Orthopaedic Outpatient Clinic Research Articles

An assessment of mobility and fall behaviour among older patients admitted to the orthopaedic outpatient clinic

An assessment of mobility and fall behaviour among older patients admitted to the orthopaedic outpatient clinic

The Diagnostic Accuracy of Ultrasound in Detecting Distal Radius Fractures in a Pediatric Population

Objective: Sports ultrasound (US) is becoming popular in diagnosing musculoskeletal injuries. This study, also called the Pediatric Distal Radius Ultrasound Study (PeDRUS), compared the diagnostic accuracy of sports US with plain radiographs in possible distal radius buckle fractures in pediatric population. Methods: In this prospective observational study, patients (2-15 years) presenting to an outpatient orthopedic injury clinic with distal forearm injuries without deformity were recruited. Bedside ultrasonography was performed and interpreted by the investigators as positive or negative for fracture. Plain radiographs were then performed and interpreted by the same investigator. The radiographs were considered the definitive imaging study for this investigation. Results: Fifty-one patients were included with a mean age of 9.9 years. Fractures were diagnosed on both US and plain radiographs in 34 patients. Fractures were ruled out on both US and plain radiographs in 16 patients. There was only one case in which the US was interpreted differently than radiograph. For fractures of the distal radius in this population, the sensitivity was 97.1% [95% confidence interval (CI) = 89.2-97.1] and the specificity was 100% (95% CI = 82.5-100). The positive predictive value was 100% (95% CI = 91.8-100), whereas the negative predictive value was 94.1% (95% CI = 77.7-94.1). The positive likelihood ratio was infinite, suggesting utility in confirming a fracture. The negative likelihood ratio was 0.03 (95% CI = 0.03-0.13), suggesting that US has value in ruling out a fracture. Conclusions: Our study suggests that diagnostic sports US is sensitive and specific for detecting distal radius fractures in pediatric patients with nondeformed forearm injuries, demonstrating that US is an acceptable alternative to plain radiographs for evaluating fractures in a pediatric population.

Assessment of construct validity of the Finnish versions of the Disabilities of Arm, Shoulder and Hand Instrument and the Michigan Hand Outcomes Questionnaire

Study DesignCross-sectional study. IntroductionThere is a lack of information on the measurement properties of patient-reported upper extremity instruments and their association to health-related quality of life (HRQoL). Purpose of the StudyThis study aimed to examine and compare the measurement properties and construct validity of the Disabilities of Arm, Shoulder, and Hand (DASH) Instrument and the Michigan Hand Questionnaire (MHQ) using a heterogeneous sample of patients with hand and wrist problems. MethodsTwo hundred fifty consecutive patients visiting a general orthopedic outpatient clinic due to various hand/wrist problems were invited to participate in the study. A total of 193 (77%) participants provided sufficient patient-reported outcome data and were included in the analysis. Participants completed the DASH, the MHQ, the EQ-5D-3L, and pain on a visual analog scale instruments. Grip and key pinch forces were measured. Scale targeting, relatedness of demographics, and construct validity of the DASH and the MHQ were assessed. ResultsBoth the DASH and the MHQ had good targeting, but the DASH had wider coverage. The convergence between the DASH and the MHQ was high. The DASH was more closely related to HRQoL than the MHQ in terms of EQ-5D scores. DiscussionThe DASH instrument appeared to measure hand function and disability from a perspective of HRQoL superior to the MHQ among patients with heterogeneous hand and wrist complaints. ConclusionThe DASH performs well in measuring the HRQoL-related hand outcomes while the MHQ might be more specific for the affected hand.

Depression and Non-modifiable Patient Factors Associated with Patient Satisfaction in an Academic Orthopaedic Outpatient Clinic: Is it More Than a Provider Issue?

