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Beel W, Firth AD, Tulloch S, Abdelrehman T, Olotu O, Bryant D, Getgood A. Extrusion After Meniscal Allograft Transplantation Is Lower or Equal With Bony Compared With Soft-Tissue Root Fixation: A Systematic Review. Arthroscopy 2024:S0749-8063(24)00232-9. [PMID: 38521206 DOI: 10.1016/j.arthro.2024.02.045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 02/19/2024] [Accepted: 02/29/2024] [Indexed: 03/25/2024]
Abstract
PURPOSE To provide an update on the incidence and extent of graft extrusion after meniscal allograft transplantation (MAT) and to systematically review the literature to identify whether the type of root fixation or additional surgical techniques may reduce the risk of graft extrusion development. METHODS A systematic search, in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) guidelines, was conducted using the MEDLINE database, EMBASE database, Cochrane Database of Systematic Reviews, and Cochrane Central Register of Controlled Trials (CENTRAL) database. Patients undergoing medial meniscal allograft transplantation (MMAT) or lateral meniscal allograft transplantation (LMAT) were included. The primary outcome measure was meniscal extrusion measured on postoperative magnetic resonance imaging scans taken more than 6 weeks after MAT. The following extrusion outcomes were investigated: absolute extrusion (AE), relative percentage of extrusion (RPE), and proportion of major extrusion (PME). Additional surgical techniques that reduced the risk of graft extrusion development in the included comparative studies were identified. RESULTS For MMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.2 mm versus 3.36 mm and RPE of 44.43% versus 33.18%. The pooled mean PME for MMAT with soft-tissue fixation was 51.62%. For LMAT, the pooled mean extrusion outcomes for soft-tissue versus bony fixation were as follows: AE of 3.72 mm versus 2.78 mm, RPE of 31.89% versus 29.47%, and PME of 64.37% versus 35.80%. Additional capsulodesis was identified as a technique to reduce LMAT extrusion. CONCLUSIONS This study highlights that graft extrusion is a common finding after MMAT and LMAT, independent of the root fixation technique. However, MAT extrusion with bony fixation was, depending on the outcome measurement, lower than or equal to that with soft-tissue fixation. LEVEL OF EVIDENCE Level IV, systematic review of Level I, III, and IV studies.
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Affiliation(s)
- Wouter Beel
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada
| | - Andrew D Firth
- Department of Surgery, Schulich School of Medicine & Dentistry, Western University, London, Canada; Department of Epidemiology & Biostatistics, Schulich School of Medicine & Dentistry, Western University, London, Canada
| | - Scott Tulloch
- Department of Orthopedic Surgery, Western Health, Footscray Hospital, Melbourne, Australia
| | | | - Olumide Olotu
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada
| | - Dianne Bryant
- School of Physical Therapy, Faculty of Health Science, Western University, London, Canada
| | - Alan Getgood
- Fowler Kennedy Sports Medicine Clinic, University of Western Ontario, London, Canada.
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2
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Martin RK, Marmura H, Wastvedt S, Pareek A, Persson A, Moatshe G, Bryant D, Wolfson J, Engebretsen L, Getgood A. External validation of the Norwegian anterior cruciate ligament reconstruction revision prediction model using patients from the STABILITY 1 Trial. Knee Surg Sports Traumatol Arthrosc 2024; 32:206-213. [PMID: 38226736 DOI: 10.1002/ksa.12031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Revised: 11/10/2023] [Accepted: 12/05/2023] [Indexed: 01/17/2024]
Abstract
PURPOSE A machine learning-based anterior cruciate ligament (ACL) revision prediction model has been developed using Norwegian Knee Ligament Register (NKLR) data, but lacks external validation outside Scandinavia. This study aimed to assess the external validity of the NKLR model (https://swastvedt.shinyapps.io/calculator_rev/) using the STABILITY 1 randomized clinical trial (RCT) data set. The hypothesis was that model performance would be similar. METHODS The NKLR Cox Lasso model was selected for external validation owing to its superior performance in the original study. STABILITY 1 patients with all five predictors required by the Cox Lasso model were included. The STABILITY 1 RCT was a prospective study which randomized patients to receive either a hamstring tendon autograft (HT) alone or HT plus a lateral extra-articular tenodesis (LET). Since all patients in the STABILITY 1 trial received HT ± LET, three configurations were tested: 1: all patients coded as HT, 2: HT + LET group coded as bone-patellar tendon-bone (BPTB) autograft, 3: HT + LET group coded as unknown/other graft choice. Model performance was assessed via concordance and calibration. RESULTS In total, 591/618 (95.6%) STABILITY 1 patients were eligible for inclusion, with 39 undergoing revisions within 2 years (6.6%). Model performance was best when patients receiving HT + LET were coded as BPTB. Concordance was similar to the original NKLR prediction model for 1- and 2-year revision prediction (STABILITY: 0.71; NKLR: 0.68-0.69). Concordance 95% confidence interval (CI) ranged from 0.63 to 0.79. The model was well calibrated for 1-year prediction while the 2-year prediction demonstrated evidence of miscalibration. CONCLUSION When patients in STABILITY 1 who received HT + LET were coded as BPTB in the NKLR prediction model, concordance was similar to the index study. However, due to a wide 95% CI, the true performance of the prediction model with this Canadian and European cohort is unclear and a larger data set is required to definitively determine the external validity. Further, better calibration for 1-year predictions aligns with general prediction modelling challenges over longer periods. While not a large enough sample size to elicit the true accuracy and external validity of the prediction model when applied to North American patients, this analysis provides more support for the notion that HT plus LET performs similarly to BPTB reconstruction. In addition, despite the wide confidence interval, this study suggests optimism regarding the accuracy of the model when applied outside of Scandinavia. LEVEL OF EVIDENCE Level 3, cohort study.
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Affiliation(s)
- R Kyle Martin
- Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, Minnesota, USA
- Department of Orthopaedic Surgery, CentraCare, Saint Cloud, Minnesota, USA
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway
| | - Hana Marmura
- Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
| | - Solvejg Wastvedt
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Ayoosh Pareek
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Andreas Persson
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway
- Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
| | - Gilbert Moatshe
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway
- Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
| | - Dianne Bryant
- School of Physical Therapy, University of Western Ontario, London, Ontario, Canada
| | - Julian Wolfson
- Division of Biostatistics, University of Minnesota, Minneapolis, Minnesota, USA
| | - Lars Engebretsen
- Oslo Sport Trauma Research Center, Norwegian School of Sports Science, Oslo, Norway
- Orthopaedic Clinic, Oslo University Hospital Ullevål, Oslo, Norway
| | - Alan Getgood
- Department of Orthopaedic Surgery, University of Western Ontario, London, Ontario, Canada
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Heard M, Marmura H, Bryant D, Litchfield R, McCormack R, MacDonald P, Spalding T, Verdonk P, Peterson D, Bardana D, Rezansoff A, Getgood A. Corrigendum to 'No increase in adverse events with lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction - Results from the stability randomized trial' [Journal of ISAKOS 8 (2023) 246-254]. J ISAKOS 2023; 8:513. [PMID: 37845163 DOI: 10.1016/j.jisako.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2023]
Affiliation(s)
- M Heard
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; Banff Sport Medicine, T1W 0L5, Canada
| | - H Marmura
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - D Bryant
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - R Litchfield
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada
| | - R McCormack
- Department of Orthopaedics, University of British Columbia, V5Z 1M9, Canada; New West Orthopaedic & Sports Medicine Centre, V3L 5P5, Canada
| | - P MacDonald
- Department of Surgery, University of Manitoba, R3A 1R9, Canada; Pan Am Clinic, R3M 3E4, Canada
| | - T Spalding
- University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX, UK
| | - P Verdonk
- Department of Physical Medicine and Orthopedics, Ghent University, 9000, Belgium; Antwerp Orthopedic Center, 2018, Belgium
| | - D Peterson
- Department of Surgery, McMaster University, L8S 4K1, Canada
| | - D Bardana
- Department of Surgery, Queen's University, K7L 2V7, Canada
| | - A Rezansoff
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; University of Calgary Sport Medicine Centre, T2N 1N4, Canada
| | - A Getgood
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada.
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McNeill K, Marmura H, Werstine M, Alcock G, Birmingham T, Willits K, Getgood A, LeBel ME, Litchfield R, Bryant D, Giffin JR. The Effect of Staged Versus Usual Care Physiotherapy on Knee Function Following Anterior Cruciate Ligament Reconstruction. J Sport Rehabil 2023; 32:884-893. [PMID: 37699588 DOI: 10.1123/jsr.2022-0343] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 06/15/2023] [Accepted: 06/26/2023] [Indexed: 09/14/2023]
Abstract
CONTEXT The long duration and high cost of anterior cruciate ligament reconstruction (ACLR) rehabilitation can pose barriers to completing rehabilitation, the latter stages of which progress to demanding sport-specific exercises critical for a safe return to sport. A staged approach shifting in-person physiotherapy sessions to later months of recovery may ensure patients undergo the sport-specific portion of ACLR rehabilitation. Design/Objective: To compare postoperative outcomes of knee function in patients participating in a staged ACLR physiotherapy program to patients participating in usual care physiotherapy through a randomized controlled trial. METHODS One hundred sixty-two patients were randomized to participate in staged (n = 80) or usual care physiotherapy (n = 82) following ACLR and assessed preoperatively and postoperatively at 2 weeks, 6 weeks, 3 months, and 6 months. The staged group completed the ACLR rehabilitation protocol at home for the first 3 months, followed by usual care in-person sessions. The usual care group completed in-person sessions for their entire rehabilitation. Outcome measures included the Lower Extremity Functional Scale, International Knee Documentation Committee Questionnaire, pain, range of motion, strength, and hop testing. RESULTS There were no statistically significant between-group differences in measures of knee function at 6 months postoperative. Patients in the usual care group reported significantly higher International Knee Documentation Committee scores at 3 months postoperative (mean difference = 5.8; 95% confidence interval, 1.3 to 10.4; P = .01). CONCLUSION A staged approach to ACLR rehabilitation does not appear to impede knee function at 6 months postoperative but may result in worse patient reported outcomes at early follow-ups.
