Orthopaedic Outpatient Clinic Research Articles

The Pain Self-Efficacy Questionnaire: Validation of an Abbreviated Two-Item Questionnaire

The Pain Self-Efficacy Questionnaire (PSEQ) is a validated tool to assess pain self-efficacy and is strongly correlated with disability. Reducing the number of questions of the original PSEQ to screen for self-efficacy will result in more efficient screening and less burden for the patient. The aim of this study was to prospectively validate the shortened version of the PSEQ. Overall, 249 new and follow-up patients visiting our outpatient orthopedic hand surgery clinic were prospectively enrolled and asked to complete the PSEQ, short version of the Disabilities of the Arm Shoulder and Hand, and 2-question version of the Patient Health Questionnaire (PHQ-2) depression questionnaires. The patients completed the questionnaires in the office and online 2 weeks after their visit. At the follow-up visit, the PSEQ was substituted with the 2-question version of the Pain Self-Efficacy Questionnaire (PSEQ-2). The factors associated with higher short forms of the Disabilities of the Arm, Shoulder and Hand scores were investigated in a bivariate and multivariable analysis. Paired t-test was used to compare the mean values of the short and long questionnaires at enrollment. There was a large correlation (r = 0.90; p < 0.001) between the original PSEQ and the PSEQ-2 at enrollment. The Cronbach α were comparable for the PSEQ and the PSEQ-2 (α = 0.95 compared with α = 0.91). There was a small but statistically significant difference between the average scores of the PSEQ and PSEQ-2 (4.4 vs 4.8; p < 0.001). For the shortened PSEQ, a smaller-but still large-correlation was found with the short forms of the Disabilities of the Arm, Shoulder and Hand (r = 0.71 vs r = 0.61). Both the PSEQ-2 and the PSEQ were the most important predictors of the short forms of the Disabilities of the Arm, Shoulder and Hand scores. A substantial test-retest reliability was found for the PSEQ-2 (0.66). The PSEQ-2 can be used to quickly assess patients׳ pain self-efficacy.

Reliability and Clinically Important Improvement Thresholds for Osteoarthritis Pain and Function Scales: A Multicenter Study

To assess the reliability and clinically meaningful thresholds of intermittent and constant osteoarthritis pain (ICOAP) score, the Knee injury and Osteoarthritis Outcome Score Physical function Short-form (KOOS-PS), the Hip disability and Osteoarthritis Outcome Score Physical function Short-form (HOOS-PS), and the Quality of life subscales of HOOS/KOOS (HOOS-QOL/KOOS-QOL) in patients with knee or hip arthritis. One hundred and ninety-five patients (141 knee, 54 hip) seen at 2 orthopedic outpatient clinics with a diagnosis of knee or hip OA completed patient-reported questionnaires (ICOAP pain scale, KOOS-PS, HOOS-PS, KOOS-QOL, HOOS-QOL) at baseline and 2-week followup. Reliability was assessed using intraclass correlation coefficients (ICC). We calculated minimum clinically important difference (MCID) and moderate improvement in the subgroup that reported change in the status of their affected joint. The reliability as assessed by ICC was as follows: ICOAP pain scale, 0.63 (0.48, 0.74) in patients with knee arthritis, and 0.86 (0.73, 0.93) for hip arthritis; KOOS-PS, 0.66 (0.52, 0.77); HOOS-PS, 0.82 (0.66, 0.91); KOOS-QOL, 0.79 (0.69, 0.86); and HOOS-QOL, 0.67 (0.42, 0.83). MCID and moderate improvement estimates in patients with knee arthritis were ICOAP pain scale, 18.5 and 26.7; KOOS-PS, 2.2 and 15.0; and KOOS-QOL, 8.0 and 15.6. A smaller sample in patients with hip arthritis precluded MCID and moderate improvement estimates. We found that ICOAP pain and KOOS-PS/HOOS-PS scales were reasonably reliable in patients with hip OA. Reliability of these scales was much lower in patients with knee arthritis. Thresholds for clinically meaningful change in pain or function on these scales were estimated for patients with knee arthritis.