Patient satisfaction surveys play an increasingly important role in United States healthcare policy and serve as a marker of provided physician services. In attempts to improve the patient's clinical experience, focus is often placed on components of the healthcare system such as provider interaction and other experiential factors. Patient factors are often written off as "non-modifiable"; however, by identifying and understanding these risk factors for dissatisfaction, another area for improvement and intervention becomes available. (1) Do patients in the orthopaedic clinic with a preexisting diagnosis of depression report lower satisfaction scores than those without a preexisting diagnosis of depression? (2) What other non-modifiable patient factors influence patient-reported satisfaction? We reviewed Press Ganey Survey scores, which assess patient experiential satisfaction with a single clinical encounter, from 3044 clinic visits (2527 patients) in adult reconstructive, sports, and general orthopaedic clinics at a single academic medical center between November 2010 and May 2017, during which time approximately 19,000 encounters occurred. Multiple patient factors including patient age, gender, race, health insurance status, number of previous clinic visits with their physician, BMI, and a diagnosis of depression were recorded. Patient satisfaction was operationalized as a binary outcome as satisfied or less satisfied, and a multiple logistic regression analysis was used to estimate the odds of being satisfied. After adjusting for all other covariates in the model, we found that patients with a diagnosis of depression were less likely to be satisfied than patients without this diagnosis (odds ratio 0.749 [95% confidence interval, 0.600-0.940]; p = 0.01). Medicare-insured patients were more likely to be satisfied than non-Medicare patients (OR 1.257 [95% CI, 1.020-1.549]; p = 0.03), patients in the sports medicine clinic were more likely to be satisfied than those seen in the general orthopaedic clinic (OR 1.397 [95% CI, 1.096-1.775]; p = 0.007), and established patients were more likely to be satisfied than new patients (OR 0.763 [95% CI, 0.646-0.902]; p = 0.002). Given the association of depression with lower satisfaction with a single visit at the orthopaedic clinic, providers should screen for depression and address the issue during the outpatient encounter. The impact of such comprehensive care or subsequent treatment of depression on improving patient-reported satisfaction offers areas of future study. Level III, therapeutic study.

Impact of a major sporting event on local orthopaedic service provision: Commonwealth Games 2018, Gold Coast, Australia

The Gold Coast (Queensland, Australia) held the 2018 Commonwealth Games. Previous studies have focussed on the socio-economic and employment impact of hosting a major sporting event; however, there is limited research available about the provision of medical recourses required of the host city. Twelve weeks of data were retrospectively collected from the local health service to quantify the orthopaedic department workload for the period surrounding the 2018 Commonwealth Games. Data collected included referrals to Orthopaedic Fracture Outpatient clinic, theatre cases - emergency and category 1 (scheduled trauma) performed, and entries made into electronic medical records by the on-call orthopaedic staff. A statistically significant increase was found for theatre cases performed during the Commonwealth Games (86 versus 71 cases per week, P = 0.033, 95% confidence interval 1.46-27.5). We found no statistically significant increase in Fracture Outpatient Clinic referrals or medical record entries between peri-games and games periods (P = 0.149 and 0.699, respectively). Based on our experience, orthopaedic departments should plan for an increase in operative intervention requirements of at least 20%, in consultation with other local services. Strategic use of pre-existing resources and staff may be sufficient to address the increased workload during the event period.

What are the Implications of Excessive Internet Searches for Medical Information by Orthopaedic Patients?

Cyberchondria may be defined as heightened distress evoked through excessive searches of the internet for medical information. In healthy people, cyberchondria is associated with a greater intolerance of uncertainty and greater health anxiety. These relationships are likely bidirectional. People who have a greater intolerance of uncertainty may be more likely to search the internet for medical information and have greater health anxiety. This greater health anxiety may lead to an increased likelihood of engaging in further internet searches and greater intolerance of uncertainty. These three constructs are important for patients because they impact patient function and health care costs. We were specifically interested in understanding the role of cyberchondria in the association between intolerance of uncertainty and health anxiety among orthopaedic patients because it has not been explored before and because knowledge about these interactions could inform treatment recommendations. Does cyberchondria mediate (that is, explain) the association between intolerance of uncertainty and health anxiety in orthopaedic patients searching for medical information on the internet, after controlling for potentially confounding variables? This was a cross-sectional study of 104 patients who had searched the internet for any medical information about their current condition. A research assistant approached 155 patients attending two orthopaedic outpatient clinics, one hand and upper extremity service and one sports medicine clinic, during a 3-month period. Ten patients declined to participate and 41 patients were excluded, predominantly because they had never searched for medical information online. The patients completed the Cyberchondria Severity Scale, Intolerance of Uncertainty Scale-short version, Short Health Anxiety Inventory, and a numerical rating scale for pain intensity at baseline, as well as demographic and clinical questionnaires. We performed a series of linear regression analyses to determine whether a greater intolerance of uncertainty predicts greater cyberchondria (mediator) and whether cyberchondria predicts greater health anxiety. Although it is more appropriate to use the language of association (such as "whether cyberchondria is associated with health anxiety") in many observational studies, here, we opted to use the language of causation because this is the conventional language for studies testing statistical mediation. After controlling for potentially confounding variables including pain intensity, multiple pain conditions, and education, cyberchondria explained 33% of the variance of the effect of intolerance of uncertainty on health anxiety (95% CI, 6.98 to 114.72%; p < 0.001). Among orthopaedic patients who search the internet for medical information, a greater intolerance of uncertainty is associated with greater cyberchondria, which is associated with greater anxiety about health. Identifying patients with an intolerance of uncertainty and educating them about the negative role of compulsive searches for medical information may improve the success of orthopaedic treatment. Orthopaedic surgeons should also consider making referrals for cognitive behavioral therapy in these instances to increase the patient's tolerance of uncertainty, decrease internet searching habits, and reduce anxiety about health. Level III, prognostic study.

