Orthopaedic Assessment Research Articles

Measuring Student Engagement in a Flipped Athletic Training Classroom

Context Active learning describes any instructional approach that fosters student engagement in the content and is believed to promote critical thinking more fully than do traditional lecture formats. Objective Investigate student engagement, specifically professional relevance and peer interaction, with active learning techniques used in a flipped classroom format. Design An exploratory study utilizing both quantitative and qualitative survey instruments. Setting Commission on Accreditation of Athletic Training Education–accredited undergraduate entry-level athletic training program. Patients or Other Participants Seventeen students (11 females, 6 males) of at least sophomore level, enrolled in the lower extremity orthopaedic assessment course in the athletic training program. Main Outcome Measure(s) A mixed-method analysis was used. Quantitative questionnaires were analyzed with comparisons of medians and the Friedman test for nonparametric analysis. Qualitative questionnaires were coded using deductive and inductive reasoning and analyzed with emerging themes and shared coding procedures. Validity evidence is presented for quantitative data. Independent coding was used to confirm the trustworthiness of the qualitative data analysis. Results Participants reported a high level of course preparation, perceived content relevance, and value of peer interaction, all of which are indicators of student engagement. Four qualitative themes emerged: (1) content relevant to profession, (2) class activities fostering professional development, (3) becoming a reflective practitioner, and (4) pedagogical reflections. Conclusions A primary finding of our study was the high degree of perceived relevance of classroom content to professional practice. Participants indicated they learned as much as they taught in peer interactions and perceived both to be at essentially the same high level. Evidence supports the use of an active learning instructional format to engage students. Participants indicated a high level of support for the flipped classroom despite the greater effort required by the emphasis on student responsibility and the active learning nature of the course.

A Global Perspective on the Outcomes of Surgical Decompression in Patients With Cervical Spondylotic Myelopathy

Prospective, multicenter international cohort. To evaluate outcomes of surgical decompression for cervical spondylotic myelopathy (CSM) at a global level. CSM is a degenerative spine disease and the most common cause of spinal cord dysfunction worldwide. Surgery is increasingly recommended as the preferred treatment strategy for CSM to improve neurological and functional status and quality of life. The outcomes of surgical intervention for CSM have never been evaluated at an international level. Between October 2007 and January 2011, 479 symptomatic patients with image evidence of CSM were enrolled in the prospective, multicenter AOSpine CSM-International study from 16 global sites. Preoperative and postoperative clinical status, functional impairment, and quality of life were evaluated using the modified Japanese Orthopaedic Assessment Scale, Nurick Scale, Neck Disability Index, and Short-Form-36v2. Preoperative and 12- and 24-month postoperative outcomes were compared using mixed-model analysis of covariance for repeated measurements. The study cohort consisted of 310 males and 169 females, with a mean age of 56.37 ± 11.91 years. There were significant differences in age, etiology, and surgical approaches between the regions. At 24 months postoperatively, the mean modified Japanese Orthopaedic Assessment Scale score improved from 12.50 (95% confidence interval [CI], 12.24-12.76) to 14.90 (95% CI, 14.64-15.16); the Neck Disability Index improved from 36.38 (95% CI, 34.33-38.43) to 23.20 (95% CI, 21.24-25.15); and the SF36v2 Physical Component Score and Mental Composite Score improved from 34.28 (95% CI, 33.46-35.10) to 40.76 (95% CI, 39.71-41.81) and 39.45 (95% CI, 38.25-40.64) to 46.24 (95% CI, 44.94-47.55), respectively. The rate of neurological complications was 3.13%. Surgical decompression for CSM is safe and results in improved functional status and quality of life in patients around the world, irrespective of differences in medical systems and sociocultural determinants of health. 3.

Book Reviews A practical approach to orthopaedic medicine assessment, diagnosis and treatment.

Book Reviews A practical approach to orthopaedic medicine assessment, diagnosis and treatment.

The Suspected Infected Prosthetic Joint: Clinical Acumen and Added Value of Laboratory Investigations.

