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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 37 - 37
1 Oct 2022
Trickett H Billington J Wellington K Khatri M
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Purpose of study and background

Spinal surgery is a high-risk surgical speciality, a patient's understanding of surgical interventions, alternative treatment options, and the benefits and risks must be ascertained to gain informed consent. This pilot study aims to evaluate if the provision of a digital recording of a patient's consultation enhances patient satisfaction, improves recall of clinical diagnosis, recall of treatment options and the risks and benefits of Spinal Surgery.

Methodology and results

A coalition team was identified. A safe and secure process for recording and storage identified. Both qualitative and quantitative data was collected via questionnaires. 62 patients were invited to participate in the pilot, 12 declined. Data was collected immediately post consultation, and two weeks following the consultation via telephone. Comparison was made of the relative increase or decrease in patient recall of the clinical diagnosis, treatment options, and the benefits and the risks of spinal surgery. Patient satisfaction was measured pre- and post- consultation. 50 patients (81%) participated. 32 participants (52%) responded to follow up questionnaire at 2 weeks. Recall of risk for surgical intervention increased by 37%, and of benefit by 36%. Patient satisfaction was rated excellent or very satisfied in 93% at initial consultation and at 2 week follow up all participant's rated satisfaction as excellent or very satisfied.


Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 6 - 6
1 Oct 2022
Veerappa P Wellington K Billington J Kelsall C Madi M Berg A Khatri M Austin R Baker A Bourne J
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Purpose of Study and Background

Degenerative cervical myelopathy resulting in cord compromise is a progressive condition that results in significant quality of life limitations. Surgical treatment options available are anterior and/or posterior decompression of the affected levels. Patients are counselled pre-operatively that the aim of surgical intervention is to help prevent deterioration of neurology. Anecdotal evidence suggested improvements in both EMS and PROMs in this cohort of patients. A 2-year prospective study tested this hypothesis.

Methodology and Results

67 patients undergoing anterior cervical surgery were followed up to two years. Myelopathic features, radiological cord compression, myelomalacia change and levels of surgery were recorded. Pre/post intervention myelopathy scores/grades, and PROM's were recorded. Paired t-test was performed when comparing pre/post intervention scores and Annova test when comparing results across levels. Our prospective study identified statistically significant improvements in European myelopathy scores and grade and patient reported clinical outcomes in the said population.


Orthopaedic Proceedings
Vol. 99-B, Issue SUPP_10 | Pages 14 - 14
1 May 2017
Wellington K Taylor J Khatri M
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Purpose of Study/Background

To identify whether patients were satisfied with the overall educational component of the specialist nurse (CNS)/occupational therapist (OT) led pre-operative assessment clinic in order to identify areas which required improvement.

The pre-operative specialist nurse led clinic was set up in 2002. The aim was to provide high quality information to patients undergoing elective spinal surgery in order to manage expectations and optimise post-operative recovery. Initially the clinic was specialist nurse led however, in 2006 occupational therapy input was introduced in order to provide an increased depth of information in regard to function and activities of daily living post operatively. In addition this has allowed assistive equipment to be provided pre-operatively. The format of this clinic has enhanced the patient's journey by facilitating reduced length of stay and more timely discharge.

Methodology

A questionnaire was forwarded to a random sample of two hundred patients who attended for pre-operative assessment in the twelve-month period between April 2014 & March 2015. Sixty questionnaires were returned (30% response rate).


Orthopaedic Proceedings
Vol. 95-B, Issue SUPP_17 | Pages 8 - 8
1 Apr 2013
Dunderdale CS Wellington K Khatri M
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Aim

To investigate the role of websites in enhancing patients' understanding of reason and risk of surgery as a part of informed consent for elective un-instrumented lumbar spine surgery (EULSS).

Methodology

This was a National Research Ethical Committee approved RCT study. 63 patients underwent EULSS, out of which 14(29%) declined participation and 14(29%) were excluded. One did not have surgery therefore 34 were randomised to Standard (S) and intervention group (I) using sealed envelope. Standard group were given verbal information & leaflet while the Intervention group were given information on relevant section of www.eurospine.org and www.spinesurgeons.ac.uk websites. A 13 item Informed Consent Questionnaire (ICQ) was used to collect data. The primary outcomes were patients' perceived understanding of reason and risk of EULSS.