Effect of Patients' Education on Their Performance and Outcomes Regarding Lumbar Disk Herniation

Context: Lumbar disc herniation is a common condition in adults and can impose a heavy burden on both the individual and society.Aim: The present study aimed to evaluate the effect of patients' education on their performance and outcomes regarding lumbar disk herniation.Methods: Quasi-experimental design used to achieve aim in this study. The study conducted at the orthopedic outpatient clinic at Benha University Hospital. Purposive sample of 60 patients of both genders who aged from (18-60 years old) included in the study. Patients who were attending surgical operation regarding lumbar disk herniation excluded. Three tools used to collect the study data. These are structured interview questionnaire regarding the patients' demographic characteristics, medical data, and patient's knowledge regarding lumbar disk herniation, observational checklist for patient's practice regarding lumbar disk herniation exercises, and modified Oswestry low back pain &amp; disability scaleResult: There was a statistically significant improvement in the total level of patient's knowledge, practices &amp; outcomes immediately post and three months post-program implementation. Also, there was a significant statistical correlation between patients' knowledge and pain disability scale three months post-program implementation.Conclusion: The results of the study conclude that the educational program was effective and resulted in a significant improvement in patient's knowledge, practice, and outcomes regarding lumbar disk herniation. The study suggested equips the orthopedic department with simple illustrated guidelines protocol covering lumbar disc herniation practices, knowledge; reapply this research on a more substantial probability sample acquired from different geographical areas in Egypt for generalization.

Psychosocial factors affecting variation in patient-reported outcomes after elbow fractures

The purpose of this study was to identify factors associated with limitations in function measured by patient-reported outcome measures (PROMs)6-9 months after elbow fractures in adultsfrom a range of demographic, injury, psychological, and social variables measured within a week and 2-4 weeks after injury. We enrolled 191 adult patients sustaining an isolated elbow fracture and invited them to complete PROMs at their initial visit to the orthopedic outpatient clinic (within a maximum of 1 week after fracture), between 2 and 4 weeks, and between 6 and 9 months after injury; 183 patients completed the final assessment. Bivariate analysis was performed, followed by multivariable regression analysis accounting for multicollinearity. This was evaluated using partial R2, correlation matrices, and variable inflation factor assessment. There was a correlation between multiple variables within a week of injury and 2-4 weeks after injury with PROMs 6-9 months after injury in bivariate analysis. Kinesiophobia measured within a week of injury and self-efficacy measured at 2-4 weeks were the strongest predictors of limitations 6-9 months after injury in multivariable regression. Regression models accounted for substantial variance in all PROMs at both time points. Developing effective coping strategies to overcome fears related to movement and reinjuryand finding ways of persevering with activity despite pain within a month of injurymay enhance recovery after elbow fractures. Heightened fears around movement and suboptimal coping ability are modifiable using evidence-based behavioral treatments.