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Affiliation(s)
- Kestrel McNeill
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON,Canada
| | - Hana Marmura
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Bone and Joint Institute, Western University, London, ON,Canada
| | - Melanie Werstine
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
| | - Greg Alcock
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
| | - Trevor Birmingham
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Bone and Joint Institute, Western University, London, ON,Canada
- Wolf Orthopedic Biomechanics Lab, Western University, London, ON,Canada
| | - Kevin Willits
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - Marie-Eve LeBel
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - Robert Litchfield
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - Dianne Bryant
- Department of Health Research Methods, Evidence, and Impact, Faculty of Health Sciences, McMaster University, Hamilton, ON,Canada
- School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON,Canada
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
| | - J Robert Giffin
- Fowler Kennedy Sport Medicine Clinic, Western University, London, ON,Canada
- Wolf Orthopedic Biomechanics Lab, Western University, London, ON,Canada
- Division of Orthopedics, Department of Surgery, The Schulich School of Medicine and Dentistry, Western University, London, ON,Canada
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5
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Degen RM, Firth A, Sehmbi H, Martindale A, Wanlin S, Chen C, Marsh JD, Willits K, Bryant D. Multimodal analgesia did not improve post-operative pain scores, reduce opioid consumption or reduce length of stay following hip arthroscopy. Knee Surg Sports Traumatol Arthrosc 2023; 31:4016-4026. [PMID: 37170015 DOI: 10.1007/s00167-023-07445-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2023] [Accepted: 04/25/2023] [Indexed: 05/13/2023]
Abstract
PURPOSE To determine whether different regimens of multimodal analgesia will reduce postoperative pain scores, opioid consumption, costs and hospital length-of-stay following hip arthroscopy. METHODS From 2018 to 2021, 132 patients undergoing hip arthroscopy for femoroacetabular impingement syndrome (FAIS) were included in this prospective, single-center randomized controlled trial. Patients were randomized into four treatment groups: (1) Group 1-Control: opioid medication (oxycodone-acetaminophen 5 mg/325 mg, 1-2 tabs q6H as needed), Heterotopic ossification prophylaxis-Naprosyn 500 mg twice daily × 3 weeks); (2) Group 2-Control + postoperative sleeping aid (Zopiclone 7.5 mg nightly × 7 days); (3) Group 3-Control + preoperative and postoperative Gabapentin (600 mg orally, 1 h preoperatively; 600 mg postoperatively, 8 h following pre-op dose); (4) Group 4-Control + pre-medicate with Celecoxib (400 mg orally, 1 h preoperatively) The primary outcome was pain measured with a visual analog scale, monitored daily for the first week and every other day for 6 weeks. Secondary outcomes included opioid consumption, healthcare resource use, and hospital length of stay. RESULTS Patient characteristics were similar between groups. There were no statistically significant differences in pain scores between groups at any timepoint after adjusting for intra-operative traction time, intra-operative opioid administration and preoperative pain scores (p > 0.05). There were also no significant differences in the number of days that opioids were taken (n.s.) and the average daily morphine milligram equivalents consumed (n.s.). Similarly, there were no statistically significant differences in length of stay in the experimental groups, compared with the control group (n.s.). Finally, there were no differences in cost between groups (n.s.). CONCLUSION The routine use of Zopiclone, Celecoxib and Gabapentin did not improve postoperative pain control or reduce length-of-stay following hip arthroscopy. Therefore, these medications are not recommended for routine postoperative pain control following hip arthroscopy. LEVEL OF EVIDENCE l.
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Affiliation(s)
- Ryan M Degen
- Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada.
- Bone and Joint Institute, Western University, London, ON, Canada.
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada.
| | - Andrew Firth
- Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada
| | - Herman Sehmbi
- Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada
- Department of Anesthesia, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Ashley Martindale
- Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada
| | - Stacey Wanlin
- Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada
| | - Clara Chen
- Faculty of Health Sciences, Western University, London, Canada
| | | | - Kevin Willits
- Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dianne Bryant
- Fowler Kennedy Sport Medicine Clinic, Western University, 1151 Richmond Street, 3M Centre, London, ON, Canada
- Bone and Joint Institute, Western University, London, ON, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
- Faculty of Health Sciences, Western University, London, Canada
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
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6
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Heard M, Marmura H, Bryant D, Litchfield R, McCormack R, MacDonald P, Spalding T, Verdonk P, Peterson D, Bardana D, Rezansoff A, Getgood A. No increase in adverse events with lateral extra-articular tenodesis augmentation of anterior cruciate ligament reconstruction - Results from the stability randomized trial. J ISAKOS 2023; 8:246-254. [PMID: 36646169 DOI: 10.1016/j.jisako.2022.12.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/10/2022] [Revised: 12/02/2022] [Accepted: 12/08/2022] [Indexed: 01/15/2023]
Abstract
OBJECTIVES Results from the Stability Study suggest that adding a lateral extra-articular tenodesis (LET) to a hamstring tendon autograft reduces the rate of anterior cruciate ligament reconstruction (ACLR) failure in high-risk patients. The purpose of this study is to report adverse events over the 2-year follow-up period and compare groups (ACLR alone vs. ACLR + LET). METHODS Stability is a randomized clinical trial comparing hamstring tendon ACLR with and without LET. Patients aged 14-25 years with an ACL deficient knee were included. Patients were followed and adverse events documented (type, actions taken, resolution) with visits at 3, 6, 12, and 24 months postoperatively. Adverse events were categorized as none, minor medical, minor surgical, contralateral ACL rupture, or graft rupture. Patient reported outcome measures (PROMs) collected at each visit included the Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Score (IKDC), and ACL Quality of Life Questionnaire (ACL-QOL). RESULTS In total, 618 patients were randomized (mean age 18.9 years, 302 (49%) male). Forty-five patients (7%) suffered graft rupture; 34 (11%) in the ACLR group compared to 11 (4%) in the ACLR + LET group (RRR = 0.67, 95% CI 0.36 to 0.83, p < 0.001). There were no differences in effusion or infection rates between groups. The ACLR + LET group experienced an increased number of hardware removals (10 vs. 4). Overall, the rate of minor medical events (11%), minor surgical events (7%), and ipsilateral or contralateral ACL tears (10%) were low considering the high-risk patient profile. Increasing severity of adverse events was associated with lower PROMs at 24 months post-operative. Patients in the ACLR + LET group reported greater degree of pain at 3 months only. There were no clinically significant differences in range of motion between groups. CONCLUSIONS The addition of LET to hamstring tendon autograft ACLR in young patients at high risk of re-injury resulted in a statistically significant reduction in graft rupture. While the addition of LET may increase rates of hardware irritation, there was no significant increase in overall rates of minor medical adverse events, minor surgical events, or overall re-operation rates. The concerns regarding complications associated with a LET did not materialize in this study. LEVEL OF EVIDENCE Level I.
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Affiliation(s)
- M Heard
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; Banff Sport Medicine, T1W 0L5, Canada
| | - H Marmura
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - D Bryant
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; School of Physical Therapy, Western University, N6A 3K7, Canada
| | - R Litchfield
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada
| | - R McCormack
- Department of Orthopaedics, University of British Columbia, V5Z 1M9, Canada; New West Orthopaedic & Sports Medicine Centre, V3L 5P5, Canada
| | - P MacDonald
- Department of Surgery, University of Manitoba, R3A 1R9, Canada; Pan Am Clinic, R3M 3E4, Canada
| | - T Spalding
- University Hospital Coventry and Warwickshire NHS Trust, CV2 2DX, UK
| | - P Verdonk
- Department of Physical Medicine and Orthopedics, Ghent University, 9000, Belgium; Antwerp Orthopedic Center, 2018, Belgium
| | - D Peterson
- Department of Surgery, McMaster University, L8S 4K1, Canada
| | - D Bardana
- Department of Surgery, Queen's University, K7L 2V7, Canada
| | - A Rezansoff
- Deparment of Surgery, University of Calgary, T2N 1N4, Canada; University of Calgary Sport Medicine Centre, T2N 1N4, Canada
| | - A Getgood
- Fowler Kennedy Sport Medicine Clinic, N6A 3K7, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, N6A 5C1, Canada.
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McNeill K, Reyes N, Choe S, Peterson D, Bryant D, Sonnadara RR. A History of Musculoskeletal Medicine and Its Place and Progress in Undergraduate Medical Education. Med Sci Educ 2023; 33:777-790. [PMID: 37501799 PMCID: PMC10368607 DOI: 10.1007/s40670-023-01782-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 03/23/2023] [Indexed: 07/29/2023]
Abstract
Musculoskeletal diseases are responsible for some of the most prevalent conditions affecting population health in the world. Despite the prevalence of these conditions, musculoskeletal medicine has a fraught history within the world of undergraduate medical education. We review the origins of musculoskeletal medicine, its evolution in undergraduate medical education, and progress that has been made over the last decade as a result of global initiatives such as the Bone and Joint Decade. Understanding the history of musculoskeletal medicine is essential to contextualizing the problems that exist today and creating comprehensive solutions to fill the gaps that persist in musculoskeletal curricula.