Costs and Utilities of Manual Therapy and Orthopedic Standard Care for Low-prioritized Orthopedic Outpatients of Working Age

Treatment for musculoskeletal disorders in primary care in Sweden is generally initiated with advice and medication. Second-line therapy is physiotherapy and/or injection and radiography; third-line therapy is referral to an orthopedist. Manual therapy is not routine. It is a challenge to identify patients who benefit from treatment by different specialists. The current referral strategy probably contributes to long waiting lists in orthopedic departments, which is costly and implies prolonged suffering for the patients. The aim of this health economic evaluation was to compare costs and outcomes from naprapathic manual therapy (NMT) with orthopedic standard care for common, low-prioritized, nonsurgical musculoskeletal disorders, after second-line treatment. Diagnose Related Groups were used to define the costs, and the SF-36 was encoded to evaluate the outcomes in cost per quality adjusted life years gained. Results from a 12 months' follow-up showed significantly larger improvement for the NMT than for orthopedic standard care, significantly lower mean cost per patient; 5427 SEK (*Price level 2009; 1 Euro=106,213 SEK; 1 US Dollar=76,457 SEK) (95% confidence interval, 3693-7161) compared to14298 SEK (95% confidence interval, 8322-20,274), and more gains in outcomes in cost per quality adjusted life years per patient (0.066 compared with 0.026). Thus the result is "dominant." It is plausible that improved outcomes and reasonable cost savings for low-prioritized nonsurgical outpatients would be attainable if NMT were available as an additional standard care option in orthopedic outpatient clinics.

Association between bone mineral density and clinical consequences: cross-sectional study of Korean postmenopausal women in an orthopaedic outpatient clinic.

This study is to identify the characteristics of BMD and the related clinical consequences through a nationwide, consecutive, cross-sectional study. A total of 1,281 postmenopausal women was enrolled nationwide and underwent measurement for BMD using dual energy x-ray absorptiometry. Following the T-spine and L-spine plane radiography, they were evaluated for vertebral fracture by a semi-quantitative method using the Genant's method. Relationship between BMD and osteoporotic fracture and a degree of deformity in vertebral fracture, treatment history in osteoporosis and the EQ-5D was analyzed. The distribution of the normal, osteopenia and osteoporosis group was 25.9%, 37.0%, and 37.2% in lumbar spine, and 31.4%, 45.3%, and 23.3% in femur neck, respectively. BMD in subjects with symptomatic or asymptomatic vertebral fracture was significantly lower than those without fracture. The femur neck and total hip BMDs were significantly lower in hip fracture group (0.646 g/cm2 and 0.643 g/cm2, respectively) and wrist fracture group (0.661 g/cm2 and 0.712 g/cm2, respectively) than in subjects without fracture (0.721 g/cm2 and 0.712 g/cm2, respectively). The BMD was significantly lower with more severe degree of deformity in vertebral fracture and lower scores in mobility, usual activities and pain/discomfort of the EQ-5D. In Korean postmenopausal women, the prevalence of osteoporosis and vertebral, hip and wrist fracture increase and quality of life decreases with lower BMD.Graphical

Influence of Insurance Benefit Criteria on the Administration Rate of Osteoporosis Drugs in Postmenopausal Females

BackgroundPreventive measures need to be implemented to lower the incidence of osteoporotic fractures. Osteoporotic fractures increase morbidity and mortality as well as impose a socioeconomic burden; however, current research is limited to the administration rates of osteoporosis drugs for Korean postmenopausal females.MethodsThis study represents a nationwide, observational, and cross-sectional survey that investigates the administration rates of osteoporosis drugs based upon a bone mineral density (BMD) test performed on Korean postmenopausal patients who visited outpatient orthopedic clinics. BMD test results were examined in postmenopausal female patients (50 to 80 years of age); subsequently, the patients were classified into an osteoporosis group, osteopenia group, and normal group. The administration rates of osteoporosis drugs and bisphosphonates were then analyzed. The osteoporosis group was subdivided into a T-score less than -3.0 group and a T-score between -3.0 and -2.5 group that were separately analyzed.ResultsBased on the lumbar spine BMD, the rate of administration of osteoporosis drugs in the osteoporosis group was 42.1%, which was significantly higher compared to the osteopenia group or normal group. A significantly low bone mineral density was observed in patients who were administered bisphosphonates. Based on the lumbar spine BMD, the administration rate of osteoporosis drugs in the group with a T-score between -3.0 and -2.5 (34.2%) was significantly lower than the group with a T-score less that -3.0 (46.2%). The bisphosphonate administration rate was also significantly low; however, the administration rate for osteoporosis drugs was significantly lower than that of the osteopenia group.ConclusionsOnly about 40% of Korean postmenopausal female patients with osteoporosis were administered osteoporosis drugs. The administration rate in patients with a T-score between -3.0 and -2.5 was particularly low and active treatment to prevent osteoporotic fractures is required in this group.