Improving the referral pattern of patients with knee osteoarthritis to the orthopaedic surgeon: Development and evaluation of a new screening algorithm based on patient-reported data and radiographs

IntroductionMany patients with knee osteoarthritis referred to orthopaedic surgeons are not eligible for surgery and might benefit from being examined by other healthcare professionals. The objective of this study was to develop and test a screening algorithm to define relevant referral to the OS. MethodsPrior to clinical examination, 173 consecutive patients referred to the orthopaedic outpatient clinic completed questionnaires, and radiographic osteoarthritis severity was graded. The gold standard for relevant referral to an orthopaedic surgeon was based on actual treatment. The performance of the algorithm in predicting relevant referrals and total knee replacement (TKR) was assessed using sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV). ResultsReferral to an orthopaedic surgeon was considered relevant in 65% (113/173) of patients. Sensitivity, specificity, PPV and NPV for predicting relevant referral to an orthopaedic surgeon were 0.70, 0.56, 0.76 and 0.48, respectively. The corresponding estimates for predicting TKR surgery were 0.92, 0.56, 0.55 and 0.92. ConclusionsThe algorithm was able to identify most patients relevant for referral to an orthopaedic surgeon, but less suitable for identifying those not relevant. The algorithm demonstrated excellent performance in predicting TKR surgery. With further development, this screening algorithm might contribute to improvement of the referral pattern in the orthopaedic outpatient clinic.

What Do U.K. Orthopedic Surgery Patients Think About PROMs? Evaluating the Evaluation and Explaining Missing Data.

The NHS routinely evaluates the quality of life of patients receiving hip or knee replacement surgery using patient-reported outcome measures (PROMs), but some hospital completion rates are only 30%, restricting data usefulness. Statistics limit insights into how and why data are missing, so qualitative methods were used to explore this issue. Observation periods preceded semistructured interviews with 34 preoperative patients attending an orthopedic outpatient clinic. Interview themes covered: completion time/timing, orientation, setting, measures, and practicalities. Triangulated against observations, pragmatic barriers, and facilitators were considered. Refined themes included completion conditions, patient support, and national delivery. Simple improvements (e.g., quiet zone) could improve completion rates and reducing missing data. Reorganizing preoperative leaflets and their systematic distribution via standardized procedures could reassure patients, enhancing PROMs acceptance, while reducing inquiries and subsequent staff burden. Findings have implications for interpreting national statistics. They indicate that further debate about mandating preoperative PROMs is due.

Investigation of Comorbidity, Trauma History, and Osteoporotic Fractures in the Postmenopausal Population: A Nationwide, Observational, and Cross-Sectional Study of Korean Orthopedic Outpatient Clinics.

Study DesignA nationwide, observational, and cross-sectional study targeting postmenopausal patients from 62 orthopedic outpatient clinics in Korea between October 2010 and February 2011.PurposeThis study was carried out to investigate comorbidity, trauma history, and the status of osteoporotic fracture treatment in Korean postmenopausal women.Overview of LiteratureThere has been little reports on the comorbidity, family history, trauma history, and treatment status of osteoporotic fractures in patients visiting the orthopedic outpatient clinics in Korea.MethodsA total of 1,255 postmenopausal women between the ages of 50 and 80 years were enrolled in the study and the population distribution was reflected by region. Comorbidity, familial history of osteoporosis, familial history of osteoporotic fracture, history of falls, and status of osteoporotic fracture management were evaluated using an interview and questionnaire. The relationship between family history of osteoporosis and bone mineral density was analyzed.ResultsA number of patients (23%) had a family history of osteoporosis and 16.5% had a family history of fractures. Most (64.7%) of the patients had one or more comorbidities, including 58.8% exhibiting a chronic disease and 16.4% suffering from diseases that restrict exercise or walking. The results of the questionnaire indicated that 21.8% of these fracture patients had experienced a fracture previously and that the most common type of fracture was that of the spine. Lumbar spine bone mineral density was found to be lower in the presence of family history of osteoporosis.Conclusions Postmenopausal women are liable to have osteoporotic fractures due to the high prevalence of osteoporosis, a history of falling, and the comorbidity with diseases that restrict ambulation. A better understanding of postmenopausal women in the orthopedic outpatient settings is important to the management of osteoporotic fractures.

AO Patient Outcomes Center: Design, Implementation, and Evaluation of a Software Application for the Collection of Patient-Reported Outcome Measures in Orthopedic Outpatient Clinics.

