Orthopaedic Outpatient Clinic Research Articles

Association of ulnar variance with primary distal radio-ulnar joint arthritis: a matched case-control study.

Knowledge regarding risk factors for primary distal radioulnar joint (DRUJ) arthritis is limited. This study evaluated the association between ulnar variance (UV) and the development of primary DRUJ arthritis in a matched case-control cohort. Patients with symptomatic DRUJ arthritis were identified from those attending an orthopaedic outpatient clinic between January 2017 and April 2023. The control group comprised individuals without radiographic evidence of DRUJ arthritis. Propensity score matching was performed, aiming for a 1:3 ratio with an age difference limit of five years or less. UV and grade of DRUJ arthritis were assessed using a previously described method. Differences in UV between the case and control groups, and the association between ulnocarpal joint (UCJ) and DRUJ arthritis, were analysed. Receiver operating characteristic (ROC) analysis was used to determine the UV cut-off value for predicting symptomatic DRUJ arthritis. The case group comprised 49 wrists from 44 patients, while the control group included 147 wrists from 132 individuals. The mean ages of the case and control groups were 69.6 and 67.5 years, respectively. UV was significantly higher in the case group (3.5 ± 2.9 vs. 1.6 ± 1.5mm). The prevalence of UCJ arthritis increased with higher DRUJ arthritis grades. ROC curve analysis revealed a UV cut-off of 2.9mm, with a sensitivity of 0.612 and specificity of 0.816. A UV greater than 2.9mm was associated with symptomatic primary DRUJ arthritis. Patients with more advanced DRUJ arthritis were also more likely to have concomitant UCJ arthritis.

Possible association between Sever’s disease and attention deficit hyperactivity disorder. a prospective observational study

BackgroundSever’s disease is among the most common causes of foot pain in childhood.The etiology of Sever’s disease is still under debate.The objective of this prospective study is to investigate the relationship between Sever’s disease and attention deficit hyperactivity disorder(ADHD).MethodsThe study was prospectively conducted for 1 year between 2023–2024.Of 238 children admitted to our clinic with foot pain, 88 children diagnosed with Sever’s disease were included in the study.A control group including 90 individuals was employed.Patients diagnosed with Sever’s disease in the orthopedics outpatient clinic and healthy control group were evaluated by a pediatric psychiatrist in terms of ADHD based on the DSM-4 diagnostic criteria.ResultsFifty-seven patients were male, and 31 were female.While 45 male patients were diagnosed with ADHD, 12 of them did not have ADHD.While 17 female patients were diagnosed with ADHD, 14 did not have ADHD. ADHD was detected in 12 (13.3%) of 90 patients in the control group, comprising 9 boys and 3 girls. The prevalence of ADHD in the Sever’s disease cohort was 62 (70.5%) out of 88, significantly higher than the control group’s 12 (13.3%) out of 90 patients (p < 0.01). The high number of the patients diagnosed with ADHD among the Sever’s patients who were not engaged in sports was found to be statistically significant(p < 0.01).The diagnosis of ADHD was found to be statistically more significant in boys with Sever’s disease compared to girls(p < 0.018).ConclusionChildren with Sever’s disease can be the candidates for attention deficit hyperactivity disorder.It is thought that evaluating children, especially male children, diagnosed with calcaneal apophysitis within the framework of attention deficit hyperactivity disorder will be valuable.

Evaluating ChatGPT, Gemini and other Large Language Models (LLMs) in orthopaedic diagnostics: A prospective clinical study.