Prevalence of neuropathic pain in cases with chronic pain related to spinal disorders

BackgroundThe incidence and characteristics of neuropathic pain associated with spinal disorders have not yet been fully clarified. The purpose of this study was to investigate the prevalence of neuropathic pain and the degree of deterioration of quality of life (QOL) in patients with chronic pain associated with spinal disorders who visited orthopedic outpatient clinics. MethodsThis cross-sectional study was conducted in 1,857 patients recruited from 137 medical institutions nationwide. Participants were men and women aged 20-79 years with a history of spine-related pain for at least 3 months and a visual analog scale (VAS) score of at least 30 in the previous week. Patients were screened using a neuropathic pain screening questionnaire. The degree of QOL deterioration and its correlation with the presence of neuropathic pain were assessed using the Short Form Health Survey with 36 questions (SF-36). ResultsOverall prevalence of neuropathic pain was 53.3 %. It was relatively high in patients with cervical spondylotic myelopathy (77.3 %) and ligament ossification (75.7 %) and relatively low in those with low back pain (29.4 %) and spondylolysis (40.4 %). Only 56.9 % of patients with radiculopathy were diagnosed with neuropathic pain. Logistic regression analysis identified several risk factors, including advanced age, severe pain, disease duration of at least 6 months, and cervical lesions. In QOL assessment, physical functioning, role-physical, role-emotional, and social functioning were severely affected, and this trend was more pronounced in patients who were more likely to have neuropathic pain. ConclusionsThe frequency of neuropathic pain tended to be higher in patients with diseases associated with spinal cord damage and lower in patients with diseases that primarily manifested as somatic pain. A bias toward allodynia symptoms in the screening questionnaire may have resulted in the failure to diagnose neuropathic pain in some patients with radiculopathy. Poor QOL, primarily from the aspect of physical functioning, was demonstrated in patients with neuropathic pain associated with spinal disorders.

Effect of Health Insurance Type on Access to Care

Growing orthopedic and nonorthopedic literature illustrates the point that having health insurance does not equal having access to care. The goal of this study was to evaluate the burden placed on patients to gain access to outpatient orthopedic care. For this study, burden was quantified as the distance traveled by the patient to be seen in clinic. This study was a retrospective review of all new patient encounters at an adult orthopedic outpatient clinic in an academic tertiary referral center over 1 calendar year. All patients were stratified into 4 categories: commercial/private insurance, Medic-aid, Medicare, and uninsured/private pay. The average distance traveled by each patient to the center was then calculated based on the patient's billing zip code. Patient visits were further stratified based on whether the patients were seen by 1 of 3 different categories of providers: general orthopedics/adult reconstruction, spine, and sports/upper extremity. The study group comprised 774 (31.1%) Medicaid patients, 653 (26.2%) Medicare patients, 917 (36.8%) commercial/private insurance patients, and 146 (5.9%) uninsured/private pay patients. The average 1-way distance traveled was 36.2 miles for Medicaid patients, 21.3 miles for Medicare patients, 24.1 miles for commercial/private insurance patients, and 25.3 miles for uninsured/private pay patients (P<.00). Subgroup analysis noted a statistical difference in distance traveled for the general orthopedics/adult reconstruction and sports/upper extremity groups. The study's findings suggest that having insurance does not equal access to outpatient orthopedic care at a single institution. The specific burdens that each group faces to gain access to care are unclear.

