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He Y, Gao J, Liu Y, Qian J. Global trends and hotspots related to whiplash injury: A visualization study. Medicine (Baltimore) 2024; 103:e38777. [PMID: 39029013 DOI: 10.1097/md.0000000000038777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/21/2024] Open
Abstract
Whiplash injury, commonly occurring as a result of car accidents, represents a significant public health concern. However, to date, no comprehensive study has utilized bibliometric approaches to analyze all published research on whiplash injury. Therefore, our study aims to provide an overview of current trends and the global research landscape using bibliometrics and visualization software. We performed a bibliometric analysis of the data retrieved and extracted from the Web of Science Core Collection database in whiplash injury research up to December 31, 2022. Research articles were assessed for specific characteristics, such as year of publication, country/region, institution, author, journal, field of study, references, and keywords. We identified 1751 research articles in the analysis and observed a gradual growth in the number of publications and references. The United States (379 articles, 21.64%), Canada (309 articles, 17.65%), and Australia (280 articles, 16.00%) emerged as the top-contributing countries/regions. Among institutions, the University of Queensland (169 articles, 9.65%) and the University of Alberta (106 articles, 6.05%) demonstrated the highest productivity. "Whiplash," "Neck Pain," "Cervical Spine Disease," and "Whiplash-associated Disorders" are high-frequency keywords. Furthermore, emerging areas of research interest included traumatic brain injury and mental health issues following whiplash injury. The number of papers and citations has increased significantly over the past 2 decades. Whiplash injury research is characteristically multidisciplinary in approach, involving the fields of rehabilitation, neuroscience, and spinal disciplines. By identifying current research trends, our study offers valuable insights to guide future research endeavors in this field.
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Affiliation(s)
- Yaqi He
- School of Sports Medicine and Rehabilitation, Beijing Sport University, Beijing, China
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Dlott CC, Metcalfe T, Khunte A, Jain S, Bahel A, Hsiang WR, Donnelley CA, Kayani J, Wiznia DH. Evaluating musculoskeletal urgent care center triage and transfer of emergency conditions for emergency surgical assessment and intervention. Medicine (Baltimore) 2022; 101:e32519. [PMID: 36595864 PMCID: PMC9794202 DOI: 10.1097/md.0000000000032519] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
Musculoskeletal urgent care centers (MUCCs) are an alternative to emergency departments (EDs) for patients to seek care for low acuity orthopedic injuries such as ankle sprains or joint pain, but are not equipped to manage orthopedic emergencies that require a higher level of care provided in the ED. This study aims to evaluate telephone and online triage practices as well as ED transfer procedures for MUCCs for patients presenting with an orthopedic condition requiring urgent surgical intervention. We called 595 MUCCs using a standardized script presenting as a critical patient with symptoms of lower extremity compartment syndrome. We compared direct ED referral frequency and triage frequency for MUCCs for patients insured by either Medicaid or by private insurance. We found that patients presenting with an apparent compartment syndrome were directly referred to the ED by < 1 in 5 MUCCs. Additionally, < 5% of patients were asked additional triage questions that would increase clinician suspicion for compartment syndrome and allow MUCCs to appropriately direct patients to the ED. MUCCs provide limited telephone and online triage for patients, which may result in delays of care for life or limb threatening injuries that require ED resources such as sedation, reductions, and emergency surgery. However, when MUCCs did conduct triage, it significantly increased the likelihood that patients were appropriately referred to the ED. Level of Evidence: Level II, prognostic study.