Large Language Models (LLMs) such as ChatGPT are gaining attention for their potential applications in healthcare. This study aimed to evaluate the diagnostic sensitivity of various LLMs in detecting hip or knee osteoarthritis (OA) using only patient-reported data collected via a structured questionnaire, without prior medical consultation. A prospective observational study was conducted at an orthopaedic outpatient clinic specialized in hip and knee OA treatment. A total of 115 patients completed a paper-based questionnaire covering symptoms, medical history, and demographic information. The diagnostic performance of five different LLMs-including four versions of ChatGPT, two of Gemini, Llama, Gemma 2, and Mistral-Nemo-was analysed. Model-generated diagnoses were compared against those provided by experienced orthopaedic clinicians, which served as the reference standard. GPT-4o achieved the highest diagnostic sensitivity at 92.3 %, significantly outperforming other LLMs. The completeness of patient responses to symptom-related questions was the strongest predictor of accuracy for GPT-4o (p < 0.001). Inter-model agreement was moderate among GPT-4 versions, whereas models such as Llama-3.1 demonstrated notably lower accuracy and concordance. GPT-4o demonstrated high accuracy and consistency in diagnosing OA based solely on patient-reported questionnaires, underscoring its potential as a supplementary diagnostic tool in clinical settings. Nevertheless, the reliance on patient-reported data without direct physician involvement highlights the critical need for medical oversight to ensure diagnostic accuracy. Further research is needed to refine LLM capabilities and expand their utility in broader diagnostic applications.

Ultrasound Accuracy in the Diagnosis of Anterior Talofibular Ligament Acute Injury: A Single-Center Study

Background: Ankle sprains are the most common injury in ankle joint and rank as the second most frequent injury in sports. Objectives: To compare ultrasonography sensitivity in identifying anterior talofibular ligament (ATFL) tears in patients who came within four days of injury vs those who presented later. Methods: A prospective study was conducted at Al-Kindy Teaching Hospital between October 2022 and April 2023, involving consecutive patients who presented to orthopedic outpatient clinic unit with an inversion-type ankle injury. All patients underwent clinical examination by an orthopedic surgeon, followed by an ultrasound assessment of lateral ankle ligaments using a standard protocol, performed by a qualified radiologist. MRI was used as the reference standard for comparison. The patients were divided into two groups based on the timing of the examination. Early examination, for those presented within the first 4 days after the injury, and delayed examination, including those who presented later. Results: This study recruited 40 individuals with magnetic resonance imaging (MRI) -confirmed ATFL tears with a mean age of 32.3 years. Twenty-five (62.5%) patients presented within four days of the injury, whereas 15 (37.5%) patients did so later. Ultrasound identified 35 ATFL tears at an overall sensitivity of 87.5%. Early ultrasound showed the tear in 21 with a sensitivity of 84%. In 14 of 15 delayed presentation patients, ultrasonography detected the ATFL tear with a sensitivity of 93.3%. Conclusions: Ultrasound is useful in early detection of ATFL tears; however, its efficiency improved even further after 4 days post-injury.

Evaluation of the relationship between the bone alignment of the lower extremity and the importance of Q angle in male athletes.

Evaluating the mechanical-anatomical alignment and angles of the knee joint is crucial for athletes. We aimed to analyse the relationship between lower extremity bone alignment and the importance of the Q angle (QA) in male athletes. We included 38 male professional football athletes without any alignment or varus-valgus deformity who actively played football in various football clubs in Istanbul. This study was conducted using quantitative research methods within the scope of a cohort study design and employed a correlational survey method. A health specialist at the orthopaedic outpatient clinic of the Haseki Training and Research Hospital, Istanbul, evaluated the participants' lower extremity bone alignment using standing anteroposterior radiographs and assessed the QA using the goniometric measurement method. The anatomical lateral distal femoral angle (aLDFA), medial proximal tibial angle (MPTA) and QA data were analysed to assess lower extremity straightness. Significant relationships between the right and left leg aLDFA, MPTA and QA values of the participants' lower extremity mechanical axis values and between the aLDFA and right leg QA values (r = 0.380, p = 0.019) were found. These relationships were attributed to the difference between proximal and distal alignments of the lower extremities. The correlation between QA and certain mechanical alignment parameters was due to unilateral and bilateral symmetrical arrangements of the lower extremities. The parameters of lower extremity mechanical-anatomical alignment are considered preliminary indicators of relationships among sports injuries, structural factors and predisposition to such injuries. Individual differences in the angular values of mechanical-anatomical alignment and the application of different methods for determining these angles have revealed some uncertainties. We determined the mechanical axis data of football athletes who predominantly used their lower extremities using the most reliable methods and examined the relationship among the right and left leg aLDFA, MPTA and QA values. We believe that our findings provide insights and guidance for experts in the field.

TITLE: Patient Preferences for Carpal Tunnel Release Education: A Comparison of Education Materials from Popular Healthcare Websites and ChatGPT.