Investigating well-being, work limitations and preferences for self-management education and peer support among younger people with hip and knee osteoarthritis: protocol for a cross-sectional study

IntroductionOsteoarthritis (OA) has traditionally been considered a condition of older age. However, younger people are also affected by hip and knee OA, often as a result of sporting and work-related...

Diagnostic value of patient characteristics, history, and six clinical tests for traumatic anterior shoulder instability

It is unknown which combination of patient information and clinical tests might beoptimal for the diagnosis of traumatic anterior shoulder instability. This study aimed to determinethe diagnostic value of individual clinical tests and to develop a prediction model that combined patient characteristics, history, and clinical tests for diagnosis of traumatic anterior shoulder instability. This prospective cohort study included 169 consecutive patients with shoulder complaints who were examined at an orthopaedic outpatient clinic. One experienced clinician conducted 25 clinical tests; of these, 6 were considered to be specific for testing of traumatic anterior shoulder instability (apprehension, relocation, release, anterior drawer, load and shift, and hyperabduction tests). Magnetic resonance arthrography was used to determine the final diagnosis. A prediction model was developed by logistic regression analysis. In this cohort, 60 patients (36%) were diagnosed with anterior shoulder instability on the basis of magnetic resonance arthrography. The overall accuracy of individual clinical tests was 80.5% to 86.4%. Age, previous shoulder dislocation, sudden onset of complaints, and the release test were important predictors for the diagnosis of traumatic anterior shoulder instability. The prediction model demonstrated high discriminative ability (AUC 0.95). Individual clinical shoulder tests provide good diagnostic accuracy. Young age, history of shoulder dislocation, sudden onset of complaints, and positive result of the release test were the most important predictors for traumatic anterior shoulder instability.

Risk factors in an association with the osteoarthritis of the knee in Mosul city

Background: Osteoarthritis of knee is a common cause of pain and disability. It is becoming increasingly prevalent worldwide due to its association with an aging and obesity. Objective: The aim of this study was to examine the associations between body mass index, gender, Islamic praying, praying in sitting position, usage of stairs, history of traumas, diabetes, hypertension, and hypothyroidism as risk factors for knee osteoarthritis in population of Mosul city. Patients and methods: This study is a case - control design, it was conducted through the period from Jan 2010 - Jan 2011 in the orthopedic outpatient clinic of Aljumhoori Teaching Hospital in Mosul. The target population of this study consisted of 213, 71 cases (61 females, 10 males), their ages mean 51.77 years, and 142 as controls. Results: The body mass index was higher in cases and shows highly significant difference between cases and control (p ≤ 0.000). Sex distribution in knee osteoarthritis revealed that there was significant difference between females and males as cases of osteoarthritis, (P ≤ 0.0001). Normal Islamic praying, Praying in sitting position, usage of stairs, appeared to be an associated risk factors, history of trauma was significantly higher in cases, while diabetes, hypertension, and hypothyroidism was not associated with the development of osteoarthritis of the knee. Conclusion: Females as a gender, obesity, Islamic praying in sitting position and history of trauma to the knee are important risk factors of osteoarthritis of the knee, while diabetes, hypertension and hypothyroidism are not associated with knee osteoarthritis. Keywords: Osteoarthritis, knee, risk factors.

OP0025 Different Patterns of Synovitis Present in OA Patients Associate Differentially with Pain

BackgroundSynovitis is prevalent in knee OA and is an important determinant of pain.ObjectivesTo better understand the nature of synovitis and its association with pain we investigated patterns of synovitis on...

FRI0303 Degree of synovitis on MRI is correlated with histological and macroscopic features of synovial tissue inflammation in knee osteoarthritis

BackgroundSynovitis is often present on MRI of OA knees and is an important determinant of pain.ObjectivesTo evaluate the association between synovitis at contrast enhanced (CE) MRI with microscopic and macroscopic...

