Purpose. Previous studies have demonstrated pronounced reduction of
Purpose and Background. Back pain impinges upon all aspects of life, has a reported UK lifetime prevalence as high as 84% and considering approximately a third of our lives are spent asleep the paucity of research into the effect a mattress has on back pain and sleep is surprising. Mood changes, effecting an increase in pain perception, due to sleep loss may also lead to a downward spiral of increasing back pain and greater sleep loss. A controllable factor in this spiral, affecting both aspects, is the mattress but to the authors' knowledge none currently available on the market have any robust, published research to objectively support any claims made and at best being ‘endorsed’ by experts. This may lead to possible misinterpretation of efficacy and leave professionals at a loss with what to advise when questioned. Methods and Data collection. Method:. A three month, randomised, controlled, double blind crossover field study is proposed to take place in the participants own homes, ensuring the most natural sleep environment. Data collection:. Three 28 day phases. 1 - Baseline data, participants sleeping on their own mattress. 2 - Random allocation of mattresses, half allocated test and half control. 3 - Crossover of test and control mattress. Subjective measures of back pain and
Aims. Patient-reported outcome measures have become an important part of routine care. The aim of this study was to determine if Patient-Reported Outcomes Measurement Information System (PROMIS) measures can be used to create patient subgroups for individuals seeking orthopaedic care. Methods. This was a cross-sectional study of patients from Duke University Department of Orthopaedic Surgery clinics (14 ambulatory and four hospital-based). There were two separate cohorts recruited by convenience sampling (i.e. patients were included in the analysis only if they completed PROMIS measures during a new patient visit). Cohort #1 (n = 12,141; December 2017 to December 2018,) included PROMIS short forms for eight domains (Physical Function, Pain Interference, Pain Intensity, Depression, Anxiety,
Aims. The primary aim was to assess change in health-related quality of life (HRQoL) of patients as they waited from six to 12 months for a total hip (THA) or total or partial knee arthroplasty (KA). Secondary aims were to assess change in joint-specific function, mental health,
Abstract. Introduction. There is a need to develop approaches to reduce chronic pain after total knee replacement. There is an established link between disturbed sleep and pain. We tested the feasibility of a trial evaluating the clinical and cost-effectiveness of a pre-operative sleep assessment and complex intervention package for improving long-term pain after TKR. Methodology. REST was a feasibility multi-centre randomised controlled trial with embedded qualitative study and health economics. Participants completed baseline measures and were randomised to usual care or the intervention, a tailored sleep assessment and behavioural intervention package delivered by an extended scope practitioner three months pre-operatively with a follow-up call up at four-weeks. Patient reported outcomes were assessed at baseline, one-week pre-surgery, and 3-months post-surgery. Results. 57 patients were randomised and 20 had surgery within the study timelines. All patients allocated the intervention attended an appointment and most engaged with treatment. The intervention group reported improvements in sleep (Sleep Conditions Indicator) and neuropathic pain (painDETECT) scores. Participants found the sleep treatments and study processes to be acceptable. The mean cost of the intervention was estimated at £134.45 per patient. Conclusion. The feasibility study has shown that patient recruitment is feasible, engagement with and adherence to the intervention is high, and the intervention is acceptable to patients and clinicians. Preliminary findings show that the intervention group had improved
Background and purpose. Sleep disturbance is frequently reported by people with chronic low back pain (CLBP >12 weeks), but there is limited knowledge of their
Background and purpose. Sleep disturbance is a prevalent symptom in people with chronic low back pain (CLBP >12 weeks), but there is currently no knowledge of the effectiveness of physiotherapy for this problem. This study evaluated the feasibility of a randomised controlled trial (RCT) exploring the effects of physiotherapy on sleep disturbance in CLBP [Current controlled trial ISRCTN 54009836]. Methods. A sample of 60 consenting patients with CLBP [23 M, 37 F; mean (SD) age = 44.93 (13.41) years] were recruited in Beaumont Hospital, Dublin and randomly allocated to one of three groups [supervised exercise class (SEC), walking programme (WP) and usual physiotherapy (UP)] in a concealed manner. The main outcomes were
Purpose: To measure quality and quantity of sleep in patients before and after hip arthroplasty. Methods: A prospective survey where 50 participants were sent a sleep diary, an acti-watch motion-logger, and a 32 item sleep questionnaire. These data were collected at least four weeks prior to and three months after surgery. Data analyses included descriptive statistics and within-subject pre and post surgery comparisons. For the subjective data, comparison was by the McNamar Test for the significance of changes. For the acti-graphy variables, comparison was by mixed model analysis of variance. Results: Preliminary results indicate that subjective measures of