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Affiliation(s)
- Kestrel McNeill
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Natasha Reyes
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Stella Choe
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Devin Peterson
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
| | - Dianne Bryant
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, Western University, 1151 Richmond St, London, ON N6A 3K7 Canada
| | - Ranil R. Sonnadara
- Department of Health Research Methods, Evidence, and Impact, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Psychology, Neuroscience, and Behaviour, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, McMaster University, 1280 Main Street West, Hamilton, ON L8S 4L8 Canada
- Department of Surgery, University of Toronto, 27 King’s College Cir, Toronto, ON M5S 1A1 Canada
- Compute Ontario, Toronto, ON Canada
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8
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Furtado R, MacDermid JC, Bryant D, Faber KJ, Drosdowech DS, Athwal GS. Balancing clinician and patient priorities for total shoulder replacement preoperative education programs. Patient Educ Couns 2023; 112:107759. [PMID: 37075651 DOI: 10.1016/j.pec.2023.107759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Revised: 04/09/2023] [Accepted: 04/14/2023] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To investigate patient and clinician preferences regarding a preoperative educational program for patients undergoing shoulder replacement surgery. METHODS This study used a cross-sectional survey of patients awaiting shoulder replacement surgery and clinicians. The survey was comprised of 41 questions for patients and clinicians, regarding preferences for receiving information, content preferences and device preferences. Descriptive statistics were reported for survey questions. RESULTS 180 patients and 175 clinicians completed the survey. Patients and clinicians' top choices for ways to receive information were: in-person, website and booklets, with use of CD/DVD being extremely unlikely. Patients and clinicians had different preferences regarding content choices. Patients rated the following content topics as important to include in a program: including other patient's previous experiences with this surgery (83 % patients; 40 % clinicians), information for caregivers (84 % patients; 65 % clinicians), expectations for hospital stay (89 % patients; 57 % clinicians), process of anesthesia (87 % patients; 51 % clinicians), and how the surgery is performed (94 % patients; 60 % clinicians). CONCLUSIONS Clinicians and patients have differing priorities and perspectives on the content and delivery of preoperative education programs, however, therapeutic goals and accessibility should be considered when designing programs. PRACTICE IMPLICATIONS Creating education programs should include the lens of both clinicians and patients.
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Affiliation(s)
- Rochelle Furtado
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada; School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada; Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.
| | - Joy C MacDermid
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada; School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada; Department of Surgery Western University and Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada; School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
| | - Kenneth J Faber
- Department of Surgery Western University and Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Darren S Drosdowech
- Department of Surgery Western University and Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - George S Athwal
- Department of Surgery Western University and Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
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Day T, Pasic N, Churchill L, Bryant D, Degen R. A scoping review of postoperative return to sport criteria and protocols for patients with femoroacetabular impingement syndrome. PHYSICIAN SPORTSMED 2023; 51:97-106. [PMID: 34836488 DOI: 10.1080/00913847.2021.2011628] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
PURPOSE To identify the objective criteria and guidelines utilized to determine if patients diagnosed with FAIS can safely return to sport following hip arthroscopy. METHODS The electronic databases MEDLINE Ovid, EMBASE Ovid, and CINAHL were searched to identify eligible studies. Details of study design, sample size, primary diagnosis, and return to sport protocol, duration, and rate were collected by two reviewers, independently. RESULTS Sixty-two studies were selected for full text review of which 14 were included in the final analysis. Of these, nine were clinical commentaries and five were retrospective cohort studies. Three types of rehabilitation guidelines are currently utilized postoperatively: 4-phase, 5-phase, and 6-phase protocols. Although all 14 studies recommend using various types of outcome measures to evaluate a patient's ability to return to sport, only eleven outlined the specific outcome criteria they must achieve to do so. The most utilized outcome measures are the hip outcome score, active and passive range of motion tests, gait analysis, single- and double-leg squat tests, and the Vail hip sports test. Criteria across all three types of protocols was variable, but they all evaluated the same international classification of disability and function constructs described by the World Health Organization: body function, body structure limitations, and activity capacity limitations. CONCLUSIONS There is no consensus on the optimal methods of evaluating a patient's readiness to return to sport after undergoing hip arthroscopy, with most criteria focused on expert opinion. Performance-based return to sport outcome criteria is not clearly defined, and validated outcome measures are not being used for FAIS patients post hip arthroscopy. Lastly, well-conducted prospective cohort studies using validated outcome measures and objective definitions of return to sport are needed to consistently identify signs that are prognostic of safe return to sport.
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Affiliation(s)
- Trevor Day
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Nicholas Pasic
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
| | - Laura Churchill
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
| | - Dianne Bryant
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Faculty of Health Sciences, School of Physical Therapy, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
- Faculty of Medicine, Michael G. DeGroote School of Medicine, Department of Health Research Methods, Evidence, and Impact (Formerly Clinical Epidemiology & Biostatistics), McMaster University, Hamilton, Ontario, Canada
| | - Ryan Degen
- Fowler Kennedy Sport Medicine Clinic, Western University, London, Ontario, Canada
- Schulich School of Medicine & Dentistry, Department of Surgery, Western University, London, Ontario, Canada
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10
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Dima R, Birmingham TB, Philpott HT, Bryant D, Fenster A, Appleton CT. Cross-sectional reliability and concurrent validity of a quantitative 2-dimensional ultrasound image analysis of effusion and synovial hypertrophy in knee osteoarthritis. Osteoarthritis and Cartilage Open 2023; 5:100356. [PMID: 37008822 PMCID: PMC10060736 DOI: 10.1016/j.ocarto.2023.100356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 03/07/2023] [Indexed: 03/17/2023] Open
Abstract
Objective Effusion-synovitis is related to pain and progression in knee osteoarthritis (OA), but current gold standard ultrasound (US) measures are limited to semi-quantitative grading of joint distension or 1-dimensional thickness measures. A novel quantitative 2-dimensional image analysis methodology is applied to US images of effusion-synovitis; reliability and concurrent validity was assessed in patients with knee OA. Methods Cross sectional analysis of US images collected from 51 patients with symptomatic knee OA were processed in ImageJ and segmented in 3DSlicer to produce a binary mask of the supra-patellar synovitis region of interest (ROI). Area measures (mm2) of total synovitis, effusion and hypertrophy components were exported. Intra-rater reliability and test-retest reliability (1-14 days washout) were estimated with intra-class correlation coefficients (ICCs). Concurrent validity was measured by Spearman correlations between quantitative measures and gold standard OMERACT and caliper measurements of synovitis. Results Intra-rater reliability for hypertrophy area was estimated at 0.98, 0.99 for effusion area, and 0.99 for total synovitis area. The test-retest reliability for total synovitis area was 0.63 (SEM 87.8 mm2), 0.59 for hypertrophy area (SEM 21.0 mm2), and 0.64 for effusion area (SEM 73.8 mm2). Correlation between total synovitis area and OMERACT grade was 0.84, 0.81 between total synovitis area and effusion-synovitis calipers, and 0.81 between total effusion area and effusion calipers. Conclusion This new research tool for image analysis demonstrated excellent intra-rater reliability, good concurrent validity, and moderate test-retest reliability. Quantitative 2D US measures of effusion-synovitis and its individual components may enhance the study and management of knee OA.