ChatGPT has been increasingly utilized to create, simplify, and revise hand surgery patient education materials. While significant research has examined the quality and readability of ChatGPT-derived hand surgery patient education, the patient perspective has not previously been evaluated. This study compared patient reported clarity and readability grades as well as patient preferences for carpal tunnel surgery educational information from medical education websites and ChatGPT. Patients without a history of carpal tunnel release surgery at two orthopaedic hand surgery outpatient clinics were asked to complete an anonymous survey which gathered demographic information and included a blinded educational passage on carpal tunnel release surgery from ChatGPT, WebMD, or Mayo Clinic. Patients graded the blinded passages regarding clarity, readability, length, likeliness to recommend to others, and overall satisfaction with the education material. There were no significant differences in clarity (p = 0.682),readability (p = 0.328), or likeliness to recommend to others (p = 0.106) between the different educational sources. When stratified by age, younger patients (under 55) were more likely to recommend Mayo Clinic over other resources (p = 0.002). When further stratified to include only those who reported previously using websites for healthcare information, patients tended to have a higher likelihood of recommending Mayo Clinic compared to other sources, but this was not a statistically significant difference. There were no differences in clarity, readability, or preference ratings between patient education materials that were produced by ChatGPT, WebMD and Mayo Clinic. However, while ChatGPT-generated materials are comparable in quality based on patient ratings, younger patients may still favor well-established sources for medical education. This information regarding patient preferences provides valuable insights for hand surgeons when selecting suitable educational resources for their patients.

A comparison of handheld versus cart-based ultrasound in the evaluation and diagnosis of carpal tunnel syndrome

Carpal tunnel syndrome (CTS) is responsible for over 90% of median nerve neuropathies. Though a clinical diagnosis, evaluation of nerve conduction via electrodiagnostic studies (EDX) and median nerve cross sectional area (CSA) through sonographic imaging provides supporting evidence and insight into disease severity. The advent of handheld ultrasound devices offers a portable, cost-effective and non-invasive method for median nerve assessment, yet its accuracy compared to traditional cart-based ultrasound has not been assessed in this setting. 43 consecutive patients who presented to an outpatient orthopedic clinic within a large academic institution for symptoms consistent with CTS between August 2023 and April 2024 were included. Handheld sonography was performed with the Clarius Convex L20 HD3 8-20MHz transducer. The GE Venue Go with a 4-20MHz linear transducer was used for conventional cart-based ultrasound evaluation. A paired t-test was performed to compare the mean cross-sectional area (CSA) measured with the GE machine to the mean CSA measured with the Clarius transducer (p<0.05). The average CSA measurement obtained with the GE was 14.21±4.89mm2. The average CSA measurement obtained with the Clarius handheld transducer was 13.54±4.50mm2. The mean difference between the GE and Clarius groups was 0.62mm2 (95% CI=-1.47 to 2.71), p=0.55. CSA measurements of the median nerve obtained by a handheld ultrasound transducer are comparable to those measured by a traditional cart-based ultrasound machine for carpal tunnel diagnosis. The adoption of handheld ultrasounds in clinical settings holds the potential for quicker, more precise diagnoses and broader access to imaging.

Effects of Disturbed Body Perception on Arm Function in Patients With Frozen Shoulder.