Consensus definitions have emerged for the discrimination between infected and uninfected prosthetic joints but diagnostic uncertainty often occurs. We examined the accuracy of orthopaedic surgeons’ assessments to diagnose the infected prosthetic hip or knee and elucidated the added value of laboratory parameters. A prospective cohort study of patients undergoing revision arthroplasty of hip or knee was conducted over a one-year period. Orthopaedic surgeons’ determinations prior to arthroplasty were recorded. A reference diagnostic standard was determined retrospectively by independent review from 3 infectious diseases physicians. Patients were followed up to 12 months. For 198 patients enrolled, 228 surgical encounters (110 knee, 118 hip) were classified by independent reviewers as 176 uninfected and 52 infected. Orthopaedic surgeons’ preoperative diagnoses of infection had high diagnostic accuracy (sensitivity 89%, specificity 99%, PPV 98%, NPV 97%). Addition of intraoperative findings and histopathology improved their diagnostic accuracy. Addition of culture and PCR results improved sensitivity of diagnostic determinations but not specificity. We provide evidence that clinical acumen has high diagnostic accuracy using routine preoperative parameters. Histopathology from intraoperative specimens would improve surgeons’ diagnostic accuracy but culture and PCR from intraoperative specimens could create greater diagnostic uncertainty. This study is critical to further our understanding of the added value, if any, of laboratory testing to support clinical decision making for the suspected infected joint and allow us to identify diagnostic gaps for emerging technologies to fill that will improve our ability to diagnose the infected prosthetic joint.

2091284 Using Sonographic Measurements to Compare two Orthopedic Assessments of Inferior Glenohumeral Stability

2091284 Using Sonographic Measurements to Compare two Orthopedic Assessments of Inferior Glenohumeral Stability

A short generic patient experience questionnaire: howRwe development and validation.

BackgroundPatient experience is a key quality outcome for modern health services, but most existing survey methods are long and setting-specific. We identified the need for a short generic questionnaire for tracking patient experience.MethodsWe describe the development and validation of the howRwe questionnaire. This has two items relating to clinical care (treat you kindly; listen and explain) and two items relating to the organisation of care (see you promptly; well organised) as perceived by patients. Each item has four responses (excellent, good, fair and poor). The questionnaire was trialled in 828 patients in an orthopaedic pre-operative assessment clinic (PAC).ResultsThe howRwe questionnaire is shorter (29 words) and more readable (Flesch-Kincaid grade score 2.2) than other questionnaires with broadly similar objectives. Psychometric properties in this sample are good with Cronbach’s α=0.82. Following a change to the appointments system in the clinic, howRwe showed improvement in promptness and organisation, but not in kindness and communication, showing that it can distinguish between the clinical and organisational aspects of patient experience.ConclusionshowRwe meets the criteria for a short generic patient experience questionnaire that is suitable for frequent use. In the validation study of PAC patients, it showed good psychometric properties and concurrent, construct and discriminant validity.

Accuracy of Ultrasonography for Determining Successful Realignment of Pediatric Forearm Fractures

The primary objective of this study is to assess the accuracy of point-of-care ultrasonography compared with blinded orthopedic assessment of fluoroscopy in determining successful realignment of pediatric forearm fractures. The secondary objective is to determine the rate of agreement of ultrasonography and fluoroscopy in real-time by the treating physician. A cross-sectional study was conducted in children younger than 18 years and presenting to an academic emergency department with forearm fractures requiring realignment of a single bone. Physicians performed closed reductions with ultrasonographic assessment of realignment until the best possible reduction was achieved. Fluoroscopy was then immediately performed and images were saved. A positive test result was defined as an inadequately reduced fracture on fluoroscopy by a blinded pediatric orthopedic surgeon (reference standard) and on ultrasonography (index test) and fluoroscopy in real-time by the treating physician. One hundred patients were enrolled (median age 12.1 years; 74% male patients); the radius was involved in 98%, with 27% involving the growth plate. The sensitivity, specificity, positive predictive value, and negative predictive value were 50% (95% confidence interval [CI] 15.4% to 84.6%), 89.1% (95% CI 82.8% to 95.5%), 28.6% (95% CI 4.9% to 52.2%), and 95.3% (95% CI 90.9% to 99.8%), respectively. The treating physicians' agreement rate of the real-time images was 98%. Point-of-care ultrasonography can help emergency physicians determine when pediatric forearm fractures have been adequately realigned, but inadequate reductions should be confirmed by other imaging modalities.