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Affiliation(s)
- Robert Dima
- Faculty of Health Sciences, University of Western Ontario, London, ON, N6G 1H1, Canada
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, ON, N6A 5B5, Canada
| | - Trevor B. Birmingham
- Faculty of Health Sciences, University of Western Ontario, London, ON, N6G 1H1, Canada
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, ON, N6A 5B5, Canada
| | - Holly T. Philpott
- Faculty of Health Sciences, University of Western Ontario, London, ON, N6G 1H1, Canada
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, ON, N6A 5B5, Canada
| | - Dianne Bryant
- Faculty of Health Sciences, University of Western Ontario, London, ON, N6G 1H1, Canada
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, ON, N6A 5B5, Canada
| | - Aaron Fenster
- Department of Medical Biophysics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
- Centre for Medical Imaging, Robarts Research Institute, London, ON, N6A 5K8, Canada
| | - C. Thomas Appleton
- Bone and Joint Institute, University of Western Ontario, London Health Sciences Centre-University Hospital, London, ON, N6A 5B5, Canada
- Department of Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, N6A 5C1, Canada
- Corresponding author. SJHC Rheumatology Centre, 268 Grosvenor St., London, ON, N6A 4V2, Canada
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11
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Lodhia P, Nazari G, Bryant D, Getgood A, McCormack R, Getgood AM, Bryant DM, Litchfield R, Willits K, Birmingham T, Hewison C, Firth AD, Wanlin S, Pinto R, Martindale A, O’Neill L, Jennings M, Daniluk M, McCormack RG, Boyer D, Zomar M, Moon K, Moon R, Fan B, Mohan B, Payne K, Heard M, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, MacDonald PB, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Rezansoff A, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Peterson D, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Bardana D, Howells F, Tough M, Spalding T, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Milan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Verdonk PC, Declerq G, Vuylsteke K, Van Haver M. Performance of 5-Strand Hamstring Autograft Anterior Cruciate Ligament Reconstruction in the STABILITY Study: A Subgroup Analysis. Am J Sports Med 2022; 50:3502-3509. [PMID: 36260487 PMCID: PMC9630854 DOI: 10.1177/03635465221128581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Anterior cruciate ligament (ACL) reconstructions (ACLRs) with graft diameters <8mm have been shown to have higher revision rates. The 5-strand (5S) hamstring autograft configuration is a proposed option to increase graft diameter. PURPOSE To investigate the differences in clinical outcomes between 4-strand (4S) and 5S hamstring autografts for ACLR in patients who underwent ACLR alone or concomitantly with a lateral extra-articular tenodesis (LET) procedure. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Data from the STABILITY study were analyzed to compare a subgroup of patients undergoing ACLR alone or with a concomitant LET procedure (ACLR + LET) with a minimum graft diameter of 8mm that had either a 4S or 5S hamstring autograft configuration. The primary outcome was clinical failure, a composite of rotatory laxity and/or graft failure. The secondary outcome measures consisted of 2 patient-reported outcome scores (PROs)-namely, the ACL Quality of Life Questionnaire (ACL-QoL) and the International Knee Documentation Committee (IKDC) score at 24 months postoperatively. RESULTS Of the 618 patients randomized in the STABILITY study, 399 (228 male; 57%) fit the inclusion criteria for this study. Of these, 191 and 208 patients underwent 4S and 5S configurations of hamstring ACLR, respectively, with a minimum graft diameter of 8mm. Both groups had similar characteristics other than differences in anthropometric factors-namely, sex, height, and weight, and Beighton scores. The primary outcomes revealed no difference between the 2 groups in rotatory stability (odds ratio [OR], 1.19; 95% CI, 0.77-1.84; P = .42) or graft failure (OR, 1.13; 95% CI, 0.51-2.50; P = .76). There was no significant difference between the groups in Lachman (P = .46) and pivot-shift (P = .53) test results at 24 months postoperatively. The secondary outcomes revealed no differences in the ACL-QoL (P = .67) and IKDC (P = .83) scores between the 2 subgroups. CONCLUSION At the 24-month follow-up, there were no significant differences in clinical failure rates and PROs in an analysis of patients with 4S and 5S hamstring autografts of ≥8mm diameter for ACLR or ACLR + LET. The 5S hamstring graft configuration is a viable option to produce larger-diameter ACL grafts.
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Affiliation(s)
- Parth Lodhia
- Parth Lodhia, MD, University of British Columbia, 403-233
Nelson’s Crescent, New Westminster, V3L 0E4, Canada (
)
| | - Goris Nazari
- Canadian Institutes of Health Research, Ottawa,
Ontario, Canada
| | - Dianne Bryant
- The University of Western Ontario, London,
Ontario, Canada
| | - Alan Getgood
- Western Ontario University, London, Ontario,
Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michal Daniluk
- London Health Sciences Centre, Western
University, Fowler Kennedy Sport Medicine Clinic, London, Canada
| | | | | | | | | | | | | | | | - Kyrsten Payne
- Fraser Orthopaedic Institute, New Westminster,
Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Michelle Mayer
- Sport Medicine Centre, University of Calgary,
Calgary, Canada
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Mieke Van Haver
- Antwerp Orthopaedic Center, Ghent,
Belgium,Investigation performed at University of
British Columbia, Vancouver, BC, Canada
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12
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Marmura H, Firth A, Batty L, Bryant DM, Getgood AMJ, Bryant D, Litchfield R, Willits K, Birmingham T, Hewison C, Wanlin S, Firth A, Pinto R, Martindale A, O’Neill L, Jennings M, Daniluk M, Boyer D, McCormack B, Zomar M, Moon K, Moon R, Fan B, Mohan B, Heard M, Buchko GM, Hiemstra LA, Kerslake S, Tynedal J, MacDonald P, Stranges G, Mcrae S, Gullett L, Brown H, Legary A, Longo A, Christian M, Ferguson C, Rezansoff A, Mohtadi N, Barber R, Chan D, Campbell C, Garven A, Pulsifer K, Mayer M, Peterson D, Simunovic N, Duong A, Robinson D, Levy D, Skelly M, Shanmugaraj A, Bardana D, Howells F, Tough M, Spalding T, Thompson P, Metcalfe A, Asplin L, Dube A, Clarkson L, Brown J, Bolsover A, Bradshaw C, Belgrove L, Millan F, Turner S, Verdugo S, Lowe J, Dunne D, McGowan K, Suddens CM, Verdonk P, Declerq G, Vuylsteke K, Van Haver M. Meniscal repair at the time of primary ACLR does not negatively influence short term knee stability, graft rupture rates, or patient-reported outcome measures: the STABILITY experience. Knee Surg Sports Traumatol Arthrosc 2022; 30:3689-3699. [PMID: 35451638 DOI: 10.1007/s00167-022-06962-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/25/2021] [Accepted: 03/24/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE To assess how meniscal repair and excision impact short term patient-reported outcome measures (PROMs), knee stability, and early graft rupture rates following primary hamstring anterior cruciate ligament reconstruction (ACLR) with or without lateral extra-articular tenodesis (LET) in a group of young active patients where meniscal repair is commonly advocated. METHODS Six hundred and eighteen patients under 25 years of age at high-risk of graft failure following ACLR were recruited to the Stability 1 study. Multivariable regression models were developed to identify statistically and clinically significant surgical and demographic predictors of Knee Injury and Osteoarthritis Outcome Score (KOOS), International Knee Documentation Committee Subjective Knee Form (IKDC), ACL Quality of Life Questionnaire (ACL-QOL) and Marx Activity Rating Scale (MARS) scores. Chi-Square tests of independence were used to explore the association between meniscal status (torn, not torn), meniscal treatment (excision or repair), graft rupture, and rotatory knee laxity. RESULTS Medial meniscus repair was associated with worse outcomes on the KOOS (β = -1.32, 95% CI: -1.57 to -1.10, p = 0.003), IKDC (β = -1.66, 95% CI: -1.53 to -1.02, p = 0.031) and ACL-QOL (β = -1.25, 95% CI: -1.61 to 1.02, p = n.s.). However, these associations indicated small, clinically insignificant changes based on reported measures of clinical relevance. Other important predictors of post-operative PROMs included age, sex, and baseline scores. Medial meniscus excision and lateral meniscus treatment (repair or excision) did not have an important influence on PROMs. There was no significant association between meniscal treatment and graft rupture or rotatory knee laxity. CONCLUSION While repairing the medial meniscus may result in a small reduction in PROM scores at two-year follow-up, these differences are not likely to be important to patients or clinicians. Any surgical morbidity associated with meniscal repair appears negligible in terms of PROMs. Meniscal repair does not affect rotatory laxity or graft failure rates in the short term. Therefore, meniscal repair should likely be maintained as the standard of care for concomitant meniscal tears with ACLR. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hana Marmura
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada
| | - Andrew Firth
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada
| | - Lachlan Batty
- Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,OrthoSport Victoria Research Unit, Richmond, Australia.,St. Vincent's Hospital, Melbourne, Australia
| | - Dianne M Bryant
- Faculty of Health Sciences, Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada.,Bone and Joint Institute, Western University, London, Canada.,Lawson Research, London Health Sciences Centre, London, Canada.,Schulich School of Medicine and Dentistry, Western University, London, Canada.,Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Alan M J Getgood
- Faculty of Health Sciences, Western University, London, Canada. .,Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, 3M Centre, London, ON, N6K 4P3, Canada. .,Bone and Joint Institute, Western University, London, Canada. .,Lawson Research, London Health Sciences Centre, London, Canada. .,Schulich School of Medicine and Dentistry, Western University, London, Canada.
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13
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Churchill L, Lukacs MJ, Lebedeva Y, MacDonald SJ, Giffin JR, Rudman DL, Bryant D. Primary care physicians' perceptions of the utility of novel education materials for patients with knee osteoarthritis. Disabil Rehabil 2022:1-7. [PMID: 35931102 DOI: 10.1080/09638288.2022.2107088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
PURPOSE To support primary care physicians (PCPs) and their patients with knee osteoarthritis (OA), we created a series of evidence-based whiteboard educational videos for patients with knee OA. In a previous study we piloted these videos with patients to understand their acceptability and impact. The purpose of this study was to explore PCPs' perspectives to understand the utility of novel patient education videos to support management. MATERIALS AND METHOD We conducted a qualitative descriptive study using semi-structured interviews of newly practicing and resident PCPs after watching a series of patient education videos. A thematic analysis approach was used combining both inductive and research question driven coding, category formation, and theme identification. RESULTS Ten participants were included. Barriers to optimal management were identified including the challenge of patient adherence and access to non-operative treatments. PCPs indicated that the videos would support their management of patients with knee OA by (1) supporting credibility and building trust with their patient, (2) reinforcing patient understanding, and (3) enhancing their own management of patients. CONCLUSION Future implementation of these resources with attention to barriers that may limit uptake is necessary and may optimize management of knee OA in primary care.IMPLICATIONS FOR REHABILITATIONThe provision of patient educational materials may support patient buy-in regarding appropriate management, enhance patient understanding, and improve physicians' future practice.Viewing these videos could potentially improve physicians' future resource use, recommendation of non-operative treatments, and the quality of their total knee replacement referrals, which has benefits to both the patient and the healthcare system.Perceived barriers to implementing evidence-based recommendations may pose a challenge for patients and clinicians and should be considered to help facilitate the uptake of educational interventions.
