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Murphy MC, French H, McCarthy G, Cunningham C. Informing low back pain care from the ground up: Survey of national musculoskeletal triage physiotherapists in Ireland. Musculoskelet Sci Pract 2024; 72:103101. [PMID: 38851176 DOI: 10.1016/j.msksp.2024.103101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 05/08/2024] [Accepted: 06/04/2024] [Indexed: 06/10/2024]
Abstract
BACKGROUND Healthcare is changing to meet the challenge of a rising musculoskeletal burden associated with the expanding, aging population. Clinicians, important stakeholders in healthcare provision, have crucial insights into service improvement, but clinician consultation is a shortcoming in healthcare development. In Ireland, specialist physiotherapist-led musculoskeletal (MSK) triage services operate at the primary-secondary care interface to expedite patient care. OBJECTIVES To inform future development of low back pain (LBP) care in Ireland through profiling the operationalisation of the national MSK triage service for LBP, including access, referral management, clinical investigations, onward referral options, access to multidisciplinary team (MDT) services and integration with primary healthcare services. DESIGN Cross-sectional observational study using a bespoke, anonymous electronic survey. PARTICIPANTS Thirty-eight clinical specialist physiotherapists working in national programme Irish MSK triage services. RESULTS Thirty-eight MSK Triage physiotherapists submitted responses (response rate 72%). There was considerable site-dependent variation in LBP service provision, with discrepancies in access to triage services, wait times, referral processing and prioritisation, access to clinical investigations and onward referral options. Most respondents (81%) reported wait times exceeding the three-month target; 75% reported that the level of clinical autonomy associated with their role limited service efficiency; 75% were dissatisfied with primary-secondary care service integration. Respondents identified insufficient availability of primary care multidisciplinary services. CONCLUSION Lack of standardisation of LBP services exists in Ireland. Services would benefit from improved standardisation, reduced wait times, national accreditation and a defined scope of advanced physiotherapy practice and the development of nationwide community multidisciplinary infrastructure with enhanced interservice communication.
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Affiliation(s)
- Ms Cathriona Murphy
- Physiotherapy Department, University Hospital Kerry, Tralee, Co. Kerry, Ireland.
| | - Helen French
- School of Physiotherapy, Royal College of Surgeons in Ireland, Dublin, Ireland.
| | - Geraldine McCarthy
- School of Medicine, University College Dublin, Ireland; Department of Rheumatology, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Caitriona Cunningham
- School of Public Health, Physiotherapy and Sports Science, University College Dublin, Ireland.
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Marotte L, Marsaa H, Robin N, Sellier A, Beucler N, Thefenne L, Dagain A, Joubert C. Neurosurgical Consultation Referral from the Forces: Regarding 328 Patients Referred to the Department of Neurosurgery, Sainte Anne Military Hospital, France. Mil Med 2024; 189:1114-1122. [PMID: 37032562 DOI: 10.1093/milmed/usad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2022] [Revised: 10/13/2022] [Accepted: 03/15/2023] [Indexed: 04/11/2023] Open
Abstract
INTRODUCTION There are little data regarding elective referral to the military specialist, especially considering common pathologies such as spinal diseases, which, in the French forces, involve military neurosurgeons. An overview of the management of the military patient referred to neurosurgery consultation, especially considering spinal diseases that both constitute an operational healthissue in the forces and appear of special interest. The objective was to describe the reasons, demographics, and care pathways, addressed to the neurosurgeon. MATERIALS AND METHODS This retrospective, single-center study focused on all military patients referred for neurosurgery consultation at Sainte Anne Military Hospital in Toulon. Extracted data included demographic characteristics, army, unit, military specialty, the reason for referral, the diagnosis by the neurosurgeon, treatment, and outcome. RESULTS From January 2018 to December 2019, 352 patients were referred for neurosurgical consultation by the unit general practitioner. Spinal disease (n = 297, 91%) was the most frequent reason. Lumbar degenerative disk disease accounted for 20% of consultations, regardless of the patient's unit or specialty. Most of the patients seen in consultation received nonsurgical management (n = 271, 82.6%). These patients mainly presented with cervical or lumbar degenerative disk disease (n = 99, 36.5%) or cervical or lumbar herniated discs (n = 57, 21.0%). Ninety-eight patients (29.9%) were referred exclusively for medical fitness assessment. Few patients experienced full resolution of their presenting complaint after management (n = 9, 2.8%). CONCLUSIONS This descriptive study demonstrates the predominance of degenerative spinal diseases in military patients referred to neurosurgery. It reflects the importance of the medical and military competence required to maintain operational capability upstream and downstream of war traumatology. The description of the care pathways invites us to define more proactive multidisciplinary pathways for the management of these diseases in the armed forces.