Lumbar Spine Distraction Exercise—Surprisingly Innovation in Conservative Treatment of Degenerative Lumbar Spine Disorder

Introduction It is not possible to prevent the progression of degenerative disc disease of lumbar spine. Conservative treatment offered today help minimize the load coming on lumbar intervertebral disc (IVD). It has no useful effect in improving the important pathological change of degenerative lumbar disc disease that is impaired nutrition of IVD. Healthy IVD contracts during mechanical loading and expands on unloading. Nutrition of the IVD is possible only in expanded disc. Considering this pathophysiology of IVD, an exercise named lumbar spine distraction exercise was developed to distract intervertebral space with a view to make conservative treatment truly “effective” in degenerative lumbar disc disease. Materials and Methods A study was conducted to see the effect of this exercise in 100 patients presented on outdoor from June 2008 to August 2009 with low backache with sciatica of any long duration. Patients with significant motor deficit or with possibility of psychiatric component were excluded. Magnetic resonance imaging (MRI) was done before treatment. Patients having functionally disabling low back pain were put on rest for a brief period of a day or 2 before the distraction exercise was started. Back care was taught to all patients. Patients were followed up first time at 1 week and then every 3 to 4 weeks. In random 20 patients out of 80 patients who were responding to the treatment and who had significant advanced MRI changes in pretreatment MRI, repeat MRI was done at 4 weeks, 8 weeks, and 6 months. Results More than 80% (80/100) patients had significant subjective pain relief and had maintained satisfactorily improved functional capacity on average follow-up of 9 months. Objective findings on follow-up MRI such as widening of canal, increased interspinous distance, decompression of nerve root, increased whiteness of IVD, regression of Schmorl nodule, and correction of angles between vertebrae were seen in all patients followed up on MRI. Conclusion Lumbar spine distraction exercise is a very promising exercise for low backache with sciatica. Subjective improvement (in few days) is much faster than MRI changes (few weeks). It could reduce number of surgery on lower back for degenerative lumbar spine disease and could also help those operated for neuromeningeal compression in preventing recurrence. Although number of patients in whom this exercise was used effectively as treatment is 100, small number of them (20) were followed up objectively with MRI at regular interval because of financial constraint. Disclosure of Interest None declared References McCulloh J, Transfeldt E. McNab's Backache. 3rd ed. Baltimore: Williams and Wilkins; 1997:75-83, 393–413 Patel RK, Slipman CW. Lumbar degenerative disk disease. Available at: http://emedicine.medscape.com/article/309767-diagnosis. Accessed August 28, 2009 Anderson G, Singh K, Kahill P, Lee M, Tannoury C, Zmurko M. In: Fischgrund J, ed. Orthopedic Knowledge Update [OKU 9]. Chicago: American Academy of Orthopedic Surgeons; 2008:531-540, 551–564 Pandya M. Degenerative Lumbar Spine Disorder and Its Conservative Treatment. 1st ed. New Delhi, India: Jaypee Brothers Publication; 2011 Waddell G, McCulloch JA, Kummel E, Venner RM. Nonorganic physical signs in low-back pain. Spine 1980;5(2):117–125 Williams KD, Park AL. Lower back pain and disorders of intervertebral discs. In: Canale ST, ed. Campbell's Operative Orthopaedics. Vol. 2. 10th ed. Philadelphia, PA: Mosby Elsevier; 2003:1955–2002 Magee DJ. Orthopedic Physical Assessment. 5th ed. Philadelphia: Elsevier Saunders; 2008:515–621 Netter FH. Atlas of Human Anatomy. 4th ed. Philadelphia: Elsevier Saunders; 2006:263 Richards JC, Majumdar S, Lindsey DP, Beaupré GS, Yerby SA. The treatment mechanism of an interspinous process implant for lumbar neurogenic intermittent claudication. Spine 2005;30(7):744–749