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Affiliation(s)
- Chloe C. Dlott
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
- * Correspondence: Chloe C. Dlott, Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, 800 Howard Avenue, New Haven, CT 06519, United States (e-mail: )
| | - Tanner Metcalfe
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Akshay Khunte
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Sanjana Jain
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Anchal Bahel
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Walter R. Hsiang
- University of California San Francisco, Department of Urology, San Francisco, CA, United States
| | - Claire A. Donnelley
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Jehanzeb Kayani
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
| | - Daniel H. Wiznia
- Yale University School of Medicine, Department of Orthopaedics & Rehabilitation, New Haven, CT, United States
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Dlott CC, Wiznia DH. CORR Synthesis: What Triage Recommendations Are Available for Emergent or Urgent Musculoskeletal Conditions? Clin Orthop Relat Res 2022; 480:1980-1988. [PMID: 35901435 PMCID: PMC9473775 DOI: 10.1097/corr.0000000000002312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2022] [Accepted: 06/15/2022] [Indexed: 02/04/2023]
Affiliation(s)
- Chloe C. Dlott
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
| | - Daniel H. Wiznia
- Department of Orthopaedics and Rehabilitation, Yale School of Medicine, New Haven, CT, USA
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Use of Soft Cervical Collar among Whiplash Patients in Two Italian Emergency Departments Is Associated with Persistence of Symptoms: A Propensity Score Matching Analysis. Healthcare (Basel) 2021; 9:healthcare9101363. [PMID: 34683043 PMCID: PMC8544415 DOI: 10.3390/healthcare9101363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2021] [Revised: 10/05/2021] [Accepted: 10/07/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose: Although the use of soft cervical collars in the emergency department (ED), for whiplash-associated disorders (WAD), is controversial, it is still widely adopted. The purpose of our study was to investigate the impact of the early use of soft cervical collars on the return to the ED, within three months of a road traffic collision. Methods: We conducted a retrospective observational study on WAD patients from two EDs in Verona (Italy). Patients in the earlier acute phase of WAD (within 48 h from the trauma) were included; those with serious conditions (WAD IV) were excluded. As an end point, we considered patients who returned to the ED complaining of WAD symptoms within three months as positive outcome for WAD persistence. Results: 2162 patients were included; of those, 85.4% (n = 1847/2162) received a soft cervical collar prescription. Further, 8.4% (n = 156/1847) of those with a soft cervical collar prescription, and 2.5% (n = 8/315) of those without a soft cervical collar (p < 0.001) returned to the ED within three months. The use of the soft cervical collar was an independent risk factor for ED return within three months, with an OR, adjusted for possible clinical confounders, equal to 3.418 (95% CI 1.653–7.069; p < 0.001). After the propensity score matching, 25.5% of the patients (n = 25/98) using the soft cervical collar returned to the ED at three months, compared to the 6.1% (n = 6/98) that did not adopt the soft cervical collar. The use of a soft cervical collar was associated with ED return with an OR = 4.314 (95% CI 2.066–11.668; p = 0.001). Conclusions: Our study shows that the positioning of the soft collar in a cohort of patients with acute WAD, following a rear-end car collision, is an independent potential risk factor to the return to the ED. Clinically, the use of the collar is a non-recommended practice and seems to be related to an increased risk of delayed recovery. There is a need to inform healthcare providers involved in the ED of the aim to limit the use of the soft cervical collar. A closer collaboration between clinicians (e.g., physicians, physical therapists, nurses) is suggested in the ED. Future primary studies should determine differences between having used or not having used the collar, and compare early physical therapy in the ED compared with the utilization of the collar.
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Mourad F, Lopez G, Cataldi F, Maselli F, Pellicciari L, Salomon M, Kranenburg H, Kerry R, Taylor A, Hutting N. Assessing Cranial Nerves in Physical Therapy Practice: Findings from a Cross-Sectional Survey and Implication for Clinical Practice. Healthcare (Basel) 2021; 9:1262. [PMID: 34682942 PMCID: PMC8535196 DOI: 10.3390/healthcare9101262] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2021] [Revised: 09/14/2021] [Accepted: 09/17/2021] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND AND OBJECTIVE Serious pathologies of the neck can potentially result in cranial nerve palsy. Knowledge about cranial nerve examination (CNE) seems sparse, and its use is still unknown. We aim to investigate the knowledge, skills, and utilization of CNE of Italian physiotherapists. MATERIALS AND METHODS An online cross-sectional survey. RESULTS 396 completed the survey, reaching the required sample size. Although Italian physiotherapists consider CNE relevant (mean ± SD = 7.6/10 ± 2.0), over half of all responders (n = 229 (57.8%)) were not trained in the fundamentals and around a third did not use it in their daily practice (n = 138 (34.8%)). Additionally, participants were unconfident and insecure in conducting (n = 152 (38.4%) and n = 147 (37.1%)), interpreting (n = 140 (35.4%) and n = 164 (41.4%)), and managing the CNE (n = 141 (35.6%) and n = 154 (38.9%)). Possessing a musculoskeletal specialization was associated with an increased value attributed to clinical practice guidelines and reduced the lack of confidence in conducting, interpreting, and managing the CNE (respectively, n = 35 (25.5%), p = 0.0001; n = 32 (23.4%) p = 0.0002; n = 32 (23.4%) p = 0.0002). Working in a direct access setting significantly increased the considered relevance of guidelines and the concerns about arterial (p = 0.004) and other serious pathologies (p = 0.021). Pain and visual disturbances were considered the main indicators to CNE, demonstrating limited knowledge of signs and symptoms' indicating CNE. Participants considered specific training in CNE as relevant (mean ± SD = 7.6/10 = 2.1). CONCLUSIONS a substantial proportion of Italian physiotherapists are not schooled in the fundamentals of cranial nerve examination. Given the number of physiotherapists who work in first contact roles, this is a professional concern.