Validation of an advanced practice physiotherapy model of care in an orthopaedic outpatient clinic

BackgroundIn Canada, new models of orthopaedic care involving advanced practice physiotherapists (APP) are being implemented. In these new models, aimed at improving the efficiency of care for patients with musculoskeletal disorders, APPs diagnose, triage and conservatively treat patients. Formal validation of the efficiency and appropriateness of these emerging models is scarce. The purpose of this study is to assess the diagnostic agreement of an APP compared to orthopaedic surgeons as well as to assess treatment concordance, healthcare resource use, and patient satisfaction in this new model.Methods120 patients presenting for an initial consult for hip or knee complaints in an outpatient orthopaedic hospital clinic in Montreal, Canada, were independently assessed by an APP and by one of three participating orthopaedic surgeons. Each health care provider independently diagnosed the patients and provided triage recommendations (conservative or surgical management). Proportion of raw agreement and Cohen’s kappa were used to assess inter-rater agreement for diagnosis, triage, treatment recommendations and imaging tests ordered. Chi-Square tests were done in order to compare the type of conservative treatment recommendations made by the APP and the surgeons and Student t-tests to compare patient satisfaction between the two types of care.ResultsThe majority of patients assessed were female (54%), mean age was 54.1 years and 91% consulted for a knee complaint. The raw agreement proportion for diagnosis was 88% and diagnostic inter-rater agreement was very high (κ=0.86; 95% CI: 0.80-0.93). The triage recommendations (conservative or surgical management) raw agreement proportion was found to be 88% and inter-rater agreement for triage recommendation was high (κ=0.77; 95% CI: 0.65-0.88). No differences were found between providers with respect to imaging tests ordered (p≥0.05). In terms of conservative treatment recommendations made, the APP gave significantly more education and prescribed more NSAIDs, joint injections, exercises and supervised physiotherapy (p<0.05). Patient satisfaction was significantly higher for APP care than for the surgeons care (p<0.05).ConclusionThe diagnoses and triage recommendations for patients with hip and knee disorders made by the APP were similar to the orthopaedic surgeons. These results provide evidence supporting the APP model for orthopaedic care.

Methylprednisolone Injections for the Treatment of Morton Neuroma

Morton neuroma is a common cause of neuralgia affecting the web spaces of the toes. Corticosteroid injections are commonly administered as a first-line therapy, but the evidence for their effectiveness is weak. Our primary research aim was to determine whether corticosteroid injection is an effective treatment for Morton neuroma compared with an anesthetic injection as a placebo control. We performed a pragmatic, patient-blinded randomized trial set within hospital orthopaedic outpatient clinics in Edinburgh, United Kingdom. One hundred and thirty-one participants with Morton neuroma (mean age, fifty-three years; 111 [85%] female) were randomized to receive either corticosteroid and anesthetic (1 mL methylprednisolone [40 mg] and 1 mL 2% lignocaine) or anesthetic alone (2 mL 1% lignocaine). An ultrasonographic image was obtained before treatment, and injections were performed with the needle placed under ultrasonographic guidance. The primary outcome was the difference in patient global assessment of foot health between the two groups at three months after injection. This was measured with use of a 100-unit visual analog scale (VAS) anchored by "best imaginable health state" and "worst imaginable health state." Compared with the control group, global assessment of foot health in the corticosteroid group was significantly better at three months (mean difference, 14.1 scale points [95% confidence interval, 5.5 to 22.8 points]; p = 0.002). The difference between the groups was also significant at one month. Significant and nonsignificant improvements associated with the corticosteroid injection were observed for measures of pain, function, and patient global assessment of general health at one and three months after injection. The size of the neuroma as determined by ultrasonography did not significantly influence the treatment effect. Corticosteroid injections for Morton neuroma can be of symptomatic benefit for at least three months.