Early orthopaedic challenges in haemophilia patients and therapeutic approach

IntroductionThere is growing evidence that subclinical joint bleeding early in life may lead to subtle changes in joint function, gait, and muscle development in young children with haemophilia. The early identification of such changes provides an opportunity for clinicians to intervene before irreversible structural changes occur. Materials and methodsWe have undertaken motion analysis of the knee in 273 children (mean age 9.8years) with haemophilia A, haemophilia B, or von Willebrand disease and compared the results with those from 200 healthy age- and sex-matched controls (mean age 10.3years). We have also completed detailed orthopaedic assessments and evaluated overall fitness in most of these children. ResultsThere was a clear correlation between total motion score and age: r2=0.47 for the healthy children and r2=0.69 for the haemophilic children. The differences were most striking in children aged 3–4years. Significant between-group differences were also observed in the comparison of knee bends, gait scores, and rhythmicity. Orthopaedic examinations revealed previously clinically silent pressure pains in the ligaments of the knee joints of 38% of children and in the ligaments and capsule of the ankle joints of 60% of children. The five-item fitness check showed significant deficits relative to controls in overall fitness, endurance, coordination, and flexibility. ConclusionsChildren and adolescents with haemophilia show significant functional impairments relative to normal controls. Early comprehensive assessments of the musculoskeletal system should be made so that individualized physical, physiotherapy, and sports therapy programmes can be developed.

General Practitioners' Views About an Orthopaedic Clinical Assessment Service

General practitioners' (GP) views about orthopaedic clinical assessment services (OCAS) managed by physiotherapists in the NHS have seldom been sought, yet GPs are likely to be key referrers to such a service. This study aims to review GP views about an OCAS and how they believed the service could be improved. Fifteen consenting GPs were interviewed utilizing semi-structured interviews and a standardized topic guide. Interviews were recorded, transcribed and analysed for emergent themes. Interviews were analysed sequentially by date performed until saturation. Themes were discussed, and disagreements evaluated until agreement was found between the two main authors. The third author then analysed randomly selected interview transcripts and found no additional themes. The study found GPs refer to specialist services, including this OCAS, because of wait times, locality, patient experience, GP experience and knowledge of available services. No GP identified they knew all possible orthopaedic referral routes. GPs saw OCAS as another referral choice for patients suffering orthopaedic pathologies. GPs identified some difficulty in understanding the different services including the various professional roles involved. To assist with their understanding, they described requesting advertising of the different services and the clinicians involved or streamlining of services by provider services. Further detailed research addressing the limitations in this research design is indicated to investigate GP's thoughts and behaviours in relation to referral patterns especially as GPs in the UK took on commissioning for services from April 2013.

Anatomical study of distal ulna and correlation with the etiology of wrist pain and gender (919.17)

Objective: A frequent complain in orthopedic clinic is an unspecific pain in the wrist, that can have or not relation whit history of trauma. We could observe, during these evaluations that radiologic study of these wrist have demonstrate a variation in ulna distal morphology. The present study was done to evaluate the variations in morphology of the distal ulna extremity, and observe de relationship whit the variants gender and etiology. Methods: This evaluation was done in two phases, initially with the evaluation of ulna curvature obtained from cadaveric, and in a second phase with study of radiography obtained in orthopedic ambulatorial assessment. We imported the radiographs to Auto Cad® 2006, and draw a longitudinal line, tangent to medial border of diafise, and another one transversal to ulna head. We divided this line in three, and analyzed in which third the longitudinal line crossed it. The results of this second phase were correlated to the variants sex and etiology, demonstrating statistics significance with gender (p = 0.0062), but no statistics significance with etiology (p = 0.1602). Conclusion: Thedistal ulna presents a variable curvature that has demonstrated relationship whit sex.