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Affiliation(s)
- Firas Mourad
- Department of Physiotherapy, LUNEX International University of Health, Exercise and Sports, 4671 Differdange, Luxembourg;
- Luxembourg Health & Sport Sciences Research Institute A.s.b.l., 50, Avenue du Parc des Sports, 4671 Differdange, Luxembourg
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
| | - Giovanni Lopez
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physiotherapy, Kinesis, 70126 Bari, Italy
| | - Fabio Cataldi
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physiotherapy, Manual Therapy Laboratory—MTLab, 70123 Bari, Italy
| | - Filippo Maselli
- Sovrintendenza Sanitaria Regionale Puglia INAIL, 70126 Bari, Italy
- Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), Campus of Savona, University of Genova, 16132 Savona, Italy
| | | | - Mattia Salomon
- Department of Clinical Science and Translation Medicine, Faculty of Medicine and Surgery, University of Rome Tor Vergata, 00133 Roma, Italy; (G.L.); (F.C.); (M.S.)
- Department of Physical Therapy, Centro Diagnostico e Polispecialistico CST S.r.l., 38121 Trento, Italy
| | - Hendrikus Kranenburg
- Research Group Healthy Ageing, Allied Health Care and Nursing, Hanze University of Applied Sciences, 9714 CE Groningen, The Netherlands;
| | - Roger Kerry
- Division of Physiotherapy and Sport Rehabilitation, School of Health Sciences, Faculty of Medicine and Health Sciences, Nottingham University, Nottingham NG5 1PB, UK; (R.K.); (A.T.)
| | - Alan Taylor
- Division of Physiotherapy and Sport Rehabilitation, School of Health Sciences, Faculty of Medicine and Health Sciences, Nottingham University, Nottingham NG5 1PB, UK; (R.K.); (A.T.)
| | - Nathan Hutting
- Department of Occupation and Health, School of Organisation and Development, HAN University of Applied Sciences, 6503 GL Nijmegen, The Netherlands;
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Mourad F, Patuzzo A, Tenci A, Turcato G, Faletra A, Valdifiori G, Gobbo M, Maselli F, Milano G. Management of whiplash-associated disorder in the Italian emergency department: the feasibility of an evidence-based continuous professional development course provided by physiotherapists. Disabil Rehabil 2020; 44:2123-2130. [PMID: 32853029 DOI: 10.1080/09638288.2020.1806936] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
PURPOSE The management of whiplash and associated disorders (WAD) in the Italian Health System is still empirical and influenced by a single professional's expertise. Therefore, the purpose of our study is to describe a structured management changes in an Italian emergency department (ED) after an evidence based continuous professional development (CPD) course. METHODS A CPD course was organized by Orthopedic Manipulative Physical Therapists (OMPT) for personnel of ED in the hospital Girolamo Fracastoro (San Bonifacio, Verona, Italy), based on latest scientific evidence. Data regarding the number of X-Rays, computed tomography (CT) scan, orthopaedic referrals, neck collars and WAD IV (i.e., severe diagnosis) before and after the course were compared. RESULTS 3066 cases of WAD have been analyzed in 2016 and 2185 in 2017/2018. The number of X-Rays dropped down from 15.1% to 13.5%; the CT scans increased from 1.3% to 1.9%; the WAD IV diagnosis increased from 0.7% to 1.6%; the orthopaedic referrals dropped from 1.5% to 1.1%; the collars prescription dropped from 8.8% to 2.5%. CONCLUSION An updated framework increased the efficiency of ED's maintaining the same level of safety (i.e., WAD IV diagnosis). Given that, it can also be argued that, in line with other countries, the implementation of an OMPT role within the ED multidisciplinary team is advised also in Italy.Implications for rehabilitationPhysiotherapists were commissioned to organize a management change of patients in an Italian Emergency Department clinical setting for the management of whiplash;Guidelines and other appropriate clinical rules facilitate the delivery of an evidence-based and more appropriate management and care plan;An inter-disciplinary continuous professional development course has the potential to positively influence patients' journey and to optimize the use of departmental resources;The involvement of other health professionals (e.g., Physiotherapists) within the Italian Emergency Department organizational chart might lead to further improvement of service provided.