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Affiliation(s)
- Laura Churchill
- Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Canada
| | | | | | - Steven J MacDonald
- Western University, London, Canada.,London Health Sciences Center-University Hospital, London, Canada
| | - J Robert Giffin
- Western University, London, Canada.,Fowler Kennedy Sport Medicine Clinic, London, Canada.,London Health Sciences Center-University Hospital, London, Canada
| | | | - Dianne Bryant
- Western University, London, Canada.,McMaster University, Hamilton, Canada
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14
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Philpott HT, Birmingham TB, Dima R, Pinto R, Bryant D, Appleton CT. Test-Retest Reliability and Sensitivity to Change of Ultrasound-Based Methods of Measuring Synovial Inflammation in Knee Osteoarthritis. Arthritis Care Res (Hoboken) 2022; 75:902-910. [PMID: 35294110 DOI: 10.1002/acr.24882] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 02/24/2022] [Accepted: 03/10/2022] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To assess test-retest reliability of musculoskeletal ultrasound (US) measures of inflammation in patients with knee osteoarthritis (OA) and to assess the sensitivity to change of US measures of inflammation in patients with knee OA. METHODS To mimic a common clinical scenario, 36 patients (n = 70 knees) with symptomatic knee OA who were in stable condition underwent 2 assessments within 14 days by different operators and different US machines, graded by a single rater. Test-retest reliability was measured using Cohen's kappa coefficient, intraclass correlation coefficient (ICC), and absolute agreement parameters. A total of 51 patients (n = 72 knees) were tested immediately before and 21-28 days after intraarticular glucocorticoid injection to investigate sensitivity to change and longitudinal construct validity. Paired t-tests and standardized response mean (SRM) were used to assess sensitivity to change. Multivariate linear regression was used to investigate longitudinal construct validity of US with Knee Injury and Osteoarthritis Outcome Score (KOOS) pain scores, while adjusting for covariates. RESULTS US measures of inflammation demonstrated moderate (κ = 0.41, 0.60) to substantial (κ = 0.61, 0.80) agreement. Quantitative measures of synovitis and effusion demonstrated good test-retest reliability (ICC2,1 0.71, 0.92). US measures of synovitis and effusion demonstrated low-to-moderate sensitivity to change (SRM -0.29, -0.50). The associations between changes in US measures and KOOS pain scores over time were low, and 95% confidence intervals included zero. CONCLUSION In a clinical setting, US measures of inflammatory features of knee OA have substantial reliability and low-to-moderate sensitivity to change, whereas measures of structural OA features are less reliable. Longitudinal construct validity of US measures of synovitis and effusion to KOOS pain scores is not strongly supported.
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Affiliation(s)
- Holly T Philpott
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Trevor B Birmingham
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Robert Dima
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Ryan Pinto
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - Dianne Bryant
- Bone and Joint Institute, University of Western Ontario and London Health Sciences Centre-University Hospital, London, Ontario, Canada
| | - C Thomas Appleton
- Bone and Joint Institute, Schulich School of Medicine and Dentistry, and London Health Sciences Centre-University Hospital, University of Western Ontario, London, Ontario, Canada
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15
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James G, Bryant D. 1463 One Urology Unit’s Experience With Holmium Laser Enucleation Of The Prostate(Holep). Br J Surg 2021. [DOI: 10.1093/bjs/znab259.1110] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Introduction
Holmium laser enucleation of the prostate (HoLEP) is a minimally invasive procedure for the management of Benign Prostatic Hyperplasia and Bladder Outlet Obstruction. The European Associations of Urologists (EAU) recommend HoLEP should be offered to patients with prostates measuring >30cc or who are anticoagulated
Aim
To review the outcomes of one-unit HoLEP procedures. Comparing the first third of patients to the final third of patients in a 183-patient cohort.
Method
We collected data retrospectively over 44-month period from 183 patients using electronic patient records. Outcomes measured; length of stay (los), length of time for catheter. Length of time of procedure. comparing the 1st 61 patient with the last 61 patients and reviewed rates of complications from HoLEP using the Clavien-Dindo classification
Results
The mean size of prostate was 83cc. 149 (81%) of patients had a LOS of £ 1 day. The mean length of catheter time 3.44 days. Mean length of operating time – 71 minutes. Length of time for the 1st 61 patients was 70.2 minutes compared with 73.1 minutes for last 61 patients. With regards to complications, 8 patient had Grade 3 however 0 patients had grade 4 or 5.
Conclusions
Patients undergo HoLEP procedure with Prostate size in keeping with EAU. This unit has a short length of stay post-op with low complication rate. HoLEP has a short post op catheter time.
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Affiliation(s)
- G James
- Sunderland Royal Hospital, Sunderland, United Kingdom
| | - D Bryant
- Sunderland Royal Hospital, Sunderland, United Kingdom
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16
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Sultana M, Campbell K, Jennings M, Montero-Odasso M, Orange JB, Knowlton J, St George A, Bryant D. Virtual Reality Experience Intervention May Reduce Responsive Behaviors in Nursing Home Residents with Dementia: A Case Series. J Alzheimers Dis 2021; 84:883-893. [PMID: 34602467 DOI: 10.3233/jad-210010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND People with advanced dementia often exhibit responsive behaviors such as apathy, depression, agitation, aggression, and psychosis. Non-pharmacological approaches (e.g., listening to music, watching television, doing arts and crafts) are now considered as a first-line strategy to manage responsive behaviors in clinical practice due to the potential risks associated with the antipsychotic medications. To date, no evaluations of immersive non-head mounted virtual reality (VR) experience as a non-pharmacologic approach for people with advanced dementia living in nursing homes have been reported. OBJECTIVE To evaluate the feasibility (acceptance and safety) of VR experience. METHODS A single site case series (nonrandomized and unblinded) with a convenience sample (N = 24; age = 85.8±8.6 years; Cognitive Performance Scale score = 3.4±0.6) measuring depression and agitation before and after the intervention. The intervention was a 30-min long research coordinator- facilitated VR experience for two weeks (10 sessions). RESULTS The intervention was feasible (attrition rate = 0% ; adverse events = 0). A reduction in depression and in agitation was observed after the intervention. However, we suggest extreme caution in interpreting this result considering the study design and small sample size. CONCLUSION This study provides the basis for conducting a randomized controlled trial to evaluate the effect of VR experience on responsive behaviors in nursing homes. Since our intervention uses a smart remote-controlled projector without a headset, infectious exposure can be avoided following the COVID-19 pandemic-induced physical distancing policy in care homes.
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Affiliation(s)
- Munira Sultana
- Health and Rehabilitation Sciences, Western University, London, ON, Canada.,Gait & Brain Lab, Parkwood Institute, London, ON, Canada
| | - Karen Campbell
- International Skin Tear Advisory Panel, Ottawa, ON, Canada.,Primacare Living Solutions Inc.TM, Toronto, ON, Canada.,Master of Clinical Science - Advanced Health Care Practice, Western University, London, ON, Canada
| | - Morgan Jennings
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Manuel Montero-Odasso
- Gait & Brain Lab, Parkwood Institute, London, ON, Canada.,Department of Medicine and Department of Epidemiology & Biostatistics, Western University, London, ON, Canada.,Geriatric Medicine, St. Joseph's Health Care, London, ON, Canada.,Lawson Health Research Institute, London, ON, Canada
| | - J B Orange
- Lawson Health Research Institute, London, ON, Canada
| | - Jill Knowlton
- Primacare Living Solutions Inc.TM, Toronto, ON, Canada
| | | | - Dianne Bryant
- Lawson Health Research Institute, London, ON, Canada.,School of Physical Therapy and Schulich School of Medicine & Dentistry (Orthopaedic Surgery), Western University, London, ON, Canada.,Health Research Methods, Evidence and Impact, McMaster University, Hamilton, ON, Canada
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MacDermid JC, Bryant D, Holtby R, Razmjou H, Faber K, Balyk R, Boorman R, Sheps D, McCormack R, Athwal G, Hollinshead R, Lo I, Bicknell R, Mohtadi N, Bouliane M, Glasgow D, Lebel ME, Lalani A, Moola FO, Litchfield R, Moro J, MacDonald P, Bergman JW, Bury J, Drosdowech D. Arthroscopic Versus Mini-open Rotator Cuff Repair: A Randomized Trial and Meta-analysis. Am J Sports Med 2021; 49:3184-3195. [PMID: 34524031 DOI: 10.1177/03635465211038233] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patients with complete rotator cuff tears who fail a course of nonoperative therapy can benefit from surgical repair. PURPOSE This randomized trial compared mini-open (MO) versus all-arthroscopic (AA) rotator cuff repair. STUDY DESIGN Randomized controlled trial; Level of evidence, 1. METHODS Patients with rotator cuff tears were randomized to undergo MO or AA repair at 9 centers by 23 surgeons. The primary outcome (Western Ontario Rotator Cuff Index [WORC]) and secondary outcomes (American Shoulder and Elbow Surgeons [ASES] score, Shoulder Pain and Disability Index [SPADI] pain subscale, 12-Item Short Form Health Survey [SF-12], reported medication use, adverse events), as well as measurements of range of motion and strength, were collected at 1 month before surgery; at 2 and 6 weeks postoperatively; and at 3, 6, 12, 18, and 24 months postoperatively. A blinded radiologist evaluated rotator cuff integrity on magnetic resonance imaging (MRI) at baseline and 1 year. Intention-to-treat analysis of covariance with the preoperative WORC score, age, and tear size as covariates assessed continuous outcomes. Sex differences were assessed. A meta-analysis synthesized the primary outcome between MO and AA repair with previous trials. RESULTS From 954 patients screened, 411 were ineligible (276 because of recovery with physical therapy), 449 were screened at surgery (175 ineligible), and 274 completed follow-up (138 MO and 136 AA). The AA and MO groups were similar before surgery. WORC scores improved from 40 preoperatively to 89 (AA) and 93 (MO) at 2 years, for an adjusted mean difference of 3.4 (95% CI, -0.4 to 7.2). There were no statistically significant differences between the AA and MO groups at any time point. All secondary patient-reported outcomes were not significantly different between the MO and AA groups, except the 2-year SPADI pain score (8 vs 12, respectively; P = .02). A similar recovery in range of motion and strength occurred in both groups over time. MRI indicated minimal improvement in muscle relative to fat (AA: n = 3; MO: n = 2), with most worsening (AA: n = 25; MO: n = 24) or remaining unchanged (AA: n = 70; MO: n = 70). Opioid use was significantly reduced after surgery (from 21% to 5%). The meta-analysis indicated no significant standardized mean difference between groups in the primary outcome across all pooled studies (standardized mean difference, -0.06 [95% CI, -0.34 to 0.22]). CONCLUSION Both AA and MO rotator cuff repair provide large clinical benefits, with few adverse events. There is strong evidence of equivalent clinical improvements. TRIAL REGISTRATION NCT00128076.