Orthopaedic triage: cost effectiveness, diagnostic/surgical and management rates

Purpose – The purpose of this paper is to investigate cost effectiveness, diagnostic rates, surgical percentage and appropriateness for orthopaedic referrals and number of patients able to be seen in orthopaedic triage from GP orthopaedic referrals. Design/methodology/approach – The study involved triaging paper referrals for orthopaedic outpatients to an interface service, orthotics or continue normal route. Data were collected on outcome of the interface appointment and outcomes for those patients referred to orthopaedics from the appointment. Findings – The study demonstrated a 27.3 per cent cost saving from the normal orthopaedic route with 86.1 per cent of patients able to be managed by an extended scope physiotherapist (ESP) without requiring orthopaedic assessment. Appropriateness of onward orthopaedic referrals was 80.5 per cent with surgery conversion rate of 75 per cent. Originality/value – Although triage and ESP positions have been studied before, this is the first known study to look at cost effectiveness across the patient pathway despite this being a large reason for the creation of these positions. Further larger studies are required to build upon this base in terms of demonstrating the cost effectiveness of the value of these positions.

Lipofilling for functional reconstruction of the sole of the foot

BackgroundNew advances in regenerative surgery may increase the potential for rehabilitation in the injured foot. ObjectivesA clinical prospective observational study was carried out to assess the effectiveness of lipofilling to improve the functional recovery of the injured foot. MethodsFour patients with anatomical–functional impairment following repair of post-traumatic soft tissue loss of the foot were involved in the study. All of the patients complained of pain in the repaired plantar weight bearing area, skin instability, recurrent ulcerations and were walking on crutches.A combined plastic surgery and technical orthopaedic assessment identified the plantar areas requiring anatomical changes for load redistribution. Two selective sequential lipofillings with a 12 weeks’ time interval were performed. Manufacturing of custom-made plantar insoles and/or shoes followed each surgical procedure. ResultsAfter the treatment all of the patients progressively recovered both a better plantar load distribution and a local soft tissue stability, referred the remission of chronic pain and discontinued the use of crutches. ConclusionLipofilling proved to be an effective and versatile surgical technique for both reconstructive and regenerative purposes. The interaction between the Plastic Surgery staff and the Orthopaedic Technician outlined a successful multidisciplinary approach model for the rehabilitation of the injured foot.

Decision aid for patients considering total knee arthroplasty with preference report for surgeons: a pilot randomized controlled trial

BackgroundTo evaluate feasibility and potential effectiveness of a patient decision aid (PtDA) for patients and a preference report for surgeons to reduce wait times and improve decision quality in patients with osteoarthritis considering total knee replacement.MethodsA prospective two-arm pilot randomized controlled trial. Patients with osteoarthritis were eligible if they understood English and were referred for surgical consultation about an initial total knee arthroplasty at a Canadian orthopaedic joint assessment clinic. Patients were randomized to the PtDA intervention or usual education. The intervention was an osteoarthritis PtDA for patients and a one-page preference report summarizing patients’ clinical and decisional data for their surgeon. The main feasibility outcomes were rates of recruitment and questionnaire completion; the preliminary effectiveness outcomes were wait times and decision quality.ResultsOf 180 patients eligible for surgical consultation, 142 (79%) were recruited and randomized to the PtDA intervention (n = 71) or usual education (n = 71). Data collection yielded a 93% questionnaire completion rate with less than 1% missing items. After one year, 13% of patients remained on the surgical wait list. The median time from referral to being off the wait list (censored using survival analysis techniques) was 33.4 weeks for the PtDA group (n = 69, 95% CI: 26.0, 41.4) and 33.0 weeks for usual education (n = 71, 95% CI: 26.1, 39.9). Patients exposed to the PtDA had higher decision quality based on knowledge (71% versus 47%; p < 0.0001) and quality decision being an informed choice that is consistent with their values for option outcomes (56.4% versus 25.0%; p < 0.001).ConclusionsRecruitment of patients with osteoarthritis considering surgery and data collection were feasible. As some patients remained on the surgical waiting list after one year, follow-up should be extended to two years. Patients exposed to the PtDA achieved higher decision quality compared to those receiving usual education but there was no difference in wait for surgery.Trials registrationClinicalTrials.Gov NCT00743951

Validity and Reliability of the Standardized Orthopedic Assessment Tool (SOAT): A Variation of the Traditional Objective Structured Clinical Examination