Purpose Considering pain-related beliefs, this study aimed to investigate the influence of disturbed body perception on arm function in patients with frozen shoulder (FS). Methods This study included 90 patients with FS who visited the orthopedic outpatient clinic. We recorded measurements including the Visual Analog Scale (VAS) for pain at rest and during movement, the quick disability of the arm, shoulder, and hand (QDASH) questionnaire for perceived arm function, the short version of the Pain Self-Efficacy Questionnaire-2 (PSEQ-2) for self-efficacy in pain, the short version of the Pain Catastrophizing Scale (PCS-6) for catastrophic thoughts about pain, the short version of the Tampa Scale for Kinesiophobia (TSK-11) for fear of movement, and the Fremantle Shoulder Awareness Questionnaire (FreSHAQ) for disturbed perception around the shoulder. For statistical analysis, we constructed three models. Model 1 used the QDASH score as the dependent variable, with gender, age, duration of disease onset, VAS score at rest, and VAS score during movement as control variables. Model 2 included pain-related beliefs (PSEQ-2, PCS-6, and TSK-11) added to the variables in Model 1. Model 3 further included the FreSHAQ to the variables in Model 2. We calculated the difference in the adjusted coefficients of determination (R² adj) from Model 1 to Model 2 and Model 3 to determine the amount of change (ΔR² adj). Additionally, we calculated the standardized regression coefficient (β-value) of the input factors to examine their effects. Result Hierarchical multiple regression analysis showed a ΔR² adj of 0.13 and 0.17 for Models 2 and 3, respectively, indicating an increase in ΔR²adj after adding the FreSHAQ. Furthermore, the FreSHAQ had the largest effect of all factors, with β = 0.27 (p<0.05). Conclusions The influence of disturbed body perception on perceived arm function in patients with FS was demonstrated, suggesting the importance of considering somatosensory factors in clinical practice.

Effect of Time and Sex on Post-Anterior Cruciate Ligament Reconstruction Psychological Patient-Reported Outcome Measure Scores.

Low scores on psychological patient-reported outcomes measures, including the Anterior Cruciate Ligament-Return to Sport After Injury (ACL-RSI) and Injury-Psychological Readiness to Return to Sport (I-PRRS), after anterior cruciate ligament reconstruction (ACLR) have been associated with a maladaptive psychological response to injury and poor prognosis. To assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores and generate normative reference curves. Case series. Outpatient sports medicine and orthopaedic clinic. A total of 507 patients (age at ACLR, 17.9 ± 3.0 years) who had undergone primary ACLR and completed ACL-RSI or I-PRRS assessments ≥1 times (n = 796) between 0 and 1 year post-ACLR. An honest broker provided anonymous data from our institution's knee-injury clinical database. Generalized additive models for location, scale, and shape and generalized least-squares analyses were used to assess the effect of time post-ACLR and sex on ACL-RSI and I-PRRS scores. The ACL-RSI and I-PRRS scores increased over time post-ACLR. Males had higher scores than females until approximately 5 months post-ACLR, with scores converging thereafter. Males reported higher ACL-RSI and I-PRRS scores than females in the initial stages of rehabilitation, but scores converged between sexes at times associated with return to play post-ACLR. Normative reference curves can be used to objectively appraise ACL-RSI and I-PRRS scores at any time post-ACLR. This may lead to timely recognition of patients with a maladaptive psychological response to injury and a higher likelihood of a poor prognosis, optimizing ACLR outcomes.

Systematic Evaluation of Isometric Maximal Muscle Strength in an Orthopaedic Cohort.

Although the lower extremities are essential for movement function and human gait, no normalized isometric maximum strength values, which include the factors gender, age, weight, height, and body mass index (BMI), have been defined to date for orthopaedic patients. To systematically analyze the isometric maximal muscle strength of a cohort in an orthopaedic outpatient clinic and to evaluate its relation to gender, age, weight, height, BMI, and the differences between diseases. Cross-sectional study. Level 4. Isometric maximal muscle strength of knee extension, knee flexion, hip abduction, and hip adduction was measured in orthopaedic patients of an outpatient clinic using a specific muscle strength measurement device. Correlation analysis was performed for age, gender, height, weight, and BMI. Patients were grouped by disease characteristics. The cohort consisted of 311 subjects (sex: 164 male, 147 female; age: 48.63 years, SD = 16.595; BMI: 26.56 kg/m², SD = 4.9). Age correlated significantly with maximal isometric muscle strength. At the age of 54 years onward, based on 133 patients, a decline in maximum isometric muscle strength was detected. Gender showed a strong influence on maximal isometric muscle strength, with significantly higher values for male patients. Furthermore, weight and height, but not BMI, correlated significantly with muscle strength. For clinical studies comparing different evidence-based training interventions for rehabilitation, it is important to consider determinants such as gender, age, weight, and height for isometric maximum strength measurement. For further validation, follow-up examinations taking into account the performance level, other target groups, and other muscle groups are required to avoid the wide dispersion of isometric maximum strength values. These results and associated determinants are highly clinically relevant and can be used as a reference for further studies in the field of musculoskeletal regeneration.