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Affiliation(s)
- Joy C MacDermid
- Departments of Surgery and Physical Therapy, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- Departments of Surgery and Physical Therapy, University of Western Ontario, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Richard Holtby
- Department of Orthopaedic Surgery, Holland Orthopaedic & Arthritic Centre, Toronto, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Helen Razmjou
- Department of Rehabilitation, Holland Orthopaedic & Arthritis Centre, Sunnybrook Research Institute, Toronto, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Kenneth Faber
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
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- Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Robert Balyk
- Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Richard Boorman
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - David Sheps
- Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Robert McCormack
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - George Athwal
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Robert Hollinshead
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Ian Lo
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Ryan Bicknell
- Department of Surgery, Queen's University, Kingston, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Nicholas Mohtadi
- Department of Surgery, University of Calgary, Calgary, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Martin Bouliane
- Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Donald Glasgow
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Marie-Eve Lebel
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Aleem Lalani
- Department of Surgery and Glen Sather Sports Medicine Clinic, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Farhad O Moola
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Robert Litchfield
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Jaydeep Moro
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Peter MacDonald
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - J W Bergman
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Jeff Bury
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
| | - Darren Drosdowech
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Health Care, London, Ontario, Canada.,Investigation performed at the University of Western Ontario, London, Ontario, Canada
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18
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Nazari G, Barton KI, Bryant D, Getgood A, Brown CH. Five- and six-strand hamstring grafts consistently produce appropriate graft diameters for anterior cruciate ligament reconstruction. Knee Surg Sports Traumatol Arthrosc 2021; 29:2940-2947. [PMID: 33037449 DOI: 10.1007/s00167-020-06313-w] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Accepted: 09/28/2020] [Indexed: 11/26/2022]
Abstract
PURPOSE Hamstring tendon graft diameter less than 8 mm has been correlated with an increased risk of anterior cruciate ligament reconstruction (ACLR) graft failure. The purpose of this study was to measure and compare the diameter of 3-, 4-, 5-, and 6-strand gracilis and semitendinosus (ST) hamstring tendon (HT) ACLR grafts, and to determine if there is a correlation between anthropometric data, HT length, and diameter of the HT ACLR graft. METHODS Male patients (n = 78) undergoing primary or revision ACLR with a HT autograft between July 2018 and March 2020 were recruited. Pre-operative anthropometric data was collected. Gracilis and ST tendons were harvested and the length and diameter measured. The following HT graft configurations were prepared in each patient: triple ST; double gracilis + double ST; double gracilis + triple ST; triple gracilis + triple ST. Paired t-tests and Pearson's correlation coefficients were used to assess demographics, anthropometrics, graft diameter, and tendon length. A non-parametric test was used to compare femoral and tibial ACL graft diameters of the 3-, 4-, 5-, and 6-strand HT graft configurations. RESULTS For the femoral end, 10%, 19%, 69% and 86% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5- and 6-strand HT graft configurations respectively. For the tibial end, 27%, 10%, 83%, and 92% of the patients achieved graft diameters of equal to or greater than 8 mm in 3-, 4-, 5-, and 6-strand HT graft configurations respectively. The largest increases in HT graft diameters were noted between the femoral end of 6- vs. 3-strand grafts (mean difference 1.7 ± 0.5 mm; p < 0.001) and between the tibial end of 6- vs. 4-strand grafts (mean difference 2.0 ± 0.5 mm; p < 0.001). Height and leg length were moderately positively correlated with ST tendon length (r = 0.54-0.51) and gracilis tendon length (r = 0.52-0.45), and thigh and shank lengths were moderately positively correlated with ST tendon length (r = 0.43 and 0.40, respectively). CONCLUSION Traditional 4-strand HT ACL autografts in male patients undergoing ACLR in the United Arab Emirates result in graft diameters less than 8 mm in the majority of patients. LEVEL OF EVIDENCE III.
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Affiliation(s)
| | - Kristen I Barton
- Western University, London, Canada
- Orthopaedic Surgery, London Health Sciences Centre, London, Canada
| | - Dianne Bryant
- Western University, London, Canada
- Fowler Kennedy Sports Medicine Clinic, London, Canada
| | - Alan Getgood
- Western University, London, Canada
- Orthopaedic Surgery, London Health Sciences Centre, London, Canada
- Fowler Kennedy Sports Medicine Clinic, London, Canada
- International Knee and Joint Centre, Abu Dhabi, United Arab Emirates
| | - Charles H Brown
- International Knee and Joint Centre, Abu Dhabi, United Arab Emirates.
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19
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Ziebart C, MacDermid J, Bryant D, Szekeres M, Suh N. Hands-Up program: protocol for a feasibility randomised controlled trial of a combined 6-week exercise and education intervention in adults aged 50-65 with a distal radius fracture. BMJ Open 2021; 11:e046122. [PMID: 34330854 PMCID: PMC8327851 DOI: 10.1136/bmjopen-2020-046122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
INTRODUCTION This pilot study will determine the feasibility of recruitment, retention and adherence for the online combined exercise and education programme (Hands-Up) compared with usual care. METHODS AND ANALYSIS The proposed randomised controlled trial will be a pilot feasibility study with a 1:1 randomisation to the Hands-Up programme or usual physical therapy. The programme setting is an online home exercise and education program. Outcome assessments will take place at the Roth|McFarlane Hand and Upper Limb Clinic in London, Ontario, which is a tertiary care academic centre. 74 people aged 50-65 years after distal radius fracture will be recruited. Purposeful recruitment will be conducted to include a sufficient number of men in the study. The Hands-Up program includes both exercise and education. Participants will engage in approximately 45 min of a full-body home exercise routine followed by 30 min of education in an online program. The educational modules will focus on fall prevention, nutrition for osteoporosis and learning about osteoporosis. Participants will engage in the program online, twice a week for 6 weeks. Outcomes will be assessed at baseline, 6 weeks and 3, 6 and 12 months. The primary outcome of the study is feasibility. The study will be considered feasible if participants attend >60% of the sessions, 74 participants are enrolled in 12 months and >75% of participants attend the final study visit. For the secondary outcome, physical and self-report outcomes will be assessed. ETHICS AND DISCUSSION This study has been approved by the institutional ethics review board. The viability of an online exercise and education program for people after distal radius fracture between the ages of 50 and 65 will be evaluated in an attempt to help better prevent, diagnose and manage osteoporosis. This study will be disseminated through peer-reviewed publications, international conferences and social media. TRIAL REGISTRATION NUMBER NCT03997682.
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Affiliation(s)
- Christina Ziebart
- Department of Physical Therapy, Western University, London, Ontario, Canada
| | - Joy MacDermid
- Department of Physical Therapy, Western University, London, Ontario, Canada
- St Joseph's Health Centre, London, Ontario, Canada
| | - Dianne Bryant
- Faculty of Health Sciences and Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | | | - Nina Suh
- St Joseph's Health Centre, London, Ontario, Canada
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20
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Lebedeva Y, Churchill L, Marsh J, MacDonald SJ, Giffin JR, Bryant D. Wait times, resource use and health-related quality of life across the continuum of care for patients referred for total knee replacement surgery. Can J Surg 2021; 64:E253-E264. [PMID: 33908239 PMCID: PMC8327991 DOI: 10.1503/cjs.003419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022] Open
Abstract
Background The escalating socioeconomic burden of knee osteoarthritis (OA) underscores the need for innovative strategies to reduce wait times for total knee arthroplasty (TKA). The purpose of this study was to evaluate resource use, costs and health-related quality of life (HRQoL) across the continuum of care for patients with knee OA. Methods This was a prospective study of 383 patients recruited from a high-volume teaching hospital at different stages of care (referral, consultation and presurgery). Outcomes included health care resource use; costs captured from the health care payer, private sector and societal perspectives; HRQoL measured using the Western Ontario and McMaster Universities Osteoarthritis Index, the 12-Item Short Form Health Survey, and EuroQoL 5-Dimension 5-Level tool; wait times; and the proportion of referrals deemed suitable candidates for surgery. Results The most commonly used conservative treatments were pharmacotherapy, exercise and lifestyle modification. Forty percent of patients referred for TKA were deemed not to be suitable candidates for surgery. The greatest proportion of costs was borne by the patient or private insurer; a small proportion was borne by the public payer. Across all stages of care, more than 60% of the total costs was attributed to productivity losses. HRQoL remained relatively stable throughout the waiting period (mean wait time from referral to TKA 13.2 mo) but improved postoperatively. Conclusion The suboptimal primary care management of knee OA calls for the development of innovative models of care. This study may provide valuable guidance on the design and implementation of a new online educational platform to improve referral efficiency and expedite wait times for TKA.