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Affiliation(s)
| | | | - Andrea Tenci
- Emergency Department, Ospedale "Girolamo Fracastoro", S. Bonifacio (VR). Aulss 9 "Scaligera" della Regione Veneto, Veneto, Italy
| | - Gianni Turcato
- Emergency Department, Ospedale Franz Tappeiner Merano, Bolzano, Italy
| | | | | | - Massimiliano Gobbo
- Department of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy
| | - Filippo Maselli
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Campus of Savona, University of Genoa, Savona, Italy.,Sovrintendenza Sanitaria Regionale Puglia INAIL, Bari, Italy
| | - Giuseppe Milano
- Department of Bone and Joint Surgery, Spedali Civili, Brescia, Italy
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Elliott JM, Smith AC, Hoggarth MA, Albin SR, Weber KA, Haager M, Fundaun J, Wasielewski M, Courtney DM, Parrish TB. Muscle fat infiltration following whiplash: A computed tomography and magnetic resonance imaging comparison. PLoS One 2020; 15:e0234061. [PMID: 32484835 PMCID: PMC7266316 DOI: 10.1371/journal.pone.0234061] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 05/18/2020] [Indexed: 01/17/2023] Open
Abstract
Here we present a secondary analysis from a parent database of 97 acutely injured participants enrolled in a prospective inception cohort study of whiplash recovery after motor vehicle collision (MVC). The purpose was to investigate the deep and superficial neck extensor muscles with peri-traumatic computed tomography (CT) and longitudinal measures of magnetic resonance imaging (MRI) in participants with varying levels of whiplash-related disability. Thirty-six underwent standard care imaging of the cervical spine with CT at a level-1 trauma designated emergency department. All 36 participants were assessed with MRI of the cervical spine at <1-week, 2-weeks, 3-, and 12-months post-injury and classified into three groups using initial pain severity and percentage scores on the Neck Disability Index (recovered (NDI of 0–8%), mild (NDI of 10–28%), or severe (NDI ≥ 30%)) at 3-months post MVC. CT muscle attenuation values were significantly correlated to muscle fat infiltration (MFI) on MRI at one-week post MVC. There was no significant difference in muscle attenuation across groups at the time of enrollment. A trend of lower muscle attenuation in the deep compared to the superficial extensors was observed in the severe group. MFI values in the deep muscles on MRI were significantly higher in the severe group when compared to the mild group at 1-year post MVC. This study provides further evidence that the magnitude of 1) deep MFI appears unique to those at risk of and eventually transitioning to chronic WAD and that 2) pre- or peri-traumatic muscular health, determined by CT muscle attenuation, may be contribute to our understanding of long-term recovery.