Association of fear of falling with performance-based physical function and low back pain in older adults: a cross-sectional study in Iran

ObjectivesThis study investigated the association of fear of falling with performance-based physical function and low back pain (LBP) among older adults.DesignCross-sectional study.SettingParticipants were selected via convenient sampling from Iran University...

A cross-sectional study measuring the magnitude of depression and associated factors among patients attending orthopedic outpatient clinic at Ambo University Referral Hospital, Ambo Town, Oromia, Ethiopia, 2023.

Depression is a leading cause of major public health problems globally, and its frequency has been increasing, particularly in low-income and middle-income countries. The prevalence of depression in sub-Saharan Africa ranges from 15 to 30%. In Ethiopia, depression is found to be the seventh leading cause of disease burden, yet no study was done in West Shewa, Ethiopia. Therefore, this study aimed to assess the magnitude of depression and associated factors among adult orthopedic outpatients getting treatment at Ambo University Referral Hospital, West Shewa, Oromia, Ethiopia, in 2023. An institution-based cross-sectional study was conducted among 391 adult orthopedic patients from January 1-30, 2023. A systematic random sampling technique was used to select the study subjects. The data were collected by using a structured questionnaire and checklist through face-to-face interviews and chart review techniques. The collected data were entered into Epi-data, version 4.6, and then exported to SPSS, version 26.0, for statistical analysis. The binary logistic regression model was fitted, and both bivariable and multivariable logistic regression analyses were employed. The magnitude of depression was found to be 38.9% (95% CI: 34.5%, 43.9%), being female [adjusted odds ratio (AOR)=2.41; 95% confidence interval (CI): 1.45-4.00], chewing chat (AOR=2.39; 95% CI: 1.29-4.43), and no disorder on the lower limb (AOR=0.24; 95% CI: 0.07-0.85), had ligament injury (AOR=2.62; 95% CI: 1.23-5.59), had no complication (AOR=0.07; 95% CI: 0.01-0.52), and had amputation (AOR=3.83; 95% CI: 2.09-7.00) were significantly associated with depression. The study found that the prevalence of depression among orthopedic patients was considerable; nearly half of the participants developed depression at Ambo University Referral Hospital, and being female, chewing chat, having no disorder on the lower limb, having a ligament injury, having a complication, and being amputated were significantly associated with depression. Therefore, due attention is needed from concerned bodies in order to tackle this problem.

Maximizing Satisfaction in Orthopedic Outpatient Clinics: Evidence From Ireland.

Background Patient satisfaction is a critical metric in healthcare, reflecting the quality of care provided and influencing clinical outcomes and healthcare utilization. In orthopedic outpatient clinics, patient satisfaction affects patient adherence to treatment plans and overall health outcomes. This study aims to identify and analyze key factors influencing patient satisfaction in orthopedic outpatient clinics. Methodology This cross-sectional study was conducted from April to May 2024 across 10 orthopedic outpatient clinics. In this study, family members were included as respondents to the Patient Satisfaction Questionnaire (PSQ) when patients were unable to complete the survey due to age, cognitive impairment, or physical disabilities. This approach was adopted to ensure that the experiences of all patients, particularly minors, elderly individuals, and those with disabilities, were accurately captured. The PSQ assessed various aspects of patient satisfaction, including communication, treatment plans, addressing concerns, clinic environment, and overall satisfaction. Quantitative data were analyzed using SPSS version 27.0 (IBM Corp., Armonk, NY, USA). Results The study included 172 respondents. High levels of overall satisfaction were reported, with 142 (82.6%) respondents very satisfied and 28 (16.2%) somewhat satisfied. Significant associations were found between overall satisfaction and several factors, namely, effective communication, thorough explanation of treatment plans, addressing patient concerns, and a clean, comfortable clinic environment. Shorter waiting times were also associated with higher satisfaction. Regression analysis revealed that staff rating and the thoroughness of treatment plans were significant predictors of overall satisfaction. Conclusions Effective communication, thorough treatment explanations, addressing patient concerns, and maintaining a clean clinic environment are key determinants of patient satisfaction in orthopedic outpatient clinics. Reducing waiting times and investing in staff training on communication and empathetic care can further enhance patient satisfaction. These findings provide valuable insights for healthcare providers and administrators aiming to improve patient experiences in orthopedic outpatient settings. Further research is recommended to explore these relationships in diverse settings and develop targeted interventions.