Introduction:. Sleep disturbance is the one of major complaints associated with knee osteoarthritis, and sleep status is one factor that influences quality of life. The present study was designed to assess sleep status in patients undergoing total knee arthroplasty and to identify factors affecting sleep patterns. Methods:. We performed a prospective study of 112 patients undergoing total knee arthroplasty from June 2011 to February 2012. Data including demographic characteristics (age, gender, BMI, VAS pain scale score, SF 36, level of education, and psychologic comorbidities) and sleep profiles (Nottingham Health Profile – 0 to 100, with 0 indicating good sleep status; Sleep Satisfaction Scale – 0 to 10, with 10 indicating full satisfaction) was collected before and after (six days, two weeks, three months, and six months) total knee arthroplasty. Results:. There were 11 male and 101 female patients with an average age of 69.3 years (range: 49 to 85 years). The Nottingham Health Profile sleep scores were 30.3, 36.4, 21.0 and 16.7 before and two weeks, three months and six months after surgery, respectively. The corresponding sleep satisfaction scores were 6.6, 7.3, 7.3 and 7.7, respectively. A post-hoc analysis showed that the Nottingham Health Profile and sleep satisfaction scale scores had improved by three and six months after surgery, respectively. Patients with good sleep patterns six months after surgery did not differ from those with poor sleep patterns in terms of demographic characteristics, but a difference was detected in the preoperative sleep profiles between the two groups. Patients with good sleep patterns six months after surgery had better sleep profiles. Additionally, those undergoing unilateral TKA showed significantly better sleep patterns six months after surgery than those undergoing bilateral TKA. Conclusion:. These findings demonstrate that total knee arthroplasty improved
Background. Opiate abuse is a rapidly growing epidemic in the US, and orthopaedic surgeons are among the highest prescribers. While surgeons have relied heavily on opiates after total hip replacement (THR), our goal was to determine whether a multimodal pain regimen could improve pain control and reduce or even obligate the need for opiates. Methods. In a cluster-randomised, crossover trial, we assigned 235 patients undergoing THR to receive either a multimodal pain regimen with a minimal opiate supply (Group A- 10 tablets only), a conventional multimodal regimen (Group B- 60 tablets), or a traditional opiate regimen without multimodal therapy (Group C- 60 tablets). Clusters were determined by surgeon, with each cluster alternating between regimens in 4-week intervals. The multimodal pain regimen comprised standing-dose acetaminophen, meloxicam, and gabapentin. Primary outcomes were VAS pain and daily opiate use for the first 30 days postoperatively. Secondary outcomes included daily assessments of satisfaction,
Background. Back pain has become a worldwide problem and excessive, repetitive rotation has been shown to cause tissue damage. A sleeping posture similar to that of the foetal position has been suggested to limit unnecessary rotation of the lumbar spine. The Rophi™ cushion, utilises this theory to provide spinal alignment and improved sleeping posture. This study aims to assess the subjective experience and biomechanical effects of the Rophi™ cushion in participants with simple mechanical lower back pain (LBP). Methods & Results. Fifteen participants (aged 44 ± 9.7 years) with simple mechanical LBP were recruited using the Red Flags screening form. The kinematics of the pelvis, lower limbs, lumbar and thoracic spine were analysed in six degrees of freedom whilst the participants lay in a semi-foetal position. Visual analogue scales were used to measure participant pain and discomfort levels during sleep pre and post a one week cushion intervention. Kinematic results show the main significant difference in joint angles occurred at the hip in all three planes, and between the lower lumbar region and the pelvis in the coronal plane. Subjective experience showed a reduction in the number of days with poor
The October 2023 Research Roundup360 looks at: Gut microbiota in high-risk individuals for rheumatoid arthritis associated with disturbed metabolome and initiates arthritis by triggering mucosal immunity imbalance; International Consensus on Anaemia Management in Surgical Patients (ICCAMS); Sleep disturbance trends in the short-term postoperative period for patients undergoing total joint replacement; Achilles tendon tissue turnover before and immediately after an acute rupture; Quadriceps or hip exercises for patellofemoral pain? A randomized controlled equivalence trial; Total-body MRI for screening in patients with multiple osteochondromas.
The June 2024 Knee Roundup360 looks at: The estimated lifetime risk of revision after primary knee arthroplasty influenced by age, sex, and indication; Should high-risk patients seek out care from high-volume surgeons?; Stability and fracture rates in medial unicondylar knee arthroplasties; Rethinking antibiotic prophylaxis for dental procedures post-arthroplasty; Evaluating DAIR: a viable alternative for acute periprosthetic joint infection; The characteristics and predictors of mortality in periprosthetic fractures around the knee; Patient health-related quality of life deteriorates significantly while waiting six to 12 months for total hip or knee arthroplasty; The importance of looking for diversity in knee implants.