Prevalence of Vitamin D Deficiency in Patients with Lumbar Spinal Stenosis and its Relationship with Pain

Background: Patients with lumbar spinal stenosis (LSS) are at a great risk of a fall and fracture, which vitamin D protects against. Vitamin D deficiency is expected to be highly prevalent in LSS patient, and pain is thought to have a profound effect on vitamin D status by limiting activity and sunlight exposure. Objective: To identify the prevalence of vitamin D deficiency (serum 25-hydroxyvitamin D [25-OHD] &lt; 20ng/mL) and its relationship with pain. Study Design: Nonblinded, cross-sectional clinical study. Setting: University-based outpatient clinic of the Department of Orthopedic Surgery, Yonsei University College of Medicine, Korea. Methods: Consecutive patients who visited the orthopedic outpatient clinic for chronic low back pain and leg pain and were diagnosed as LSS between May 2012 and October 2012 were included. Pain was categorized into 4 groups based on location and severity: 1) mild to moderate back or leg pain; 2) severe back pain; 3) severe leg pain; and 4) severe back and leg pain. Covariates for vitamin D deficiency included age, sex, body mass index, level of education, medical history, season, region of residence, sunlight exposure score and functional disability. 25-OHD level was measured by radioimmunoassay, and bone metabolic status including bone mineral density and bone turnover markers was also measured. Multivariable logistic regression modeling was used to adjust all risk estimates for covariates. Results: The study had 350 patients enrolled. Mean serum 25-OHD level was 15.9 ± 7.1 ng/mL (range, 2.5 ~ 36.6). of the 350 patients, 260 patients out of 350 (74.3%) were vitamin D deficient. Univariate logistic regression analysis showed a significantly higher prevalence of vitamin D deficiency in the following patients: 1) medical comorbidity; 2) urban residence rather than rural; 3) lower score for sunlight exposure; and 4) severe leg pain, or severe back and leg pain rather than mild to moderate pain. Pain category was significantly associated with lower sunlight exposure; however, the association between pain category and vitamin D deficiency remained significant even after adjustment for the sunlight exposure. Furthermore, severe back pain, and severe back and leg pain were also associated with higher incidence of osteoporosis and higher level of bone resorption marker (serum CTx). Limitations: The limitation of our study is that due to its cross-sectional design, causal relationships between pain and vitamin D deficiency could not be established. Conclusion: Vitamin D deficiency was highly prevalent in LSS patients (74.3%), and severe pain was associated with higher prevalence of vitamin D deficiency and osteoporosis which could be potential risk factors or a fall and fracture. As evidenced by the present study, assessment of serum 25-OHD and bone mineral density are recommended in LSS patients with severe pain, and active treatment combining vitamin D, calcium, or bisphosphonate should be considered according to the status of the bone metabolism. Key words: Vitamin D, lumbar spinal stenosis, pain, bone mineral density

A predictive model for disability in patients with lumbar disc herniation

BackgroundLumbar disc herniation may influence patients’ daily activities and social interactions; however, no predictive models of disability could be found for patients with lumbar disc herniation. We aimed to explore predictive factors for disability in patients with lumbar disc herniation. MethodsThe sample included 216 patients recruited from the orthopedic outpatient clinics at a medical center in northern Taiwan. Data were collected on patients’ pain, fatigue, depression, disability, and demographics. Hierarchical multiple regression analysis was used in model verification. Path analysis was used to investigate causal relationships between disability and other factors. ResultsIn path analysis, the most influential factor affecting the disability level was the pain level (standardized regression coefficient, b=0.746), followed by the fatigue level (b=0.138) and depression level (b=0.100). The depression level was directly affected by the fatigue level (b=0.416) and the pain level (b=0.367), the fatigue level was directly affected by the pain level (b=0.538), and the pain level was directly affected by age (b=0.140) and previous surgery (b=0.260). ConclusionsWe recommend that health-care providers regularly assess and treat pain and depression to reduce/prevent disability among patients with lumbar disc herniation, even among those who are apparently functioning well in the community.

Referrals to Pediatric Orthopedics: Always Indicated?