Health care professions have replaced traditional multiple choice tests or essays with structured and practical, performance-based examinations with the hope of eliminating rater bias and measuring clinical competence. To establish the validity and reliability of the Standardized Orthopedic Assessment Tool (SOAT) as a measure of clinical competence of orthopaedic injury evaluation. Descriptive laboratory study. University. A total of 60 undergraduate students and 11 raters from 3 Canadian universities and 1 standardized patient. Students were required to complete a 30-minute musculoskeletal evaluation in 1 of 2 randomly assigned mock scenarios involving the knee (second-degree medial collateral ligament sprain) or the shoulder (third-degree supraspinatus muscle strain). We measured interreliability with an intraclass correlation coefficient (ICC) (2,k) and stability of the tool with standard error of measurement and confidence intervals. Agreement was measured using Bland-Altman plots. Concurrent validity was measured using a Pearson product moment correlation coefficient whereby the raters' global rating of a student was matched to the cumulative mean grade score. The ICCs were 0.75 and 0.82 for the shoulder and knee cases, respectively. Bland-Altman plots indicated no systematic bias between raters. In addition, Pearson product moment correlation analysis demonstrated a strong relationship between the overall cumulative mean grade score and the global rating score of the examinees' performances. This study demonstrated good interrater reliability of the SOAT with a standard error of measurement that indicated very modest stability, strong agreement between raters, and correlation indicative of concurrent validity.

Intra-articular transplantation of porcine adipose-derived stem cells for the treatment of canine osteoarthritis: A pilot study.

To test whether intra-articular injection of porcine adipose-derived stem cells (ADSCs) can treat canine osteoarthritis (OA). To enroll in this study dogs must have stifle joint OA that had lasted ≥ 3 mo and been treated with OA medication without significant improvement. Three dogs fulfilled these criteria and were thus subjects for ADSCs treatment. ADSCs were isolated from abdominal adipose tissue of a 2-mo-old female Yorkshire pig. Their stem cell marker expression was examined by immunofluorescence staining. For treatment, 5 million ADSCs were injected into the diseased joint of each dog. In the next 48 h, the patient was observed for signs of inflammatory and allergic reactions. The patient was then discharged to the owner and, at 2, 6, and 12 wk, followed up with orthopedic assessment, owner questionnaire, X-ray imaging, and force-plate gait analysis. Porcine ADSCs expressed mesenchymal stem cell markers CD90 and CD105. Injection of porcine ADSCs into canine stifle joints did not cause any inflammatory or allergic reactions. Orthopedic evaluation found improvements in two dogs, particularly at the longest time point. Owners' evaluation found increased capacity and decreased pain in all three dogs' activities such as walking and running. Radiographic evaluation did not find statistically significant differences before and after treatment. Force-plate analysis found significant improvements in all three dogs after treatment. Xenotransplantation of ADSCs for the treatment of OA is feasible. Further studies are needed to validate this novel treatment modality, which can then be implemented for the routine treatment of OA in veterinary medicine.

Immediate Care of Open Extremity Fractures: Where Can We Improve?

Clear guidelines are set by the British Orthopaedic Association (BOA) and British Association of Plastic, Reconstructive and Aesthetic Surgeons (BAPRAS) on the preoperative management of open fractures. This as well as the clinical consequences of poor management of open fractures means the patient workup for surgery is important as well as the timing of surgery. Experience suggests few patients are managed 100% as per the guidelines and we look to test this hypothesis. A retrospective analysis was undertaken of all open long bone fractures (total 133), excluding hand injuries, which presented to a district general hospital over a 5-year period. The implementation of 7 defined key tasks for initial management was recorded. 101 cases were eligible, with the majority of cases (71.4%) having initial orthopaedic assessment outside normal working hours. The mean number of tasks completed was 3.23/7. Assessment out of hours was associated with less tasks being implemented but doctor seniority and the presence of polytrauma made no difference to the quality of acute care. Staff involved in the acute care of open fractures require targeted education to improve the delivery of initial preoperative care. We recommend that other centres assess their performance against this data.