The December 2024 Shoulder & Elbow Roundup360 looks at: Predicting recurrence of instability after a primary traumatic anterior shoulder dislocation; Predictors of surgery and long-term outcomes in nonoperative management of full-thickness rotator cuff tears; Reverse shoulder arthroplasty viable despite acquired acromial compromise, but higher infection risk noted; LP-PRP reduces retear rates in rotator cuff repair but shows no functional outcome advantage; Long-term clinical outcomes of arthroscopic supraspinatus tendon repair using the single anchor tension band technique – minimum five-year follow-up; Arthroscopic stabilization for anterior shoulder dislocation shows low recurrence rates regardless of prior dislocations; ORIF outperforms arthroplasty for complex radial head fractures: mid-term outcomes; Routine use of surgical helmet systems may not reduce infection risk in shoulder arthroplasty.
Introduction. The Center for Medicare Services (CMS) recently proposed its phase 3 “Quality metrics” which include a section on patient engagement. CMS uses a fitness monitor as an example of an acceptable way for patients to contribute to the health record. Wearable technology allows measurement of activity, blood glucose, heart rate, sleep, and other health metrics, all of which can be useful in the management of patients in the orthopaedic practice. The purpose of this study is to thoroughly review existing fitness devices; and evaluate their potential uses in orthopaedic practice. Methods. Several fitness devices exist; we focused on the top 27 based on popularity mentioned in reputable tech review articles. Features of each device were reviewed including type, specifications, interfaces, measurable outcomes (HR, steps, distance, sleep, weight, calorie intake), cost to the patient, barriers to compliance and strengths. Ultimately all these factors were taken into consideration to look into potential uses for orthopaedic surgery. The orthopedic applications of these devices were reviewed. Nonsurgical management applications were: compliance with physiotherapy, distance walked and stairs completed, and compliance with activity restrictions. Preoperative optimization included detection of sleep apnea, blood glucose monitoring, preoperative weight, and preoperative activity level. Postoperative outcomes included postoperative activity level, stairs, and distance walked. Results. Twenty-seven devices were reviewed of which 26% were targeted for the beginner, 33% for runners and 41% were multipurpose fitness trackers. Most were designed as either a wrist band (26%) or watch (30%). Several used a smartphone as an interface (33%) while the majority (52%) synced automatically via Bluetooth to either the online, mobile device, smartphone or pc application. The majority (37%) had excellent battery life, over 7 days; all were either waterproof (26%) or water resistant (74%), and some (41%) had GPS tracking. A pedometer was included in 85% of devices, 63% monitored HR of which 26% required a separate chest strap or forearm strap, 7% measured respiratory rate and 7% devices measured temperature. Sleep was recorded in 63% of devices, mostly as length of
To identify a suite of the key physical, emotional, and social outcomes to be employed in clinical practice and research concerning Perthes' disease in children. The study follows the guidelines of the COMET-Initiative (Core Outcome Measures in Effectiveness Trials). A systematic review of the literature was performed to identify a list of outcomes reported in previous studies, which was supplemented by a qualitative study exploring the experiences of families affected by Perthes’ disease. Collectively, these outcomes formed the basis of a Delphi survey (two rounds), where 18 patients with Perthes’ disease, 46 parents, and 36 orthopaedic surgeons rated each outcome for importance. The International Perthes Study Group (IPSG) (Dallas, Texas, USA (October 2018)) discussed outcomes that failed to reach any consensus (either ‘in’ or ‘out’) before a final consensus meeting with representatives of surgeons, patients, and parents.Aims
Methods
The October 2014 Trauma Roundup360 looks at: proximal humeral fractures in children; quadrilateral surface plates in transverse acetabular fractures; sleep deprivation and poor outcomes in trauma; bipolar hemiarthroplasty; skeletal traction; forefoot fractures; telemedicine in trauma; ketamine infusion for orthopaedic injuries; and improved functional outcomes seen with trauma networks.
The April 2013 Shoulder &
Elbow Roundup360 looks at: biceps, pressure and instability; chronic acromio-clavicular joint instability; depression and shoulder pain; shoulder replacement and transfusion; cuff integrity and function; iatropathic plexus injury; the accuracy of acromio-clavicular joint injection; and tennis as a risk factor for tennis elbow.
In a prospective multicentre study we investigated
variations in pain management used by knee arthroplasty surgeons
in order to compare the differences in pain levels among patients
undergoing total knee replacements (TKR), and to compare the effectiveness
of pain management protocols. The protocols, peri-operative levels
of pain and patient satisfaction were investigated in 424 patients
who underwent TKR in 14 hospitals. The protocols were highly variable
and peri-operative pain levels varied substantially, particularly
during the first two post-operative days. Differences in levels
of pain were greatest during the night after TKR, when visual analogue
scores ranged from 16.9 to 94.3 points. Of the methods of managing pain, the combined use of peri-articular
infiltration and nerve blocks provided better pain relief than other
methods during the first two post-operative days. Patients managed
with peri-articular injection plus nerve block, and epidural analgesia
were more likely to have higher satisfaction at two weeks after TKR.
This study highlights the need to establish a consistent pain management
strategy after TKR.