Hsu EY, Schwend RM, Leamon J. How many referrals to a pediatric orthopaedic hospital specialty clinic are primary care problems?. J Pediatr Orthop. 2012; 32( 7): 727- 731; doi: org/10.1097/BPO.0b013e31826994a4[OpenUrl][1][CrossRef][2][PubMed][3] Investigators from Children’s Mercy Hospital in Kansas City, MO sought to determine how many new patient referrals evaluated by pediatric orthopedic surgeons had conditions that a pediatrician could manage if she/he chose to do so. The authors utilized the 2002 American Academy of Pediatrics guidelines for referral1 in conjunction with the American Board of Pediatrics referral criteria2 to distinguish conditions manageable by pediatricians from those requiring pediatric orthopedic management. ### PICO Question : Of new patients referred to a pediatric orthopedic clinic, how many had conditions that could be readily managed by a primary care physician? Question type : Descriptive Study design : Cross-sectional A total of 529 new referrals to the pediatric orthopedic outpatient clinic during the month of August 2010 were evaluated. A total of 246 referrals (47%) … [1]: {openurl}?query=rft.jtitle%253DJournal%2Bof%2Bpediatric%2Borthopedics%26rft.stitle%253DJ%2BPediatr%2BOrthop%26rft.aulast%253DCatena%26rft.auinit1%253DN.%26rft.volume%253D32%26rft.issue%253D7%26rft.spage%253D727%26rft.epage%253D731%26rft.atitle%253DHand%2Band%2Bupper%2Blimb%2Banomalies%2Bin%2Bpoland%2Bsyndrome%253A%2B%2Ba%2Bnew%2Bproposal%2Bof%2Bclassification.%26rft_id%253Dinfo%253Adoi%252F10.1097%252FBPO.0b013e31826994a4%26rft_id%253Dinfo%253Apmid%252F22955538%26rft.genre%253Darticle%26rft_val_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Ajournal%26ctx_ver%253DZ39.88-2004%26url_ver%253DZ39.88-2004%26url_ctx_fmt%253Dinfo%253Aofi%252Ffmt%253Akev%253Amtx%253Actx [2]: /lookup/external-ref?access_num=10.1097/BPO.0b013e31826994a4&link_type=DOI [3]: /lookup/external-ref?access_num=22955538&link_type=MED&atom=%2Faapgrand%2F29%2F3%2F29.atom

Can Onsite Presentations Led by Physical Therapist Students Increase Clinicians’ Confidence in Aspects of Evidence-Based Practice? A Pilot Study

Purpose: The purpose of this study was to compare impact of 3 different types of onsite physical therapist student-led presentations on participants' reported confidence in various skills related to EBP.Subjects. Fifty-two physical therapists from 6 outpatient orthopedic clinics participated.Materials and Methods. Six clinics were randomly assigned to 1 of 3 presentation types: topic-specific presentation (TP, n = 20); evidence-based practice (EBP) interactive education session (ED, n = 12); or EBP education handout (HO, n = 20). Data were collected from 1 prepresentation and 2 postpresentation (at 1 and 6 months after intervention) surveys. Data analysis utilized demographic summaries, cross-tabulations, frequencies, Friedman analyses of variance (ANOVA), and Kruskal-Wallis tests for survey data.Results. Pre presentation (PRE): Groups were demographically similar and did not differ in survey responses. Over 95% of all participants agreed that EBP is essential to physical therapy practice. Lack of time was most frequently identified barrier to use of EBP (92%). One (POST1) and 6 (POST6) months post presentation: Significant improvements were found from PRE to POSTl in ED group in confidence in understanding published research, and these improvements were maintained at POST6. The HO group demonstrated significantly improved confidence in ability to locate published research from PRE to POST1. No differences were found in TP group across time. A large majority of all participants reported that it was helpful to have information provided to them and that student presenters were knowledgeable and trustworthy regarding information presented. Nearly two thirds reported gaining new skills or information from presentation, and most agreed that future student-led, EBP-related presentations would be beneficial.Conclusions. Participants in this study consider EBP essential to physical therapy practice, but identified numerous barriers that may prevent EBP implementation. Student-led presentations designed to educate clinicians on methods of locating and understanding published research (ED and HO) produced several significant pre-presentation to post-presentation differences in participants' confidence in these skills. The majority of participants felt presentations were beneficial and that students provided useful information.Clinical Relevance. The academic environment affords PT students with most up-to-date, evidence-based information, and students are required to be proficient in locating, understanding, analyzing, and implementing published research. Some clinicians may lack these skills; this lack has been identified as a barrier to EBP implementation. The results of this pilot study are a positive indication that PT students may be able to provide clinicians with information and training that may improve their confidence in locating and understanding published research. This may be an early but important step toward achieving American Physical Therapy Association's vision to improve profession's implementation of EBP.Key Words: Evidence-based practice, Student-led presentations, Clinical presentations.INTRODUCTIONEvidence-based practice (EBP), the conscientious, explicit, and judicious use of current best evidence in making decisions about care of individual patients,1(p71) is at forefront of discussions about future of physical therapy. The American Physical Therapy Association (APTA) has identified EBP as one of 6 key elements for achieving vision of autonomous practice by year 2020.2 Clinician-identified barriers have been shown to make implementation of EBP difficult.3'12 This has contributed to a gap between knowledge available through published evidence and actual clinical practice. Many strategies have been suggested to bridge this gap and allow physical therapists to consistently use EBP in their professional setting. …