BackgroundPatient-reported outcomes are increasingly utilized in routine orthopedic clinical care. Computer adaptive tests (CATs) from the Patient-Reported Outcomes Measurement Information System (PROMIS) offer a brief and precise assessment that is well suited for collection within busy clinical environments. However, software apps that support the administration and scoring of CATs, provide immediate access to patient-reported outcome (PRO) scores, and minimize clinician burden are not widely available.ObjectiveOur objective was to design, implement, and test the feasibility and usability of a Web-based system for collecting CATs in orthopedic clinics.MethodsAO Patient Outcomes Center (AOPOC) was subjected to 2 rounds of testing. Alpha testing was conducted in 3 orthopedic clinics to evaluate ease of use and feasibility of integration in clinics. Patients completed an assessment of PROMIS CATs and a usability survey. Clinicians participated in a brief semistructured interview. Beta-phase testing evaluated system performance through load testing and usability of the updated version of AOPOC. In both rounds of testing, user satisfaction, bugs, change requests, and performance of PROMIS CATs were captured.ResultsPatient feedback supported the ease of use in completing an assessment in AOPOC. Across both phases of testing, clinicians rated AOPOC as easy to use but noted difficulties in integrating a Web-based software application within their clinics. PROMIS CATs performed well; the default assessment of 2 CATs was completed quickly (mean 9.5 items) with a satisfactory range of measurement.ConclusionAOPOC was demonstrated to be an easy-to-learn and easy-to-use software application for patients and clinicians that can be integrated into orthopedic clinical care. The workflow disruption in integrating any type of PRO collection must be addressed if patients’ voices are to be better integrated in clinical care.

Role of Magnetic Resonance Imaging in the evaluation of adult non-traumatic painful hip

Aim of the Work: to assess the role of Magnetic Resonance Imaging as a non-invasive diagnostic modality in adult patients with the non-traumatic painful hip joint. Patients and Methods: This study was conducted on 60 adult patients with non-traumatic hip pain, referred from the outpatient orthopedic clinic, Ain Shams University hospitals. The patients were investigated using magnetic resonance imaging (MRI). All MR imaging examinations were conducted at the Department of Radiodiagnosis of the Ain shams University with the same 1.5-T unit (Philips Healthcare, Best, the Netherlands) with a body coil. Results: avascular necrosis is the commonest cause of bilateral hip pain (25%) of the study patients followed by osteoarthritis (11.7%), while unilateral hip pain is commonly caused by stress fractures (8.3%), isolated joint effusion (10%) and tendinopathies (3.3%). Other causes included Marrow edema with hip effusion, chronic anemic state, migratory osteoporosis, osteoid osteoma, bursitis, bone infarcts, osseous hemangioma, hemosiderosis, sacroiliitis, femoral-acetabular impingement, iliacus abscess, and bone marrow edema. Magnetic resonance imaging doesn’t only demonstrate disorders of hip joint only; it also gives an accurate assessment of other extra-articular causes of referred hip pain as degenerative disc diseases and pelvic conditions. Conclusion: Magnetic resonance is the best imaging modality to assess hip joint in non-traumatic cases. It has a great ability to diagnose disorders of bone, cartilage, ligaments, muscles and soft tissue. MRI can also detect joint effusion and bone marrow edema.

Patients report inferior quality of care for knee osteoarthritis prior to assessment for knee replacement surgery – a cross-sectional cohort study