Orthopaedic Proceedings
Vol. 94-B, Issue SUPP_XXVI | Pages 45 - 45
1 Jun 2012
Pulavarti R Vadhva M Wellington K Khatri M
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Aim

Assess efficacy of caudal epidural injection with epidurogram with validated outcome measures.

Introduction

The administration of local steroids and other drugs into caudal epidural space has been well established procedure in the management of low back pain with or without leg symptoms. Various studies have been done to assess the efficacy of the different routes of administration of epidural injections. However, only a few published prospective studies have been done on performing caudal epidural injections under fluoroscopic guidance with validated outcome measures.


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_IV | Pages 491 - 491
1 Nov 2011
Warren A Mackarel D Wellington K Khatri M
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Aim: To evaluate patient satisfaction between telephone and traditional outpatient appointments following un-instrumented spinal surgery.

Material and Methods: The study was approved by the local audit committee. Fifty seven patients who underwent un-instrumented lumbar spinal micro-decompressive surgery in 2008 were identified from Bluespiers database and were contacted by telephone. A predesigned proforma was used to collect data. Ten patients had not yet had follow-up at the time of study and were excluded. Results of 47 patients were analysed and are described. No loss to follow up was encountered.

Results: Average age was 60 (Range 23 to 89 years) with 21 male (45%) and 26 female (55%). Majority (77%) of patients rated telephone follow-up as good or excellent. Average delay between scheduled appointment time and contact with the clinician was 47 minutes in traditional clinic. Majority (84%) of patients were contacted in time in telephonic clinic with minority (16%) experienced an average delay of 28 minutes. Majority (93%) of patients would recommend telephone follow up clinic and (70%) reported telephone follow-up was better or much better than traditional clinic. Reasons for preferring telephone follow-up included delay in the clinic, saving travel time and no need to find parking space. Six percent were dissatisfied with telephone clinic the reason being hearing impairment and desire to discuss their condition face-to-face.

Conclusion: Telephone follow-up clinic for un-instrumented spinal surgery appears to be a safe cost effective satisfactory alternative for the majority of patients. However traditional clinical follow up may be required for a proportion of patients.

Conflict of Interest: None

Source of Funding: None


Orthopaedic Proceedings
Vol. 93-B, Issue SUPP_I | Pages 29 - 29
1 Jan 2011
Siddique I Hakimi M Javed S Wellington K Smith R Khatri M
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Current evidence on the indications for and efficacy of non-rigid lumbar stabilisation remains unclear. The aim of this study was to review the outcome of the DYNESYS system (Zimmer, Inc.) in a consecutive series of 34 patients undergoing this procedure between 2001 and 2006.

Prospectively collected outcome measure data obtained pre-operatively and at 1 year post-operatively was analysed using the Wilcoxon Signed Rank Test. Kaplan Meier survival analysis was performed using revision surgery as the end point. Cox Regression was utilised to identify variables that were related to implant survival.

Pain rating on the visual analogue scale improved from a mean of 7 pre-op to 4 at 1 year (p=0.009), Roland Morris Disability Questionnaire scores from 13 to 9 (p=0.02), Modified Somatic Perception Questionnaire from 13 to 9 (p=0.03). When reporting subjective outcome, 54% of patients reported “better” or “much better” outcomes at last followup (12–69 months post op). Eight patients (25%) required removal of the implant and conversion to fusion, one of whom had deep infection. Kaplan Meier survival analysis revealed a survival of 78% at 5 years (95% CI, 60 – 96%). Previous spinal surgery was significantly related to the time of survival of the implant (p=0.008).

Our study has demonstrated a high revision rate for this implant and 54% patient satisfaction. We recommend that patients be counseled regarding these risks and further use of this implant should be subject to the outcome of larger studies and randomised controlled trials.