The MOCAM study is a major prospective questionnaire-based study investigating the relationship between low back pain (LBP) patient outcomes and non-specific treatment components, i.e., therapeutic relationship, healthcare environment, incidental treatment characteristics, patients' beliefs and practitioners' beliefs. Participating acupuncturists, osteopaths, and physiotherapists from the NHS and private sector have been asked to recruit at least 10 patients into the study. This paper aims to analyse current recruitment rates from MOCAM and identify barriers and facilitators to effective recruitment. Recruitment has taken place over 15 months. Invitation letters or emails were sent to individual practitioners identified using online search tools and professional networks. Recruitment rates were analysed descriptively. Within the private sector, response rates (number participating/number invited) are: acupuncturists 3% (49/1561), osteopaths 6% (53/912), physiotherapists 4% (40/1048). Private sector practitioners have each recruited on average 1, 4, and 2 patients into the study respectively. Within the NHS, the response rates are: acupuncturists 100% (2/2), osteopaths 8% (1/13), physiotherapists 63% (44/70). NHS practitioners have each recruited on average 4, 3, and 2 patients respectively.Purpose and Background
Methods and Results
More and more patients with end-stage knee OA are treated with total knee replacements (TKR). A modern TKR (Persona PS system, Zimmer Inc.) was designed with the hope to improve fit by providing additional sizing options on the femur and tibia. To date, there is very little information regarding the knee strength and knee mechanics during gait after the TKR. Furthermore, as a great percentage of knee OA patients have OA limited in one knee compartment and in the patellofemoral joint, a bi-compartmental knee replacement (BKR) (iDUO system, ConforMIS Inc.) was designed to treat OA at these affected areas. The BKR re-creates the individual's knee shape while correcting for any deformity. In addition, the BKR procedure results in less bone loss and retains the cruciate ligaments. To date, the influence of the BKR on knee strength and knee mechanics remains unknown. The purpose of the study was to evaluate knee strength and mechanics during level walking after the TKR and BKR surgeries. Twelve healthy control participants (age=57±6 yr.; mass=82±11 kg; height=175±11 cm), eight patients (age=63±10 yr.; mass=87±20 kg; height=166±8 cm) with ten BKR systems (post-op time = 17±9 mo.), and nine patients (age=65±9 yr.; mass=90±35 kg; Height=169±12 cm) with twelve TKR systems (post-op time = 14±5 mo.) participated in the study. In a laboratory setting, maximal isometric knee strength was evaluated. Motion capture and 3D kinematic and kinetic analyses were conducted for level walking. One way ANOVA was used to determine differences among the BKR, TKR, and the healthy control knees.Background
Methods
Early detection of Developmental Dysplasia of the Hip (DDH), and treatment, may prevent the need for surgical correction following late presentation. Neonatal examination, and ultrasound screening of at risk groups, does not detect all cases. Most neonates treated in the Intensive Care Unit (NICU) have abdominal radiographs performed during their stay. These include the hips but DDH is not routinely looked for. 50 neonatal abdominal films (five from patients who subsequently were found to have DDH, 45 from patients without this condition) were randomly shown to three paediatric orthopaedic surgeons and three paediatric radiologists on two separate occasions. Each was asked whether they would refer the patient for further investigation. An overall sensitivity of 25.5% (Range 0–60%) and specificity of 93.2% (Range 87–97%) was found with a positive predictive value (PPV) of 14.0% (Range 0–37%) and negative predictive value (NPV)of 96.3% (Range 95–98%). Although the low sensitivity and PPV make interpretation of these films a poor way to diagnose DDH, the high specificity and NPV suggest that they may be used as a prompt to further investigation. Therefore, we propose that DDH should be looked for on these films and, where there is radiological suspicion, ultrasound examination should be advised.