Enhancing the Evaluation of Physical Function Following Orthopaedic Trauma Care: Comparison of PROMIS Computerized Adaptive Testing and Short Musculoskeletal Function Assessment.

To compare measurement properties of Patient-Reported Outcomes Measurement Information System (PROMIS) (physical function [PF] and pain interference [PI]) computerized adaptive testing to traditional Short Musculoskeletal Function Assessment (SMFA) (dysfunction index [DI] and bother index [BI]). To explore factors associated with PROMIS scores. Cross-sectional study. Level I Trauma Center. Isolated upper/lower extremity fracture patients were recruited from the orthopaedic trauma outpatient clinic (October 1, 2021 to January 1, 2023). Correlations (Pearson), reliability (standard error [SE] [T score]), efficiency (amount of information per item [1 - SE2/Nitems]), and floor/ceiling effects were assessed. An r > 0.7 represented high correlation, and SE ≤ 2.2 represented sufficient reliability. Factors associated with worse PROMIS scores were also identified. In total, 202 patients completed PROMs at median 98 days follow-up. Correlations between PROMIS-PF and SMFA-DI, and PROMIS-PI and SMFA-BI were -0.84 and 0.65. Reliability was very high for both instruments (mean SE 2.0 [PROMIS-PF], SE 2.1 [PROMIS-PI], and SE 1.2 [SMFA-DI], SE 1.8 [SMFA-BI]). Relative efficiency for PROMIS-PF versus SMFA-DI, and PROMIS-PI versus SMFA-BI was 7.8 (SD 2.5) and 4.1 (SD 1.7), respectively. Neither PROMIS nor SMFA exhibited floor/ceiling effects. In the multivariable regression analyses, elevated levels of depression, among other factors, showed an (independent) association with worse PROMIS-PF and PROMIS-PI scores. PROMIS-PF and PROMIS-PI CATs showed a (high and moderate) correlation with SMFA and hence measure a comparable construct of physical function and discomfort. As computerized adaptive tests are much more efficient to administer, they present a compelling alternative to SMFA for evaluating impact of fracture treatment. The relation between symptoms of depression and PROMIS scores emphasizes the importance of psychosocial aspects of health in orthopaedic trauma patients. Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.

Patient-reported barriers for adherence to prophylactic enoxaparin after orthopedic trauma surgery

Venous thromboembolism following orthopedic trauma surgery remains prevalent despite prophylaxis being a standard of care. Enoxaparin injection is a commonly utilized prophylaxis regimen among high-risk patients. Patient-reported rates of nonadherence and barriers to enoxaparin use are not described in the literature. A better understanding of these barriers and their impact on adherence to post-discharge prophylaxis regimens may shed light on persistent outcomes gaps. Semi-structured interviews were administered to adult patients prescribed prophylactic enoxaparin and presenting to orthopedic surgery outpatient clinic at an urban level 1 trauma center for a post-operative appointment following traumatic injury from April to July 2023. Patients self-reported their age, gender, race, and mobility. Inductive thematic analysis with three-reviewer consensus identified common barriers among responses. Adherence rates were calculated by dividing patients' estimated number of missed doses over total prescribed doses at the point of inquiry. We identified 154 eligible patients through chart review, and 50 enrolled and interviewed. Participants had a mean age of 37 years. Of 50 participants, 20 identified as female; 25 identified as Black or African American, 16 as White, 5 as Hispanic, 2 as Asian, and 2 as multiracial. Twenty-one participants were non-ambulatory at time of interview. Mean and median patient-reported adherence were 64.5 % (SD 35.5) and 70.5 % (IQR 33-100) respectively. Five patients reported complete nonadherence, while 17 patients reported perfect adherence. Every participant reporting complete nonadherence identified as Black or African American, as compared to 8 out of 17 reporting perfect adherence. Despite acknowledging a twice-daily prescription, 17 patients reported once-daily rather than twice-daily use. Inductive thematic analysis revealed the following six barriers to prophylaxis adherence (number of participants reporting): Inconvenience (18 patients), Pain (16), Fear (12), Acquisition (7), Bruising (7), and Mechanism (7). Altogether, 40 patients endorsed at least one barrier to adherence. Most patients face barriers to adherence with post-discharge prophylactic enoxaparin, and the resultant rates of adherence are low. This may contribute to persistent outcomes gaps in the orthopedic trauma population despite prophylaxis standards. Changes in prescribing patterns and patient engagement techniques may improve post-operative thromboembolic outcomes.