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Affiliation(s)
- James M. Elliott
- Discipline of Physiotherapy, Faculty of Medicine and Health, The University of Sydney, & The Northern Sydney Local Health District, The Kolling Research Institute, St. Leonards, New South Wales, Australia
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- * E-mail:
| | - Andrew C. Smith
- School of Physical Therapy, Regis University, Denver, CO, United States of America
| | - Mark A. Hoggarth
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
- Department of Biomedical Engineering, Northwestern University, Evanston, Illinois, United States of America
| | - Stephanie R. Albin
- School of Physical Therapy, Regis University, Denver, CO, United States of America
| | - Ken A. Weber
- Department of Anesthesiology, Perioperative and Pain Medicine, Systems Neuroscience and Pain Lab, Stanford University, Palo Alto, California, United States of America
| | - Mat Haager
- School of Physical Therapy, Regis University, Denver, CO, United States of America
| | - Joel Fundaun
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - D. Mark Courtney
- Department of Emergency Medicine Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
| | - Todd B. Parrish
- Department of Anesthesiology, Perioperative and Pain Medicine, Systems Neuroscience and Pain Lab, Stanford University, Palo Alto, California, United States of America
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, United States of America
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Rydman E, Ottosson C, Ponzer S, Dahl A, Eneqvist T, Järnbert-Pettersson H, Kasina P. Intervention with an educational video after a whiplash trauma - a randomised controlled clinical trial. Scand J Pain 2020; 20:273-281. [PMID: 31747385 DOI: 10.1515/sjpain-2019-0097] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Accepted: 10/15/2019] [Indexed: 11/15/2022]
Abstract
Background and aims Previous systematic reviews have considered that providing patient information is ineffective for patients with whiplash-associated disorders (WAD), with the exception of interventional educational videos. The aim of this randomised controlled clinical trial was to determine if use of an educational video as an intervention in the acute stage after a whiplash injury might improve self-reported recovery at 6 months after the injury. Methods In total, 289 consecutive patients with a whiplash injury following a motor vehicle collision were randomised to an intervention group (educational video) or to a control group (written information sheet). The video focused on information about pain mechanisms, deep flexor physiotherapy and reassurance. Emailed questionnaires were used to collect baseline data within 2 weeks after the accident and then to collect outcome data at 6 months post-injury. Non-responders were followed up with a brief telephone interview regarding the outcome. The primary outcome measure was self-reported recovery (yes/no) at 6 months post-injury. The secondary outcomes measures were pain level according to a numeric rating scale (NRS) and the whiplash disability questionnaire (WDQ) score at the same time point. Results The response rate for the baseline questionnaire was 70% (203/289). The follow-up rate was 97% (196/203). The non-recovery rates were similar between the intervention group, at 37.9% (39/103), and the control group, at 33.3% (31/93) (p = 0.55). No differences between the groups were noted in pain levels, NRS scores (1.9 vs. 2.2, p = 0.35) or the mean WDQ scores (17.5 vs. 21.2, p = 0.42). Conclusions The intervention with the educational video used in this study had no effect on the non-recovery rate when compared to a basic written information sheet. Implications The results of this trial add knowledge to the area of patient education for patients with acute WAD. Further studies are needed before the current recommendations for patient information are modified.
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Affiliation(s)
- Eric Rydman
- Department of Orthopedics, Södersjukhuset, SE-118 83 Stockholm, Sweden.,Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Carin Ottosson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Sari Ponzer
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Anna Dahl
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Ted Eneqvist
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Hans Järnbert-Pettersson
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
| | - Piotr Kasina
- Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden
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Strudwick K, Russell T, Bell AJ, Chatfield MD, Martin-Khan M. Musculoskeletal injury quality outcome indicators for the emergency department. Intern Emerg Med 2020; 15:501-514. [PMID: 31773561 DOI: 10.1007/s11739-019-02234-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/18/2019] [Accepted: 11/09/2019] [Indexed: 12/26/2022]
Abstract
High standards of care for musculoskeletal injuries presenting to emergency departments (ED) must be maintained despite financial constraints, the model of care in place, or the pressure to reach time-based performance measures. Outcome quality indicators (QIs) provide a tangible way of assessing and improving the outcomes of health-care delivery. This study aimed to develop a set of outcome QIs for musculoskeletal injuries in the ED that are meaningful, valid, feasible to collect, simple to use for clinical quality improvement and chosen by experts in the field. The study used a multi-phase mixed methods design, commencing with a systematic review of available outcome QIs. An expert panel then developed a set of preliminary QIs based on the available scientific evidence. Prospective observational data collection was undertaken across eight EDs with subsequent retrospective chart audits, follow-up phone calls and audit of administrative databases. After statistical analysis, validated results were presented to the expert panel who discussed, refined and formally voted on a final outcome QI set. A total of 41 preliminary outcome QIs were field tested in EDs, with data collected on 633 patients. Using the field study results, the expert panel voted 11 outcome QIs into the final set. These covered effectiveness of pain management, timeliness to discharge, re-presentations to the ED and unplanned visits to health professionals in the community, missed injuries, opioids side effects and the patient experience. An evidence-based set of outcome quality indicators is now available to support clinical quality improvement of musculoskeletal injury care in the ED setting.
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Affiliation(s)
- Kirsten Strudwick
- Emergency and Physiotherapy Departments, QEII Jubilee Hospital, Metro South Health, Brisbane, QLD, Australia.