Application of “Earl's Assessment as, Assessment for, and Assessment of Learning Model” with Orthopaedic Assessment Clinical Competence

Context In order to study the efficacy of assessment methods, a theoretical framework of Earl's model of assessment was introduced. Objective (1) Introduce the predictive learning assessment model (PLAM) as an application of Earl's model of learning; (2) test Earl's model of learning through the use of the Standardized Orthopedic Assessment Tool (SOAT); and (3) establish construct validity of the SOAT. Design Quasi-experimental. Setting Three Canadian universities Patients or Other Participants A convenience sample of 57 third-year undergraduate athletic therapy students from three universities were randomly assigned into three experimental groups. Intervention(s) Treatment group 1 gave the instructor access to the SOAT, but the instructor could not explicitly share it. Treatment group 2 gave both the instructor and students access to the SOAT throughout the semester to use formatively. Group three was the comparison. Main Outcome Measure(s) All students were tested using the SOAT at the end of the semester using expert raters. An analysis of variance (ANOVA) (P &amp;lt; .05) was used to determine whether there was a difference between groups in their final examination grades. Results The ANOVA demonstrated a significant difference between groups (F2,56 = 28.6, P &amp;lt; .01). The effect size, calculated using η2, was 0.51. Post hoc analysis revealed a significant difference between treatment group 2 and the other treatment group and comparison group. Conclusions Small sample size and the quasi-experimental design prevent definitive conclusions, but the SOAT was able to discriminate between various groups, supporting our construct validity objective. The SOAT was introduced as a predictive tool that may assist orthopaedic assessment skill development. The treatment group exposed to the SOAT demonstrated that formative assessment of students using the SOAT was an effective means of teaching relative to no exposure or where only the instructor was exposed to the SOAT.

Anterior Versus Posterior Surgical Approaches to Treat Cervical Spondylotic Myelopathy

A prospective observational multicenter study. To help solve the debate regarding whether the anterior or posterior surgical approach is optimal for patients with cervical spondylotic myelopathy (CSM). The optimal surgical approach to treat CSM remains debated with varying opinions favoring anterior versus posterior surgical approaches. We present an analysis of a prospective observational multicenter study examining outcomes of surgical treatment for CSM. A total of 278 subjects from 12 sites in North America received anterior/posterior or combined surgery at the discretion of the surgeon. This study focused on subjects who had either anterior or posterior surgery (n = 264, follow-up rate, 87%). Outcome measures included the modified Japanese Orthopedic Assessment scale, the Nurick scale, the Neck Disability Index, and the Short-Form 36 (SF-36) Health Survey version 2 Physical and Mental Component Scores. One hundred and sixty-nine patients were treated anteriorly and 95 underwent posterior surgery. Anterior surgical cases were younger and had less severe myelopathy as assessed by mJOA and Nurick scores. There were no baseline differences in Neck Disability Index or SF-36 between the anterior and posterior cases. Improvement in the mJOA was significantly lower in the anterior group than posterior group (2.47 vs. 3.62, respectively, P < 0.01), although the groups started at different levels of baseline impairment. The extent of improvement in the Nurick Scale, Neck Disability Index, SF-36 version 2 Physical Component Score, and SF-36 version 2 Mental Component Score did not differ between the groups. Patients with CSM show significant improvements in several health-related outcome measures with either anterior or posterior surgery. Importantly, patients treated with anterior techniques were younger, with less severe impairment and more focal pathology. We demonstrate for the first time that, when patient and disease factors are controlled for, anterior and posterior surgical techniques have equivalent efficacy in the treatment of CSM. 3.

Case-Based Learning in Athletic Training

The National Athletic Trainers’ Association (NATA) Executive Committee for Education has emphasized the need for proper recognition and management of orthopaedic and general medical conditions through their support of numerous learning objectives and the clinical integrated proficiencies. These learning objectives and integrated clinical proficiencies are designed to prepare athletic training students to become competent professionals. In fact, the educational competencies and integrated proficiencies related to orthopaedic clinical assessment and diagnosis are just one of the vital links in becoming either a successful or an unsuccessful athletic trainer. However, this success is not accomplished overnight; rather, it is accomplished gradually over time, as students progress through the higher levels of Bloom’s taxonomy.