Purpose: To investigate 1) to which degree patients receive OA information and 2) which treatments patients with knee OA have attempted, prior to referral to an orthopaedic surgeon for an assessment of knee replacement. Methods: A cross-sectional cohort study including all patients with scheduled first-time appointments for knee OA at one Danish hospitals orthopaedic outpatient clinic from April 2017 to February 2018. Prior to their appointments with the orthopedic surgeons, patients received postal questionnaires including the OsteoArthritis Quality Indicator (OA-QI) questionnaire. The OA-QI holds 16 separate quality indicators related to patient education and information, regular provider assessments, referrals, and pharmacologic treatment of knee OA. Furthermore, questions about previous physiotherapist-delivered treatment for knee OA were asked. Results: Out of 660 eligible patients, 517 responded (78%). Responders’ mean age was 67 years and 63% were female. 128 (25%) patients had received information about OA development, 148 (29%) about possible treatment modalities, 72 (14%) about self-management and 100 (19%) about lifestyle adaptation. 247 (48%) patients felt informed about physical activity benefits, while 184 (36%) had consulted a physiotherapist due to knee problems during the past year. The physiotherapist-delivered treatments were any type of exercise therapy for 115 (22%) and participation in the Good Life with osteoArthritis in Denmark treatment concept for 61 (12%) of responding patients. Furthermore, stretching was received by 45 (9%) and massage, acupuncture and ultrasound/laser was received by 48 (9%), 37 (7%) and 24 (5%) patients, respectively. Patients may have received several treatments in combination. Paracetamol was recommended as first-line pain medication to 349 (68%) patients. Independent quality indicators were fulfilled by a mean of 32% of patients (range 8 to 74%). Sub grouped into four quality indicator categories, the percentages of fulfilled quality indicators ranged from 16 to 52% related to information, 9 to 50% related to regular provider assessment, 8 to 35% related to referrals and 16 to 74% related to pharmacological treatment. Conclusions: Patients with knee OA are undertreated in primary care. Our results call for better structure and uniform pathways for primary knee OA treatment before referral to an orthopaedic surgeon.

Comparison of STarT Back Screening Tool and Simmonds Physical Performance Based Test Battery in Prediction of Disability Risks Among Patients with Chronic Low-Back Pain

Objectives This study identified disability sub-groups of patients with chronic low back pain (LBP) using the Subgroup for Targeted Treatment (or STarT) Back Screening Tool (SBST) and Simmonds Physical Performance Tests Battery (SPPTB). In addition, the study investigated the divergent validity of SBST, and compared the predictive validity of SBST and SPPTB among the patients with the aim to enhance quick and accurate prediction of disability risks among patients with chronic LBP. Methods This exploratory cross-sectional study involved 70 (52.0% female and 47.1% male) consenting patients with chronic non-specific LBP attending out-patient physiotherapy and Orthopedic Clinics at the Obafemi Awolowo University Teaching Hospitals, Ile-Ife and Ladoke Akintola University of Technology Teaching Hospital, Osogbo, Nigeria. Disability risk subgrouping and prediction were carried out using the SBST and SPPTB (comprising six functional tasks of repeated trunk flexion, sit-to-stand, 360-degree rollover, Sorenson fatigue test, unloaded reach test, and 50 foot walk test). Pain intensity was assessed using the Quadruple Visual Analogue Scale. Data on age, sex, height, weight and BMI were also collected. Descriptive and inferential statistics were used to analyze data at p&lt;0.05 Alpha level. Results The mean age, weight, height and body mass index of the participants were 51.4 ±8.78 years, 1.61 ±0.76 m and 26.6 ±3.18 kg/m2 respectively. The mean pain intensity and duration were 5.37 ±1.37 and 21.2 ±6.68 respectively. The divergent validity of SBST with percentage overall pain intensity was r = 0.732; p = 0.001. Under SBST sub-grouping the majority of participants were rated as having medium disability risk (76%), whilst SPPTB sub-grouped the majority as having high disability risk (71.4%). There was a significant difference in disability risk subgrouping between SBST and SPPTB (χ²=12.334; p=0.015). SBST had no floor and ceiling effects, as less than 15% of the participants reached the lowest (2.9%) or highest (1.4%) possible score. Conversely, SPPBT showed both floor and ceiling effects, as it was unable to detect ‘1’ and ‘9’, the lowest and highest obtainable scores. The ‘Area Under Curve’ for sensitivity (0.83) and specificity (0.23) of the SBST to predict ‘high-disability risk’ was 0.51. The estimated prevalence for ‘high-disability risk’ prediction of SBST was 0.76. The estimate for true positive, false positive, true negative and false negative for prediction of ‘high-disability risk’ for SBST were 0.77, 0.23, 0.31, and 0.69 respectively. Conclusion The Start Back Screening Tool is able to identify the proportion of patients with low back pain with moderate disability risks, while the Simmonds Physical Performance Tests Battery is better able to identify high disability risks. Thus, SBST as a self-report measure may not adequately substitute physical performance assessment based disability risks prediction. However, SBST has good divergent predictive validity with pain intensity. In contrast to SPBBT, SBST exhibited no floor or ceiling effects in our tests, and demonstrated high sensitivity but low specificity in predicting ‘high-disability risk’.