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia.
| | - Trevor Russell
- Division of Physiotherapy, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, QLD, Australia
| | - Anthony J Bell
- Uniting Care Health, The Wesley Hospital, Brisbane, QLD, Australia
- Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Mark D Chatfield
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, QLD, Australia
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Huang JF, Wu QN, Zheng XQ, Sun XL, Wu CY, Wang XB, Wu CW, Wang B, Wang XY, Bergman M, Wu AM. The Characteristics and Mortality of Osteoporosis, Osteomyelitis, or Rheumatoid Arthritis in the Diabetes Population: A Retrospective Study. Int J Endocrinol 2020; 2020:8821978. [PMID: 33224196 PMCID: PMC7669351 DOI: 10.1155/2020/8821978] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2020] [Revised: 09/05/2020] [Accepted: 10/22/2020] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Patients with diabetes mellitus are prone to develop osteoporosis, osteomyelitis, or rheumatoid arthritis (RA). Furthermore, the presence of these complications in those with diabetes may lead to higher mortality. The aim of our study was to assess characteristics and mortality of osteoporosis, osteomyelitis, or rheumatoid arthritis in individuals with diabetes. METHODS We analyzed osteoporosis, osteomyelitis, and RA deaths associated with diabetes from 1999-2017 using the CDC WONDER system (CDC WONDER; https://wonder.cdc.gov). We used ICD-10 codes to categorize the underlying and contributing causes of death. Crude mortality rates (CMR) and age-adjusted mortality rates (AAMR) per 1,000,000 person-years were calculated. RESULTS The AAMR for osteoporosis in the population with diabetes was significantly higher in females (AAMR: 4.17, 95% CI: 4.10-4.24) than in males (AAMR: 1.12, 95% CI: 1.07-1.16). Deaths due to osteoporosis increased gradually from 1999, peaked in 2003 (AAMR: 3.78, 95% CI: 3.55-4.00), and reached a nadir in 2016 (AAMR: 2.32, 95% CI: 2.15-2.48). The AAMR for RA associated with diabetes was slightly higher in females (AAMR: 4.04, 95% CI: 3.98-4.11) than in males (AAMR: 2.45, 95% CI: 2.39-2.51). The mortality rate due to RA increased slightly from 1999 (AAMR: 3.18, 95% CI: 2.97-3.39) to 2017 (AAMR: 3.20, 95% CI: 3.02-3.38). The AAMR for osteomyelitis associated with diabetes was higher in males (AAMR: 4.36, 95% CI: 4.28-4.44) than in females (AAMR: 2.31, 95% CI: 2.26-2.36). From 1999 to 2017, the AAMR from osteomyelitis in this population was 2.63 (95% CI: 2.44-2.82) per 1,000,000 person-years in 1999 and 4.25 (95% CI: 4.05-4.46) per 1,000,000 person-years in 2017. CONCLUSIONS We found an increase in the age-adjusted mortality rates of RA and osteomyelitis and a decrease of osteoporosis associated with diabetes from 1999 to 2017. We suggest that increased attention should therefore be given to these diseases in the population with diabetes, especially in efforts to develop preventative and treatment strategies.
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Affiliation(s)
- Jin-Feng Huang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Qi-Nan Wu
- Endocrinology and Nephrology Department, Chongqing University Cancer Hospital and Chongqing Cancer Institute and Chongqing Cancer Hospital, Chongqing, China
| | - Xuan-Qi Zheng
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiao-Lei Sun
- Department of Orthopaedics, Tianjin Hospital, Tianjin 300210, China
| | - Chen-Yu Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Xiao-Bing Wang
- Department of Rheumatology, The First Affiliated Hospital of Wenzhou Medical University, Wenzhou, China
| | - Chen-Wei Wu
- Diabetes Center and Department of Endocrinology, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, China
| | - Bin Wang
- Department of Sports Medicine and Adult Reconstruction Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing 210009, China
| | - Xiang-Yang Wang
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
| | - Michael Bergman
- NYU Grossman School of Medicine, NYU Langone Diabetes Prevention Program, New York, NY 10016, USA
| | - Ai-Min Wu
- Department of Orthopaedics, The Second Affiliated Hospital and Yuying Children's Hospital of Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
- The Second School of Medicine, Wenzhou Medical University, Wenzhou, Zhejiang 325027, China
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11
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Zheng H, Lü ZG, Hu WC, Jing W, Li H, Hou WL. Clinical study on tuina for acute cervical radiculopathy. JOURNAL OF ACUPUNCTURE AND TUINA SCIENCE 2019. [DOI: 10.1007/s11726-019-1147-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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12