Assessment of somatosensory profiles by quantitative sensory testing in children and adolescents with and without cerebral palsy and chronic pain

We investigated differences in somatosensory profiles (SSPs) assessed by quantitative sensory testing in children and adolescents with cerebral palsy (CCP) with and without chronic pain and compared these differences to those in a group of typically developed children and adolescents (TDC) with and without chronic pain. All included subjects were consecutively recruited from and tested at the same outpatient orthopedic clinic by the same investigator. The subjects had their reaction times tested. The SSP consisted of the following tests: warmth (WDT), cool (CDT), mechanical (MDT), and vibration (VDT) detection thresholds; heat (HPT), pressure (PPT), and mechanical (MPT) pain thresholds; wind-up ratio (WUR); dynamic mechanical allodynia (DMA) and cold pressor test (CPT) using a conditioned pain modulation (CPM) paradigm. We included 25 CCP and 26 TDC. TDC without chronic pain served as controls. In TDC with chronic pain, WDT, HPT, HPT intensity, and PPT were higher than in controls. No differences in SSPs between CCP with and without chronic pain were observed. In CCP, the MDT, WDT, CDT, and HPT intensity were higher than in controls. CCP had longer reaction times than TDC. There were no differences regarding the remaining variables. In CCP, the SSPs were independent of pain status and findings on MR images. In all CCP the SSPs resembled TDC with chronic pain, compared to TDC without chronic pain. This suggests that CCP do not have the normal neuroplastic adaptive processes that activate and elicit functional changes in the central and peripheral nervous systems.

EFFICACY AND TOLERABILITY OF FLUPIRTINE MALEATE VERSUS DICLOFENAC IN MECHANICAL LOW BACK PAIN – A PROSPECTIVE COMPARATIVE STUDY

Objective: Low back pain (LBW) is one of the most common reasons for adults visiting orthopedic outpatient clinics in our country. The objective of the study was to compare the safety and efficacy of flupirtine, a selective neuronal potassium channel opener, with diclofenac, a widely used NSAIDs analgesic, in patients with mechanical LBW (MLBP). Methods: This prospective, open-labeled, and randomized comparative clinical study included 100 patients with MLBP for more than 6 weeks. Fifty patients received flupirtine 100 mg, and 50 patients received diclofenac 100 mg for 7 days. Follow-up was done on day 8 and day 30. Assessments of functional improvement by the Oswestry Disability Index (ODI), pain relief by the Visual Analog Scale (VAS), Numerical Rating Scale (NRS), and Pain Relief Rate (PRR) were recorded. Safety and tolerability were also assessed. Data were analyzed using the Chi-square and Paired student t-tests. Results: VAS, NRS, and ODI scores were assessed for each visit (0, 1, and 2), and PRR was assessed on visits 1 and 2. VAS (p&lt;0.05), NRS (p&lt;0.05) scores, and sustained effect after stoppage of the drug were found to be better in the flupirtine group compared to the diclofenac group. Flupirtine was well tolerated. More patients reported adverse events in diclofenac than in the flupirtine group. Conclusion: Flupirtine may have a superior sustained effect compared to diclofenac in MLBP.

Outcomes of a Novel Spine Virtual Fracture Clinic in an Australian Tertiary Hospital.