The Clinical Pattern of Knee Osteoarthritis in Jordan: A Hospital Based Study

Background: Different clinical profiles of knee osteoarthritis (KOA) have been reported in the literature. The aim of this investigation was to describe the clinical patterns of KOA in an ethnically distinct and homogenous population that has not been widely reported. Patients with KOA were seen in outpatient rehabilitation and orthopedic clinic of Jordan University Hospital (JUH), to determine any possible association between age, BMI, radiographic severity, and pain severity.Methods: Patients diagnosed with KOA attending an outpatient rehabilitation clinic at JUH were studied to describe their clinical characteristics. They were included based on criteria developed by the American College of Rheumatology. Detailed histories, clinical examinations and X-rays, and anthropometric data were obtained. Data analysis focused on descriptive statistics and correlations among demographic and clinical characteristics.Results: The study included 214 patients with a mean age of 55.3 years (range = 30-84 years). The mean BMI was 29.5± 5.6. We found a significant moderate positive correlation between age and radiographic severity of KOA (0.435; p <. 001) and pain severity (0.383; p. <. 001). There was also a significant weak positive correlation between BMI, radiographic severity of KOA (0.242, p <. 05), and pain severity (0.266, p. <. 01).Conclusions: We concluded that in this hospital-based cohort study in Jordan, the clinical pattern of KOA is comparable to Western cultures. However, the combination of BMI and mechanical loading during everyday activities that include different religious and cultural habits and may help explain the high level of radiographic severity in our sample.

Effectiveness of Mckenzie Intervention in Chronic Low Back Pain: A Comparison Based on the Centralization Phenomenon Utilizing Selected Bio-Behavioral and Physical Measures

Objectives: To compare selected physical and bio-behavioral improvements following McKenzie intervention in individuals with discogenic chronic low back pain (CLBP) demonstrating centralization and partial centralization of pain. Design: Prospective cohort study with three assessments; at base line and two follow-ups. Setting: Two out-patient orthopedic Physical Therapy clinics. Participants: 105 volunteers with CLBP (52 men and 53women) average ages 41.9 and 37.1 years. Methods: Subjects filled out pain and related fear and disability questionnaires, performed selected physical tests then underwent a McKenzie assessment protocol. McKenzie assessment protocol utilizes directional preference exercises to determine the pain centralization-phenomenon. Subjects were divided into 2-groups; completely centralized group (CCG) and partially centralized group (PCG), and underwent a McKenzie intervention. Outcome measurements were repeated at the end of the 5th and 10th weeks after completing the treatment Outcome Measurements: Pain related fear and disability beliefs were assessed using the Fear Avoidance Belief Questionnaires (FABQ) and Disability Belief Questionnaire (DBQ). The time of sit-to-stand, forward bending, and customary and fast walking was recorded. Pain (anticipated vs. actual perception), were measured before and after each physical task. Descriptive statistics, Chi-square, paired t-tests, repeated measures ANOVA were used for longitudinal comparisons across assessment intervals at p<0.05 level. Results: Significant improvements in patient physical performance times and bio-behavioral variables were observed on the 5th week following the intervention, but tended to regress thereafter. Conclusions: In this cohort study of CLBP both CCG and PCG patients demonstrated significant measurable improvements in physical performances that remained stable for 10 weeks as a result of improved pain and related fear and disability beliefs.