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Affiliation(s)
- Yekaterina Lebedeva
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - Laura Churchill
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - Jacquelyn Marsh
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - Steven J MacDonald
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - J Robert Giffin
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
| | - Dianne Bryant
- Health and Rehabilitation Sciences Program, Western University, London, Ont. (Lebedeva); School of Physical Therapy, Western University, London, Ont. (Churchill, Marsh, Bryant); Fowler Kennedy Sport Medicine Clinic, London, Ont. (Churchill, Giffin); Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (MacDonald, Giffin); University Hospital, London Health Sciences Centre, London, Ont. (MacDonald); Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Ont. (Bryant)
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21
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Ziebart C, Bobos P, Furtado R, MacDermid JC, Bryant D, Szekeres M, Suh N. The Efficacy of Fall Hazards Identification on Fall Outcomes: A Systematic Review With Meta-analysis. Arch Rehabil Res Clin Transl 2021; 2:100065. [PMID: 33543091 PMCID: PMC7853376 DOI: 10.1016/j.arrct.2020.100065] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
Objective To investigate the efficacy of fall hazards identification programs when compared to no intervention or other fall prevention programs on number of falls, falls incidence, and identifying fall hazards in community-dwelling adults. Data Sources CINAHL, PubMed, EMBASE, Scopus, and PsychINFO were used to identify articles. Study Selection Studies were selected to compare fall hazards identification programs to a control group. Studies were eligible if they were randomized controlled trials and enrolled adults older than 50 years with the incidence rate of falls as an outcome. Data Extraction Study or authors, year, sample characteristics, intervention or comparison groups, number of falls, and number of hazards identified in the intervention and control groups, and follow-up were extracted. The risk of bias assessment was performed using the Cochrane Risk of Bias tool. Quality was evaluated with Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach per outcome. Data Synthesis A total of 8 studies (N=8) and 5177 participants were included. There was a high risk of bias across the studies mostly due to improper blinding of personnel of the outcome assessor. Pooled estimate effects from 5 studies assessing the incidence rate of falls from 3019 individuals indicated no difference between fall hazards identification programs and control (incidence rate ratio=0.98; 95% confidence interval, 0.87-1.10). Conclusions The current study suggests that there may be a benefit for fall hazards programs in reducing incident falls. However, because of a moderate GRADE rating, more large-scale studies with a higher number of falls events and more consistent control groups are required to determine the true effect.
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Affiliation(s)
- Christina Ziebart
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Pavlos Bobos
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada.,Dalla Lana School of Public Health, Institute of Health Policy Management and Evaluation, Department of Clinical Epidemiology and Health Care Research, University of Toronto, Toronto, ON, Canada
| | - Rochelle Furtado
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada.,Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy C MacDermid
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada.,Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Health and Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
| | - Mike Szekeres
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
| | - Nina Suh
- Roth McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada
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22
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Lebedeva K, Bryant D, Docter S, Litchfield RB, Getgood A, Degen RM. The Impact of Resident Involvement on Surgical Outcomes following Anterior Cruciate Ligament Reconstruction. J Knee Surg 2021; 34:287-292. [PMID: 31461757 DOI: 10.1055/s-0039-1695705] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Hands-on participation in the operating room (OR) is an integral component of surgical resident training. However, the implications of resident involvement in many orthopaedic procedures are not well defined. This study aims to assess the effect of resident involvement on short-term outcomes following anterior cruciate ligament reconstruction (ACLR). The National Surgical Quality Improvement Program (NSQIP) database was queried to identify all patients who underwent ACLR from 2005 to 2012. Demographic variables, resident participation, 30-day complications, and intraoperative time parameters were assessed for all cases. Resident and nonresident cases were matched using propensity scores. Outcomes were analyzed using univariate and multivariate regression analyses, as well as stratified by resident level of training. Univariate analysis of 1,222 resident and 1,188 nonresident cases demonstrated no difference in acute postoperative complication rates between groups. There was no significant difference in the incidence of overall complications based on resident level of training (p = 0.109). Operative time was significantly longer for cases in which a resident was involved (109.5 vs. 101.7 minutes; p < 0.001). Multivariate analysis identified no significant predictors of major postoperative complications, while patient history of chronic obstructive pulmonary disease was the only independent risk factor associated with minor complications. Resident involvement in ACLR was not associated with 30-day complications despite a slight increase in operative time. These findings provide reassurance that resident involvement in ACLR procedures is safe, although future investigations should focus on long-term postoperative outcomes.
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Affiliation(s)
- Kate Lebedeva
- Department of Orthopedic Surgery, School of Physical Therapy, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Dianne Bryant
- Department of Orthopedic Surgery, School of Physical Therapy, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Shgufta Docter
- Department of Orthopedic Surgery, School of Physical Therapy, Schulich School of Medicine & Dentistry, Western University, London, Ontario, Canada
| | - Robert B Litchfield
- Fowler Kennedy Sport Medicine Clinic/Department of Surgery, Western University, London, Ontario, Canada
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic/Department of Surgery, Western University, London, Ontario, Canada
| | - Ryan M Degen
- Fowler Kennedy Sport Medicine Clinic/Department of Surgery, Western University, London, Ontario, Canada
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23
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Ziebart C, MacDermid J, Bobos P, Furtado R, MacDermid-Watts S, Bryant D, Szekeres M, Suh N. Fall Hazard Identification: A Scoping Review. Physical & Occupational Therapy In Geriatrics 2021. [DOI: 10.1080/02703181.2020.1806424] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Affiliation(s)
- Christina Ziebart
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Joy MacDermid
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Pavlos Bobos
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Rochelle Furtado
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Sara MacDermid-Watts
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
| | - Dianne Bryant
- Department of Rehabilitation Sciences, Faculty of Health Science, Western University, London, ON, Canada
- School of Physical Therapy, Faculty of Health Science, Western University, London, ON, Canada
- Collaborative Program in Musculoskeletal Health Research, Bone and Joint Institute, Western University, London, ON, Canada
| | - Mike Szekeres
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
| | - Nina Suh
- Roth
- McFarlane Hand and Upper Limb Centre, St. Joseph’s Hospital, London, ON, Canada
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24
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Churchill L, Lukacs MJ, Pinto R, Macdonald SJ, Giffin JR, Laliberte Rudman D, Bryant D. A qualitative dominant mixed methods exploration of novel educational material for patients considering total knee arthroplasty. Disabil Rehabil 2020; 44:3054-3061. [PMID: 33284645 DOI: 10.1080/09638288.2020.1851782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
PURPOSE To optimize non-operative management and decision making surrounding TKR we created educational whiteboard videos for patients with knee OA. The purpose of this study was to pilot our educational videos with end-users (patients) to determine patients' experiences and perspectives regarding the content and clarity of videos and to better understand their potential impact on patient's health behaviour. Materials and methods: This was a mixed methods evaluation, using a qualitative descriptive approach, of patients attending their first consultation with an arthroplasty surgeon for TKR. We conducted in-depth semi-structured interviews with patients. Three members of the research team coded data independently, implementing a thematic analysis. Results: Thirteen participants were included. Participants indicated that the videos enhanced their confidence and clarity surrounding their decision to undergo TKR. The videos also addressed several knowledge gaps in their understanding of OA management. Barriers to uptake of the education were identified including limited access to PTs and the challenge of weight loss. Conclusions: The current educational intervention was valued by patients with knee OA. Implementation of these videos may have important implications for patients, providers, and our health care system.IMPLICATIONS FOR REHABILITATIONPatients with knee OA referred by primary care physicians to arthroplasty surgeons have knowledge gaps that may influence their self-management and decision making surrounding their condition.Educational materials can address these gaps and support patients in their understanding and management of their condition, which may have important downstream implications.Barriers to accessing non-operative care including physiotherapy must be pre-emptively addressed to ensure that enhanced knowledge is met with improved access for patients.