Preoperative rehabilitation care in total hip joint replacement by rapid recovery approach in Slovakia

Relevance of research: Hip fractures and arthrosis are currently one of the serious illnesses presenting as a serious health problem faced by the aging population. The health problem is not just the wound itself or arthrotic changes accompanied by severe pains and difficulties to get up and walk on the affected lower limb, but also the risk of inadequate healing after surgery. Also, significant disability and reduced ADL performance may continue despite the immense advances in surgical techniques, nursing care and rehabilitation. Nowadays, which is primarily aimed at reducing the cost of health care, it is necessary to ensure that this reduction in costs is not at the expense of the quality of health care and future medical success. In general, physiotherapy for total hip joint replacement is considered to be a routine matter that deals mainly with mobility training, increased muscular strength, and basic day-to-day activities such as bed-to-chair transition, standing and walking. In addition to these attributes, physiotherapists also need the patient's own experiences and psychological responses such as anxiety and fear. Goal and methods of research: The aim of the thesis is to point out the importance of preoperative preparation of the patient for total replacement of the hip joint and its impact on the reduction of recovery after surgery. As a method, a case study of the 33 year patient indicated for total hip replacement was selected. The patient underwent a comprehensive preoperative three-month preoperative treatment (from the moment of indication to surgery to performance itself) and subsequent post-operative rehabilitation treatment of three and a half months. Results: A comprehensive rehabilitation program was developed taking into account the patient's health and Rapid recovery recommendations in preoperative and postoperative care. During the preparatory phase of the operation, the patient was modified by motor stereotype walking, strengthened lower limb muscles, especially musculus quadratus femoris and pelvis stabilizers. Lower limb circumference values increased by 2 cm, hip muscle strength increased from grade 3 to grade 4 of the Janda muscle tests, and shortened muscles iliopsos were released on the affected side. Taking into account the operational complications and subsequent comprehensive care according to Rapid Recovery recommendations, the stay in the hospital was reduced from 12 days to 5 and the patient returned to normal working life from 6 months to 4 months. Conclusion: Rapid recovery program requires the development of a new culture not only in normal orthopedic outpatient clinics but also in hospitals. In the past, and nowadays in some regions of the world, slow recovery with extended acute hospitalization for several weeks has been thought to be the best way for patients to recover and achieve a good result after complete replacement of either the hip or knee joint. The results of total hip joint surgery studies showed a significant reduction in hospital stay without increasing the remission rate. Subsequently, patient satisfaction increased, accompanied by a reduction in health care costs and a faster return to normal daily life.

Normative Data of the Hip Disability and Osteoarthritis Outcome Score, JR in a Healthy United States Population

BackgroundPatient-reported outcome measures (PROMs) play a vital role in the care we provide our patients. To help understand the application of PROMs in arthroplasty, normative and benchmark data to serve as a comparison to patients presurgery and postsurgery would be extremely valuable. We collected normative data of the Hip Disability and Osteoarthritis Outcome Score (HOOS), JR on a healthy population, greater than 17 years of age, in the United States devoid of hip injury and/or surgery. MethodsThis is a cross-sectional study, where hard copy surveys were administered to 1140 patients, being seen for an orthopedic issue unrelated to their hip, and nonpatient visitors in July 2018 at an outpatient orthopedic clinic in a suburban metropolitan city. Participants were eligible if they self-reported a medical history negative for hip arthroplasty, current hip pain/disability, or hip procedure (surgery or injection) within the past year. Mean, standard deviation, 95% confidence intervals, and ranges on the HOOS, JR interval scores were calculated by sex, age decade, body mass index (BMI), reason for visit, history of orthopedic procedure, and medical history. ResultsWe included 425 men and 575 women in the final study cohort. Women aged between 70+ years reported the lowest mean interval score (mean = 89.8). Overall women scored lower as well (93.3 vs 95.7, P = .001). There was not a statistical difference between the interval scores by tobacco consumption (93.5 vs 94.4, P = .49) and between patients versus nonpatient visitors (94.2 vs 94.5, P = .672). Lower scores were observed in participants with a past nonhip orthopedic procedure (92.6 vs 94.9, P = .016), with a medical history of a chronic illness (92.5 vs 95.9, P = <.001), and classified as obese (BMI > 30) (91.7 vs 95.2, P < .001). On regression analysis, there was a decrease of 0.3 and 0.1 in the interval score for each unit of BMI and age by year, respectively (P < .001). ConclusionThis study provides normative reference values for the HOOS, JR in a US population from a suburban metropolitan city for individuals greater than 17 years of age. These scores can facilitate physician-patient shared decision-making to help patients understand expectations after hip arthroplasty in respect to PROMs.