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Concussion in Combination With Whiplash-Associated Disorder May Be Missed in Primary Care: Key Recommendations for Assessment and Management. J Orthop Sports Phys Ther 2019; 49:819-828. [PMID: 31610758 DOI: 10.2519/jospt.2019.8946] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Whiplash and concussion may have similar presenting symptoms, biomechanical mechanisms, and neurophysiological sequelae, but neither enjoys a gold standard diagnostic test. Guidelines for whiplash and concussion are developed and implemented separately. This disparate process may contribute to misdiagnosis, delay appropriate primary care management, and impair patient outcomes. In our clinical commentary, we present 3 cases where signs and symptoms consistent with whiplash were identified in primary care. Symptoms in all cases included neck pain, headache, dizziness, and concentration deficits, raising suspicion of coexisting postconcussion syndrome. All cases were referred for specialist physical therapy. Characteristics consistent with poor recovery in both whiplash and postconcussion syndrome were confirmed, and multidisciplinary management, drawing from both whiplash and concussion guidelines, was implemented. All patients reported improvement in activities of daily living after tailored management addressing both neck and head injury-related factors, suggesting that these conditions were not mutually exclusive. Self-reported outcomes included reductions in neck disability and postconcussion symptoms of between 20% and 40%. It may be appropriate for whiplash and concussion guidelines to be amalgamated, enhanced, and mutually recognized on a patient-by-patient basis. Primary health care professionals might consider minimum screening to identify postconcussion syndrome in patients following motor vehicle collision by administering questionnaires and assessing cranial nerve function, balance, and cognition. Management should then incorporate principles from both whiplash and concussion guidelines and harmonize with available imaging guidelines for suspected spine and head trauma. J Orthop Sports Phys Ther 2019;49(11):819-828. doi:10.2519/jospt.2019.8946.
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13
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Strudwick K, Russell T, Bell AJ, Chatfield M, Martin-Khan M. Process quality indicators for musculoskeletal injuries in the emergency department. Emerg Med J 2019; 36:686-696. [PMID: 31641039 DOI: 10.1136/emermed-2019-208531] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2019] [Revised: 08/06/2019] [Accepted: 08/30/2019] [Indexed: 12/26/2022]
Abstract
OBJECTIVES Measuring quality of care for musculoskeletal injuries presenting to the ED is important given their prevalence, variations in care, the associated morbidity and financial impacts and pressure to achieve time-based performance measures. Process quality indicators (QIs) provide a quantitative method to measure the actions taken during healthcare delivery. This study aimed to develop a set of process QIs to measure the quality of care for musculoskeletal injuries in the ED. METHODS A multiphase mixed-methods study was undertaken from 2015 to 2018, commencing with a systematic review to identify existing musculoskeletal QIs. This review, along with current evidence regarding musculoskeletal injury management in the ED, informed an expert panel who developed a preliminary set of process QIs. The preliminary set was field tested at eight EDs in Queensland, Australia, to determine the validity, reliability, feasibility and usefulness of each QI. Prospective observational data collection and retrospective chart audits were used to score the process QIs. These results were presented to the expert panel who determined a final QI set. RESULTS A total of 633 patients were recruited and 36 process QIs included in the final set. The QIs covered important domains of pain assessment and management, history taking and physical examination, appropriateness and timeliness of imaging, fracture management, mobility, patient information and discharge considerations including safety and referrals. The best performing QIs included the use of opioid sparing analgesics and avoiding prescription of 'just in case' opioids at discharge. The poorest performing QIs included the completion of spinal red flag questioning and referrals for fragility fractures. CONCLUSION An evidence and best practice-based set of QIs has been developed to allow EDs to assess and quantify the quality of care for musculoskeletal presentations. This will allow EDs to compare and benchmark, leading to the optimisation of care for patients.