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Affiliation(s)
- Louis Marotte
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris 75005, France
| | - Hélène Marsaa
- Antenne médicale 148, 9e Centre Médical des Armées, Hyères 83400, France
| | - Nicolas Robin
- Service Médical de la Force d'Action Navale, Toulon 83000, France
| | - Aurore Sellier
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
| | - Nathan Beucler
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
| | - Laurent Thefenne
- Department of Rehabilitation, Laveran Military Hospital, Marseille 13384, France
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris 75005, France
| | - Arnaud Dagain
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
- French Military Health Service Academy, Ecole du Val-de-Grace, Paris 75005, France
| | - Christophe Joubert
- Department of neurosurgery, Sainte Anne Military Hospital, Toulon 83800, France
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Strayer AL, King BJ. Older Adults' Experiences Living With and Having Spine Surgery for Degenerative Spine Disease. THE GERONTOLOGIST 2023; 63:1201-1210. [PMID: 36516467 PMCID: PMC10448989 DOI: 10.1093/geront/gnac184] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Globally, older adults are undergoing spine surgery for degenerative spine disease at exponential rates. However, little is known about their experiences of living with and having surgery for this debilitating condition. This study investigated older adults' understanding and experiences of living with and having surgery for degenerative spine disease. RESEARCH DESIGN AND METHODS Qualitative methods, grounded theory, guided the study. Fourteen older adults (≥65 years) were recruited for in-depth interviews at 2 time-points: T1 during hospitalization and T2, 1-3-months postdischarge. A total of 28 interviews were conducted. Consistent with grounded theory, purposive, and theoretical sampling were used. Data analysis included open, axial, and selective coding. RESULTS A conceptual model was developed illustrating the process older adults with degenerative spine disease experience, trying to get their life back. Three key categories were identified (1) Losing Me, (2) Fixing Me, and (3) Recovering Me. Losing Me was described as a prolonged process of losing functional independence and the ability to socialize. Fixing Me consisted of preparing for surgery and recovery. Recovering Me involved monitoring progression and reclaiming their personhood. Conditions, including setbacks and delays, slowed their trajectory. Throughout, participants continually adjusted expectations. DISCUSSION AND IMPLICATIONS The conceptual model, based on real patient experiences, details how older adults living with and having surgery for degenerative spine disease engage in recovering who they were prior to the onset of symptoms. Our findings provide a framework for understanding a complex, protracted trajectory that involves transitions from health to illness working toward health again.
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Affiliation(s)
- Andrea L Strayer
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
- College of Nursing, University of Iowa, Iowa City, Iowa, USA
| | - Barbara J King
- School of Nursing, University of Wisconsin-Madison, Madison, Wisconsin, USA
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Naidu I, Ryvlin J, Videlefsky D, Qin J, Mowrey WB, Choi JH, Citron C, Gary J, Benton JA, Weiss BT, Longo M, Matmati NN, De la Garza Ramos R, Krystal J, Echt M, Gelfand Y, Cezayirli P, Yassari N, Wang B, Castro-Rivas E, Headlam M, Udemba A, Williams L, Gitkind AI, Yassari R, Yanamadala V. The Effect of a Multidisciplinary Spine Clinic on Time to Care in Patients with Chronic Back and/or Leg Pain: A Propensity Score-Matched Analysis. J Clin Med 2022; 11:2583. [PMID: 35566709 PMCID: PMC9103560 DOI: 10.3390/jcm11092583] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 02/04/2023] Open
Abstract
Chronic back and leg pain are leading causes of disability worldwide. The purpose of this study was to compare the care in a unidisciplinary (USC) versus multidisciplinary (MSC) spine clinic, where patients are evaluated by different specialists during the same office visit. Adult patients presenting with a chief complaint of back and/or leg pain between June 2018 and July 2019 were assessed for eligibility. The main outcome measures included the first treatment recommendations, the time to treatment order, and the time to treatment occurrence. A 1:1 propensity score-matched analysis was performed on 874 patients (437 in each group). For all patients, the most common recommendation was physical therapy (41.4%), followed by injection (14.6%), and surgery (9.7%). Patients seen in the MSC were more likely to be recommended injection (p < 0.001) and less likely to be recommended surgery as first treatment (p = 0.001). They also had significantly shorter times to the injection order (log-rank test, p = 0.004) and the injection occurrence (log-rank test, p < 0.001). In this study, more efficient care for patients with back and/or leg pain was delivered in the MSC setting, which was evidenced by the shorter times to the injection order and occurrence. The impact of the MSC approach on patient satisfaction and health-related quality-of-life outcome measures warrants further investigation.
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Affiliation(s)
- Ishan Naidu
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Jessica Ryvlin
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Devin Videlefsky
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Jiyue Qin
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA; (J.Q.); (W.B.M.)
| | - Wenzhu B. Mowrey
- Department of Epidemiology and Public Health, Albert Einstein College of Medicine, New York, NY 10461, USA; (J.Q.); (W.B.M.)
| | - Jong H. Choi
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Chloe Citron
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - James Gary
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Joshua A. Benton
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Brandon T. Weiss
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Michael Longo
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Nabil N. Matmati
- School of Medicine, Quinnipiac University, North Haven, CT 06518, USA;
| | - Rafael De la Garza Ramos
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Jonathan Krystal
- Department of Orthopaedic Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA;
| | - Murray Echt
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Yaroslav Gelfand
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Phillip Cezayirli
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Neeky Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Benjamin Wang
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
| | - Erida Castro-Rivas
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Mark Headlam
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Adaobi Udemba
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Lavinia Williams
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Andrew I. Gitkind
- Department of Rehabilitation Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA;
| | - Reza Yassari
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
| | - Vijay Yanamadala
- Spine Research Group, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (I.N.); (J.R.); (D.V.); (J.H.C.); (C.C.); (J.G.); (B.T.W.); (M.L.); (R.D.l.G.R.); (M.E.); (Y.G.); (P.C.); (N.Y.); (B.W.); (R.Y.)
- Department of Neurological Surgery, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY 10467, USA; (J.A.B.); (E.C.-R.); (M.H.); (A.U.); (L.W.)
- Hartford HealthCare, Westport, CT 06880, USA
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