Objective evaluations of resident performance can be difficult to simulate. A novel competency based surgical OSCE was developed to evaluate surgical skill. The goal of this study was to test the construct validity comparing previously validated Ottawa scores (O-scores) and Orthopaedic in-training evaluation scores (OITE).

An OSCE designed to simulate typical general orthopaedic surgical cases was developed to evaluate resident surgical performance. Post-graduate year (PGY) 3–5 trainees have an encounter (interview and physical exam) with a standardized patient and perform a correlating surgery on a cadaver. Examiners evaluate all components of the treatment plan and provide an overall score on the OSCE and also provide an O-score on overall surgical performance. Convergent and divergent validity was assessed comparing OSCE scores to O-scores and OITE scores. SPSS was used for statistical analysis. ANOVA was used to compare PGY averages and Pearson correlation coefficients were calculated to compare OSCE versus O-score and OITE scores.

A total of 96 simulated surgical cases were evaluated over a 3 year period for 24 trainees. There was a significant difference in OSCE scores based on year of training. (PGY3 − 6.06/15, PGY4 − 8.16/15 and PGY5 − 11.14/15, p < 0 .001). OSCE and O-scores demonstrated a strong positive correlation of +0.89 while OSCE and OITE scores demonstrated a moderate positive correlation of 0.68.

OSCE scores demonstrated strong convergent and moderate divergent correlation. A positive trajectory based on level of training and stronger correlations with established, validated scores supports the construct validity of the novel surgical OSCE.

Background and Aim of Study

Despite several hundred RCTs of exercise for persistent non-specific low back pain (NSLBP), the treatment targets of exercise are unclear. In a systematic review we observed 30 direct and indirect treatment targets of exercise described across 23 RCTs for persistent NSLBP. Since not all treatment targets and outcomes can be assessed in all RCTs, it is therefore important to prioritise these treatment targets through consensus from key stakeholders. These consensus workshops aimed to agree treatment targets for the use of exercise interventions in randomised controlled trials (RCTs) in persistent NSLBP using nominal group workshop (NGW) methodology.

Background

Complex interventions, such as exercise for LBP, often have many treatment targets. Matching a primary outcome to the target(s) of exercise interventions may provide greater standardized mean differences (SMDs) than using an unmatched primary outcome. We aimed to explore whether the conclusions of exercise trials for LBP might differ with i) improved matching of outcomes to treatment targets and ii) the use of composite outcome measures.

Background

Exercise is a complex intervention, and often has more than one treatment target. Results from randomised controlled trials (RCTs) of exercise interventions for chronic low back pain (CLBP) typically show small to moderate effect sizes, but these may differ where outcomes better reflect the targets of interventions. This review aimed to describe what treatment targets, outcome domains and primary outcome measures are used in exercise RCTs, and examined how well the selected outcome domains match the treatment targets used in each RCT.

Purpose of the study and background

Healthcare practitioners' (HCPs) attitudes and beliefs about MSK pain influence their practice behaviour. The Pain Attitudes and Beliefs Scale (PABS), developed for use in the context of LBP, consists of two subscales (biomedical and biopsychosocial) is the most widely used measure. However, poor performance of the biopsychosocial orientation scale is attributed, in part, to inadequate conceptualisation of the orientation.

A statement of the purposes of the study and background

The biopsychosocial (BPS) model is recommended for managing non-specific low back pain (NSLBP) but the best method for teaching the BPS model is unclear. E-learning is a promising alternative to face-to-face methods.

This study was a pilot randomised controlled trial (RCT) with embedded interview study to investigate the feasibility of conducting a main RCT and to explore the impact of an BPS for NSLBP e-learning programme on experienced practitioners' attitudes to back pain.

Introduction

Early intervention is advocated to prevent long-term work absence due to musculoskeletal (MSK) pain. The SWAP trial tested whether adding a vocational advice (VA) service to best current care led to fewer days work absence over 4 months.

Background:

Low back pain (LBP) is the most common symptom encountered by osteopaths in the UK and affects a third of the UK population each year. Guidelines recommend using the biopsychosocial (BPS) model for non-specific LBP but it remains unclear what the BPS model actually is and how it applies in osteopathy. The aim of this study was to define the factors included in a BPS approach for non-specific LBP in a manual therapy using a systematic search and scoping review.

Background

A wide array of measures has been developed to assess the role of psychological factors in the development and persistence of pain. Yet there is likely to be considerable conceptual overlap between such measures, and consequently a lack of clarity about the importance of psychological factors.

Background

The physiotherapy profession has experienced a paradigm shift in recent years where mounting research evidence, indicating better patient outcomes, has led to an increase in popularity of a biopsychosocial model of care. In turn physiotherapists have begun to address psychosocial ‘obstacles’ to recovery, as means of improving outcomes for patients. To date, research has not examined how this change has affected the perceptions of physiotherapists about delivering care. The aim of this study was to explore these perceptions through exploratory interviews with physiotherapists in the UK.