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Affiliation(s)
- Kirsten Strudwick
- Emergency and Physiotherapy Departments, QEII Jubilee Hospital, Brisbane, Queensland, Australia .,School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Trevor Russell
- School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Anthony J Bell
- The Wesley Hospital, Uniting Care Health, Brisbane, Queensland, Australia.,Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Mark Chatfield
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Melinda Martin-Khan
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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14
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Elliott JM, Parrish TB, Walton DM, Vassallo AJ, Fundaun J, Wasielewski M, Courtney DM. Does Overall Cervical Spine Pathology Relate to the Clinical Heterogeneity of Chronic Whiplash? Am J Emerg Med 2019; 38:869-873. [PMID: 31285071 DOI: 10.1016/j.ajem.2019.06.052] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2019] [Revised: 06/25/2019] [Accepted: 06/29/2019] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND AND PURPOSE There remains limited evidence for the clinical importance of most imaging findings in whiplash. However, it is possible the type and number of findings on Computed Tomography (CT) may contribute to prognostic recovery models. The purpose is to interpret cervical spine pathologies in the context of known factors influencing recovery. MATERIALS AND METHODS This is a secondary analysis from a database of 97 acutely injured participants enrolled in a prospective inception cohort study. Thirty-eight participants underwent standard of care cervical spine CT in the emergency medicine department. All 38 participants were assessed at <1-week, 2-weeks, and 3-months post-injury and classified using percentage scores on the Neck Disability Index (recovered/mild (NDI of 0-28%) or moderate/severe (NDI ≥ 30%)). Between-group comparison of categorical variables (gender (male/female), presence of at least one CT finding (yes/no), and presence of ≥3 pathologies on CT (yes/no)) was conducted using 2-tailed Fisher's exact test. RESULTS Participants from both groups demonstrated at least one observable pathology. The group with persistent moderate/severe symptoms presented with significantly more pathology at baseline than those who later reported recovery or milder symptoms at 3-months post injury (p = 0.02). CONCLUSIONS This preliminary study, which needs replication in a larger cohort, provides foundation that the number of degenerative pathologies seen on initial post MVC CT may be associated with the subsequent clinical course of whiplash.
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Affiliation(s)
- James M Elliott
- The University of Sydney, Faculty of Health Sciences & the Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW, Australia; Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.
| | - Todd B Parrish
- Department of Radiology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA; Department of Biomedical Engineering, Northwestern University, Evanston, IL, USA
| | - David M Walton
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - Amy J Vassallo
- The University of Sydney, Faculty of Health Sciences & the Northern Sydney Local Health District, The Kolling Institute, St. Leonards, NSW, Australia
| | - Joel Fundaun
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Marie Wasielewski
- Physical Therapy and Human Movement Sciences, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - D Mark Courtney
- Department of Emergency Medicine Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
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15
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Manansala C, Passmore S, Pohlman K, Toth A, Olin G. Change in young people's spine pain following chiropractic care at a publicly funded healthcare facility in Canada. Complement Ther Clin Pract 2019; 35:301-307. [PMID: 31003674 DOI: 10.1016/j.ctcp.2019.03.013] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2018] [Revised: 02/21/2019] [Accepted: 03/13/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND The presence of spinal pain in young people has been established as a risk factor for spinal pain later in life. Recent clinical practice guidelines recommend spinal manipulation (SM), soft tissue therapy, acupuncture, and other modalities that are common treatments provided by chiropractors, as interventions for spine pain. Less is known specifically on the response to chiropractic management in young people with spinal pain. The purpose of this manuscript was to describe the impact, through pain measures, of a pragmatic course of chiropractic management in young people's spinal pain at a publicly funded healthcare facility for a low-income population. METHODS The study utilized a retrospective analysis of prospectively collected quality assurance data attained from the Mount Carmel Clinic (MCC) chiropractic program database. Formal permission to conduct the analysis of the database was acquired from the officer of records at the MCC. The University of Manitoba's Health Research Ethics Board approved all procedures. RESULTS Young people (defined as 10-24 years of age) demonstrated statistically and clinically significant improvement on the numeric rating scale (NRS) in all four spinal regions following chiropractic management. CONCLUSION The findings of the present study provide evidence that a pragmatic course of chiropractic care, including SM, mobilization, soft tissue therapy, acupuncture, and other modalities within the chiropractic scope of practice are a viable conservative pain management treatment option for young people.
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Affiliation(s)
- Christian Manansala
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Canada
| | - Steven Passmore
- Faculty of Kinesiology and Recreation Management, University of Manitoba, Research Department, New York Chiropractic College, Canada.
| | - Katherine Pohlman
- Department of Pediatrics, University of Alberta, Clinical Research Scientist, Parker University, USA
| | - Audrey Toth
- Mount Carmel Clinic, Chiropractic Clinic, Canada
| | - Gerald Olin
- Manitoba Chiropractors Association, Canadian Chiropractic Association, Canada
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