. A protocol for the JRS Clinic was developed collaboratively by the Orthopaedic Surgery and Physiotherapy Departments at RMH. The orthopaedic surgeons conducted the initial 6 week post-operative review and the physiotherapist conducted subsequent reviews at 3, 6 and 12 months, and annually thereafter. Routine radiological imaging occurred immediately post-operatively, and at 1 year, 5 years, 10 years and then annually. Radiological credentialing allowed the physiotherapist to assess and manage patients independently. Collocation with the orthopaedic clinic facilitated immediate surgical input when required. Between October 2009 and January 2011, 156 patients were offered a total of 246 appointments in the JRS clinic. This included 174 primary joint replacements (99 hip and 75 knee), 19 revisions (16 hip and 3 knee), and 3 re-surfaced hips. The attendance rate for the clinic was 82.9%. The physiotherapist discussed 20 cases with the surgeons with only 6 patients requiring transfer back to the Orthopaedic unit for ongoing management. Two of these patients have been wait-listed for revision surgery, 2 are undergoing further investigations and the remaining patients are yet to attend their scheduled review. Four patients declined further follow up in the JRS clinic. There were no adverse outcomes reported and no nursing input for wound issues was required. A patient survey demonstrated high levels of satisfaction with the service particularly related to improved access and time efficiencies. Physiotherapist-led JRS Clinics in partnership with the Orthopaedic Surgery Department are an efficient and effective alternative model of care for the long term review of patients following arthroplasty surgery. The clinics assist in addressing the growing demand for arthroplasty services by increasing the surgeons’ capacity to manage new referrals.
The study used a qualitative methodology to explore the attitudes and beliefs of military physiotherapists and how these influenced the management of military patients presenting with chronic low back pain. Semi-structured interviews were undertaken with a sample of 16 military physiotherapists; the transcripts were analysed using a method of thematic content analysis. Analysis of semi-structured interviews undertaken resulted in the identification of six themes. These were: military culture, occupational issues, continuing professional development, clinical reasoning, need for cure and labelling the patient. The importance of understanding the occupational demands on their patients was considered highly significant by all of the military physiotherapists interviewed. However, there appeared generally poor knowledge of the biopsychosocial model in the management of low back pain and over-reliance on the medical model. Three-quarters of the military physiotherapists interviewed expressed frustration in their management of patients with low back pain. Similarly, the military physiotherapists displayed a poor awareness of current evidence-based clinical guidelines for the management of low back pain. The themes military culture and occupational issues were significant in influencing the military physiotherapist's clinical management. The highly physical and arduous nature of military occupations resulted in investigative procedures being requested at an earlier stage than is recommended in the current evidence-based guidelines. Justification for early investigations was provided on the basis of the unique occupational factors combined with requirement to optimise the number of military personnel able to deploy operationally. It was concluded that the management of low back pain in military personnel could be improved by increasing awareness of the current evidence-based guidelines. This would benefit both patients and the Armed Services, by reducing the disability caused by low back pain and increasing the number of operationally deployable service personnel.
Traditionally, sports Injuries have been sub-optimally managed through Emergency Departments (ED) in the public health system due to a lack of adequate referral processes. Fractures are ruled out through plain radiographs followed by a reactive process involving patient initiated further follow up and investigation. Consequently, significant soft tissue and chondral injuries can go undiagnosed during periods in which early intervention can significantly affect natural progression. The purpose of this quality improvement project was to assess the efficacy of an innovative Sports Injury Pathway introduced to detect and treat significant soft tissue injuries. A Sports Injury Pathway was introduced at Fiona Stanley Hospital (WA, Australia) in April 2019 as a collaboration between the ED, Physiotherapy and Orthopaedic Departments. ED practitioners were advised to have a low threshold for referral, especially in the presence of a history of a twisting knee injury, shoulder dislocation or any suggestion of a hip tendon injury. All referrals were triaged by the Perth Sports Surgery Fellow with early follow-up in our Sports Trauma Clinics with additional investigations if required. A detailed database of all referrals was maintained, and relevant data was extracted for analysis over the first 3 years of this pathway. 570 patients were included in the final analysis. 54% of injuries occurred while playing sport, with AFL injuries constituting the most common contact-sports injury (13%). Advanced Scope
Introduction and aims. Low back pain is a common complaint, affecting up to one third of the adult population costing over £1 billion to the NHS each year and £3.5 billion to the UK economy in lost production. The demand for spinal injections is increasing allowing for advanced spinal physiotherapists to perform the procedure. The objective of this study was to investigate outcome following spinal injections performed by consultant spinal surgeon (n=40) and advanced spinal physiotherapists (ASP) (n=40) at our centre. Method and Materials. Data on 80 patients who had received caudal epidural (n=36), nerve root block (n=28) and facet joint injections (n=16) form August 2010 to October 2011 consented to be in the study. 40 patients in each group completed Oswestry Disability Index (ODI), Visual Analogue Scores (VAS) before and 6 weeks after the procedure and patient satisfaction questionnaire investigating their experience and any complications related to the spinal injection retrospectively. The study included 32 males and 48 females. Mean age 57 years, range 21–88. [Consultant group M:17, F:23 mean age: 55, range 21–81. ASP group M:15, F:25 mean age 59, range 22–88]. Measures of patient satisfaction and outcome were obtained; using 2 tailed independent samples t-test with 95% confidence interval, statistical significance was investigated. Results. Data analysis shows that there are no significant differences (p>0.05) in either overall patient satisfaction or outcomes between patients of the surgeon vs physiotherapists. Patients of the surgeon were found to be more satisfied with the procedure itself (p< 0.05). Conclusion.