Patient Knowledge and Perception of Radiation Risk in Diagnostic Imaging: A Cross-Sectional Study.

Background:Informed consent dictates that patients appreciate the risks and benefits of imaging techniques that use ionizing radiation. Computed tomography (CT) and X-ray carry a stochastic lifetime risk of inducing malignancy. This risk is difficult to convey and often overlooked.Objective:This work aims to establish some basics regarding patient knowledge and perception of medical imaging to facilitate an informed consent process.Method:A questionnaire survey was conducted in a general orthopedic outpatient clinic in a United Kingdom tertiary center.Results:There were 219 respondents. Twenty-two percent understood that CT produces ionizing radiation associated with cancer risk, but only 6% knew about cancer risk from natural background radiation. Only 25% knew that CT has a higher cancer risk than X-ray. The majority (93%) knew that smoking poses higher risk than X-rays. The Internet as an information source was statistically associated with concern about X-rays.Conclusions:Patients underestimated CT cancer risk and were unable to compare risk between imaging modalities. Risk can be more effectively conveyed using better known relatable risks as comparators. Patient groups associated with lower knowledge, most in need of education, were highlighted.

Improving patient timeliness of care through efficient outpatient clinic layout design using data-driven simulation and optimisation

ABSTRACTWith greater demand for outpatient services, the importance of patient-centric clinic layout design that improves timeliness of patient care has become more elucidated. In this paper, a novel simulation-optimisation (SO) framework is proposed focusing on the physical and process flows of patients in the design of a paediatric orthopaedic outpatient clinic. A discrete-event simulation model is used to estimate the frequency of movements between clinic units. The resulting information is utilised as input to a mixed integer programming (MIP) model, optimising the clinic layout design. In order to solve the MIP model, Particle Swarm Optimisation (PSO), a metaheuristic approach enhanced with several heuristics is utilised. Finally, the optimisation model outputs are evaluated with the simulation model. The results demonstrate that improvements to the quality of the patient experience can be achieved through incorporating SO methods into the clinic layout design process.

Patient attitudes towards electronics usage in a hospital-based orthopaedic clinic: a survey study

Background: Patients and physicians are increasingly using technology to deliver healthcare for both preserving information and communication methods. However, little research has been done into patient attitudes towards technology use in the outpatient orthopaedic clinic. Methods: A paper survey was conducted of 1000 patients in a mixed-specialty hospital-based orthopaedic surgery clinic to determine patient attitudes towards common technologies. Data analysis was performed using chi-squared and Fisher exact tests. Continuous variables were examined using Kruskal-Wallis tests. Results: Most patients reported approving of desktops (98.0%, 95% CI 96.9%-98.8%) or tablets (97.4%, 95% CI 96.2-98.3%) to access medical files, as well as communication methods such as cellular phones set to silent (92.1%, 95% CI 90.3%-93.7%) and pagers set to silent (94.3%, 95% CI 92.7%-95.6%). However, most patients disapproved of cellular phones set to ring (32.3%, 95% CI 29.4%-35.3%), and approved less of pagers that are set to beep mode (70.2%, 95% CI 67.3%-73.0%), indicating that patients dislike intrusions into the clinical encounter. Conclusions: The majority of patients approve of certain technology use in the outpatient orthopaedic clinic, specifically means to access medical records and nonintrusive communication methods. As patients rank the orthopaedic surgeons’ bedside manner as a highly important aspect of outpatient clinical care, technology integration must be carefully done to preserve bedside manner.