This was a retrospective cohort study. To determine the proportion of referrals diverted by the spine virtual fracture clinic (SVFC) from traditional outpatient clinic management. The consistent rise in demand for orthopedic outpatient clinic services is creating marked challenges to the provision of quality care. Virtual fracture clinics for upper and lower limb fractures have reduced the burden on outpatient clinics by providing an alternative telehealth management pathway. To date, no study describes the expansion of virtual care to the spine trauma population. A study of spine fractures referred to the RMH Department of Orthopaedic Surgery was conducted comparing outcomes before (January to December 2021) and following (July 2022 to November 2023) implementation of an SVFC. The primary aim of this study was to investigate the effect of a telephone-based SVFC on outpatient clinic activity, represented by the proportion of referrals discharged without requiring an outpatient clinic appointment. Secondary aims included appointment utilization, lost to follow-up rates, duration of care, missed or misdiagnoses, unplanned operations, and complications. Of the 731 referrals managed by the SVFC, 91.1% were discharged without requiring in-person outpatient clinic attendance. Compared with the outpatient clinic historical cohort (150 referrals), SVFC management was associated with reductions in the average number of consultations per referral (1.8 vs . 2.4, P <0.001), appointments not attended (5% vs . 13%, P <0.001), referrals lost to follow-up (0% vs . 10.7%, P <0.001), and a shorter duration of care (median 48 vs . 58d, P <0.001). A total of 65 patients (8.1%) were redirected to the outpatient clinic, of which three underwent surgical intervention. No diagnostic errors, complications or adverse events were identified. This study demonstrates that an SVFC is an effective and safe alternative pathway to traditional hospital-based outpatient clinics, ith low-risk for any adverse outcomes.

Preoperative spinal education for lumbar spinal stenosis: A feasibility study.

Lumbar spinal stenosis (LSS) is a leading cause of chronic musculoskeletal pain among older adults. A common and costly intervention for the treatment of LSS is lumbar decompression with or without fusion (LSS surgery), which has mixed outcomes among patients. Prehabilitation is a strategy designed to optimize the consistency of positive surgical outcomes and promote patient self-efficacy, while attempting to mitigate postoperative complications. No efforts have investigated the prehabilitation strategies specifically for patients undergoing LSS surgery. To determine the feasibility of delivery and acceptability by participants of a novel prehabilitation intervention for patients undergoing LSS surgery. Feasibility study. Outpatient orthopedic clinic at an academic medical center. Patients at least 50 years of age, who were scheduled for LSS surgery between October 2020 and October 2021. PreOperative Spinal Education for Lumbar Spinal Stenosis (POSE-LSS), is a novel multimodal, education-focused, time-efficient prehabilitation program for patients undergoing LSS surgery. Participants received the following: (1) Educational booklet and video; (2) In-person physical therapy (PT) session; and (3) Telemedicine visit with a physiatrist. The primary outcomes of interest were feasibility and acceptability of intervention by participants. Key potential surgical outcomes were length of stay and discharge disposition. POSE-LSS was completed by all eligible participants enrolled (n = 15) indicating feasibility and acceptability. Potential effectiveness measures including length of stay and discharge disposition were positively associated with the POSE-LSS intervention. This study demonstrates that a novel prehabilitation intervention is feasible, acceptable, and appears positively associated with important short-term measures of postoperative recovery that may impact the trajectory of patient care following LSS surgery.

Advanced Practice Physiotherapy in Canada: A Survey of Canadian Physiotherapists

Introduction: Advanced practice physiotherapy (APP) represents an important development for the physiotherapy profession worldwide but few studies have documented these models in Canada and the physiotherapists working in such models. The objective of this study was to identify and describe Canadian physiotherapists in APP roles and their models of care (MoC) and identify barriers and facilitators of APP development in Canada. Methodology: An electronic survey was sent to Canadian physiotherapists with the collaboration of various professional organisations. The questionnaire included 37 questions about APP roles and MoC. Results: Fifty-seven physiotherapists identified themselves as APPs and completed the survey. Most practiced in private clinics (58.1%) or outpatient orthopaedic clinics (27.9%) and provided care to adults (95.3%) with orthopaedics disorders (86.0%). Most APPs were involved in first-contact and leading overall care (52.3%) or triage roles where they identify surgical candidates (68.2%). APPs mentioned their roles were established to improve care efficiency (82.1%) and were viewed positively by medical teams (76.9%) and patients (76.9%). Professional regulations (32.4%) and funding of roles and models (24.3%) were identified as barriers. Conclusions: Results of this study provide new original data regarding APP practice and MoC in Canada, acknowledging the various APP MoC and roles of respondents.