Introduction: Guidelines for the management of LBP recommend diagnostic triage where most cases are classified ‘non-specific’, although studies have suggested this term is unsatisfactory to patients and practitioners. We aimed to describe the explanations for LBP used by general practitioners (GPs) and physiotherapists (PTs) in the UK.

Methods: Content analysis of an open question in a cross-sectional survey of GPs and PTs, based on a vignette of a patient with non-specific LBP. Respondents provided their explanation for the patient’s LBP in the language they would use with the patient. A coding schedule was developed (AB and NF) and applied to all data (AB).

Results: Survey response was 22% (n=446) for GPs and 55% for PTs (n=1091, 580 had seen a patient with LBP in the preceding 6 months were analysed). Responses to the open question were provided by 430 GPs and 560 PTs. Both professions used predominantly biomedical explanations (68% GPs, 51% PTs) such as tissue labels (e.g. ‘muscle’, ’disc’), ‘degeneration’ and ‘wear and tear’. PTs often gave lifestyle factors as reasons for LBP, with ‘work’ (19% PTs) and ‘posture’ (26% PTs) the most common. Only 2.8% of GPs and 6.4% of PTs would explain that the cause of LBP is unknown and use of the term ‘non-specific LBP’ was rare (0.9% GPs, 1.6% PTs).

Conclusion: Explanations for LBP used by GPs and PTs remain predominantly biomedical. The term ‘non-specific LBP’ is used very rarely. Further research needs to investigate appropriate language that explains non-specific LBP that is acceptable to both practitioners and patients.

Introduction: Previous studies have shown that advice given to patients with low back pain (LBP) by health care practitioners (HCPs) such as physiotherapists (PTs) and general practitioners (GPs) is not in line with guidelines about encouraging early return to work. The aim of this study was to describe the attitudes, beliefs and reported practice behaviour of UK GPs and PTs about LBP and to explore associations between these.

Methods: A national cross-sectional survey of GPs and PTs (n=4000), including an attitudes measure, the Pain Attitudes and Beliefs Scale (PABS.PT), which measures ‘biomedical and behavioural orientations of HCPs. A vignette describing a patient with non-specific LBP, who had a four-week absence from work, was used to capture reported clinical management. This presentation will focus on the findings about work advice.

Results: Response rates were 22% (n=446) for GPs and 55% (n=1091) for PTs. Almost one third of GPs (32%) and one in four PTs (25%) reported that they would advise the vignette patient to remain off work. The HCPs advising the vignette patient to remain off work had significantly higher biomedical (F_1,988=78.85, p< 0.001) and lower behavioural (F_1,981=31.89, p< 0.001) scores on the PABS.PT than those suggesting a return to work.

Conclusion: An association between attitudes and reported practice behaviour was apparent, with HCPs operating within a predominantly biomedical framework being more likely to advise a patient with back pain to stay off work. Further research should explore how HCPs’ attitudes might be changed and whether this results in changes in work recommendations.

Background: Psychosocial factors have been shown to be important in the progression from acute low back pain (LBP) to chronic disability. Early identification of individuals at risk of developing chronic disability is important. The aim of this study was to determine if physiotherapists recognise when patients with LBP are at risk of chronicity due to psychosocial factors. A secondary aim was to explore the advice they give to patients about work and activities.

Methods: A cross-sectional, descriptive survey of practising, musculoskeletal physiotherapists was designed and completed. Vignettes were written based on three acute LBP patients at low, moderate or high risk of chronicity due to psychosocial factors as measured by the Acute Low Back Pain Screening Questionnaire. The vignettes were tested by an expert panel (n=6) and incorporated into a postal questionnaire, which was piloted (n=50) and then sent to a simple random sample of experienced musculoskeletal physiotherapists in the UK (n=900). After one reminder, 20% of non-responders were sent a further questionnaire (n=80) to explore the non-response bias. Data were analysed using the Statistical Package for the Social Sciences (SPSS version 11).

Results: The response rate was 57.7% (n=518). The sample consisted of experienced physiotherapists (mean of 18 years postgraduate experience) working across all practice settings. Most correctly rated the chronicity risk of the low and high risk patient cases (56.6% and 89.1 %), but the moderate risk case appeared to cause some difficulty. Chronicity rating appeared to be more highly associated with biomedical factors such as the perceived pathology. Most therapists (95%, 88.6% and 85.8%) reported they would recommend some limitation of activity for each case.

Conclusions: Most physiotherapists recognise when patients are at high and low risk of developing chronicity, but this seems to be influenced more by biomedical than psychosocial factors. Even when therapists recognise that a patient is at high risk of chronicity, many recommend the patient limit their activity levels and not work. Many physiotherapists may be providing advice, which aids the progression to chronicity. Research is needed to explore how to facilitate a change in therapists’ beliefs and practices.

The existence of pulmonary metastases in patients presenting with osteosarcoma is known to indicate a poor prognosis. Lung resection of solitary lesions is now a standard treatment approach, but with limited successful long-term results. We report the progress of a 16-year-old girl with osteosarcoma of the proximal tibia who underwent 11 lung resections for pulmonary metastases over a two-year period, and who has since then been free of disease for seven years.