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Affiliation(s)
- Laura Churchill
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Canada
| | - Michael J Lukacs
- Health and Rehabilitation Sciences, Western University, London, Canada
| | - Ryan Pinto
- Health and Rehabilitation Sciences, Western University, London, Canada
| | | | - J Robert Giffin
- Fowler Kennedy Sports Medicine Clinic, Western University, London, Canada
| | | | - Dianne Bryant
- Health and Rehabilitation Sciences, Western University, London, Canada.,Clinical Epidemiology & Biostatistics, McMaster University, Hamilton, Canada
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Docter S, Philpott HT, Godkin L, Bryant D, Somerville L, Jennings M, Marsh J, Lanting B. Comparison of intra and post-operative complication rates among surgical approaches in Total Hip Arthroplasty: A systematic review and meta-analysis. J Orthop 2020; 20:310-325. [PMID: 32494114 DOI: 10.1016/j.jor.2020.05.008] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 04/27/2020] [Accepted: 05/03/2020] [Indexed: 01/22/2023] Open
Abstract
Background Various surgical approaches exist for Total Hip Arthroplasty (THA), but approach specific complication rates remain unknown. The purpose of this systematic review and meta-analysis was to compare rates of common complications between surgical approaches. Methods Four electronic databases (Medline, Embase, AMED, Ovid Healthstar) were searched from inception to June 2019. Three pairs of reviewers were involved in determining eligibility, rating internal and external validity, and data extraction. Pooled estimates were generated using a random-effects model and relative risk (RR) was calculated for dislocation, intraoperative and early postoperative fracture, early infection, deep vein thrombosis (DVT), wound complication, and failure of implant ingrowth between four approaches (posterior, anterior, direct lateral, and anterolateral). Results Sixty-nine studies (n = 283,036) were included with nineteen randomized control trials, fourteen prospective cohort, and thirty-six retrospective cohort studies (included studies ranged from 1987 to 2019). When compared to the posterior approach, the risk for dislocation was significantly lower in the anterior (RR 0.66, 95% CI 0.54-0.77, p < 0.01), anterolateral (RR 0.50, 95% CI 0.32-0.77, p = 0.03) and lateral (RR 0.74, 95% CI 0.58-0.96, p = 0.02). When compared to the posterior approach, we found higher risk of loosening in the anterolateral (RR 1.89, 95% CI 1.59-2.25, p < 0.01) and lateral (RR 1.21, 95% CI 1.02-1.44, p = 0.03). Overall, evidence was deemed very low and low-quality following GRADE assessment. Conclusion Our findings reveal that the posterior approach was associated with a higher risk of dislocation (compared to the anterior, lateral, and anterolateral) but lower risk of loosening (compared to the lateral and anterolateral approach). However, the large number of cohorts and imprecision due to low sample size for most pooled comparisons was still insufficient to confidently conclude that one approach is superior to another. Each approach has its own strengths and weaknesses, and surgeons can use the approach they are most comfortable with.
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Affiliation(s)
- Shgufta Docter
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Holly T Philpott
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Laura Godkin
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Lyndsay Somerville
- London Health Sciences Centre, Department of Orthopaedic Surgery, London, Ontario, Canada
| | - Morgan Jennings
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Jacquelyn Marsh
- Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Brent Lanting
- Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,London Health Sciences Centre, Department of Orthopaedic Surgery, London, Ontario, Canada
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Sultana M, Bryant D, Orange J, Beedie T, Montero-Odasso M. Effect of Wii Fit© Exercise on Balance of Older Adults with Neurocognitive Disorders: A Meta-Analysis. J Alzheimers Dis 2020; 75:817-826. [DOI: 10.3233/jad-191301] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Affiliation(s)
- Munira Sultana
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Dianne Bryant
- School of Physical Therapy and Schulich School of Medicine and Dentistry (Orthopaedic Surgery), Western University; Health Research Methods, Evidence and Impact, McMaster University; Lawson Health Research Institute, London, ON, Canada
| | - J.B. Orange
- School of Communication Science and Disorders and Canadian Centre for Activity and Aging, Western University; Lawson Health Research Institute, London, ON, Canada
| | - Taylor Beedie
- Health and Rehabilitation Sciences, Western University, London, ON, Canada
| | - Manuel Montero-Odasso
- Geriatric Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, London, ON, Canada
- Gait and Brain Lab, Parkwood Institute, Lawson Health Research Institute, London, ON, Canada
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27
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Getgood A, Hewison C, Bryant D, Litchfield R, Heard M, Buchko G, Hiemstra LA, Willits KR, Firth A, MacDonald P. No Difference in Functional Outcomes When Lateral Extra-Articular Tenodesis Is Added to Anterior Cruciate Ligament Reconstruction in Young Active Patients: The Stability Study. Arthroscopy 2020; 36:1690-1701. [PMID: 32147485 DOI: 10.1016/j.arthro.2020.02.015] [Citation(s) in RCA: 39] [Impact Index Per Article: 9.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2019] [Revised: 02/05/2020] [Accepted: 02/12/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To assess the functional outcomes of patients included in the Stability Study randomized controlled trial comparing anterior cruciate ligament reconstruction (ACLR) alone with ACLR with lateral extra-articular tenodesis (LET) at 6, 12, and 24 months postoperatively. METHODS Six hundred eighteen patients undergoing ACLR, all under the age of 25 years either returning to contact pivoting sport or displaying signs of high-grade rotatory laxity or generalized ligamentous laxity, were randomly assigned to receive ACLR alone or ACLR plus LET. A total of 356 of these patients were randomized at centers participating in the functional assessments. Our primary outcome was Limb Symmetry Index, calculated using a series of 4-hop tests at 6, 12, and 24 months postoperatively. Secondary outcome measures included pain, patient-reported function, and isokinetic strength testing. RESULTS We found no statistically significant difference in the proportion of patients either unwilling or unfit to complete the hop testing in the ACLR alone or ACLR with LET group at 6 months (40 vs 40 respectively; P = 1.00), 12 months (25 vs 27; P = .76), and 24 months (21 vs 23; P = .87). Of those who completed hop testing, there were no statistically significant differences between groups in Limb Symmetry Index at 6, 12, or 24 months. Self-reported function (Lower Extremity Functional Score) significantly favored the ACLR alone group at 3 (P = .01) and 6 months (P = .02) postoperative but was similar by 12 months postoperative. Pain scores (P4) also showed a statistically significant difference in favor of the ACL alone group, but this also resolved by 6 months. Quadriceps peak torque (P = .03) and average power (P = .01) were also significantly different in favor of the ACLR alone group at 6 months postoperative; however, these were similar between groups by 12 months postoperative (P = .11 and P = .32, respectively). CONCLUSIONS The addition of a LET to ACLR results in slightly increased pain, a mild reduction in quadriceps strength, and reduced subjective functional recovery up to 6 months postoperatively. However, these differences do not have any impact on objective function as measured by hop test limb symmetry index. LEVEL OF EVIDENCE I, Randomized Controlled Trial.
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Affiliation(s)
- Alan Getgood
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada; London Health Sciences Centre, London, Ontario, Canada.
| | | | - Dianne Bryant
- Lawson Health Research Institute, London, Ontario, Canada; Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Robert Litchfield
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Mark Heard
- Banff Sport Medicine, Banff, Alberta, Canada
| | - Greg Buchko
- Banff Sport Medicine, Banff, Alberta, Canada
| | | | - Kevin R Willits
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Andrew Firth
- Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada; Lawson Health Research Institute, London, Ontario, Canada
| | - Peter MacDonald
- Pan Am Clinic, University of Manitoba, Winnipeg, Manitoba, Canada
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28
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Feldsine PT, Falbo-Nelson MT, Brunelle SL, Forgey RL, Al-Hasani S, Ball C, Beatty S, Blanchfield B, Bowen B, Bremer N, Brookman D, Brookman S, Brushaber M, Bryant J, Bryant D, Bryant R, Chlebowski ET, Copeland F, Culak DA, Dalley E, Destro C, Finkenbiner D, Frissora R, Fung DYC, Garcia GR, Gray MR, Hagen CJ, Harshavardhan T, Hart-Thakur R, Inami G, Johnson S, Kandakai LV, Lessard D, Lin S, Liu V, Matiuck S, McAteer L, Miller L, Moon B, Nasri H, Pack L, Pilot K, Price C, Pruett P, Ramirez C, Richter D, Schmieg JA, Schultz G, Sloan EM, Sprague DM, Tebay D, Tomer J, Tuncan E, Warburton D, Watson M, West D. Assurance Enzyme Immunoassay for Detection of Enterohemorrhagic Escherichia coli 0157:H7 in Selected Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.530] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Five foods types were analyzed by the Assurance EHEC (Escherichia coli 0157:H7) enzyme immunoassay (EIA) and by the Bacteriological Analytical Manual (BAM) culture method. Each sample of each food type at each inoculation level was simultaneously analyzed by both methods. A total of 21 laboratories representing state and federal government agencies and private industry in the United States and Canada participated. Samples were inoculated with E. coli 0157:H7, except for one lot of poultry that was naturally contaminated. A total of 1304 samples and controls were analyzed and confirmed, of which 473 were positive and 818 were negative by both methods. Thirteen samples were positive by BAM but negative by EIA. Because of the study design, it was not possible for the BAM method to produce false-negative or falsepositive results. The Assurance method for detection of E. coli OI57:H7 in selected foods has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
| | | | | | - Robin L Forgey
- BioControl Systems, Inc., 19805 N. Creek Parkway, Bothell, WA 98011
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29
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Entis P, Bryant D, Bryant J, Bryant RG, Inami G, Cholensky JS, Garcia GR, Ramsey SM, Courtney T, Pruett WP, Dagdag EB, Davis-DeBella PE, San D, Humes LM, Lau D, Watson J, Erickson J, Hayes M, Ingham S, Sage J, Jirele K, Zuroski K, Kelley G, Lerner I, Patel DR, Peery DA, Simpso S, Zachary C. Direct 24-Hour Presumptive Enumeration of Escherichia coli 0157:H7 in Foods Using Hydrophobic Grid Membrane Filter Followed by Serological Confirmation: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/81.2.403] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
abstract
Fifteen laboratories took part in a collaborative study to validate a method for enumerating Escherichia coli 0157:H7. The method is based on use of a hydrophobic grid membrane filter and consists of 24 h presumptive enumeration on SD-39 Agar and serological confirmation to yield a confirmed E. coli 0157:H7 count. Six food products were analyzed: pasteurized apple cider, pasteurized 2% milk, cottage cheese, cooked ground pork, raw ground beef, and frozen whole egg. The test method produced significantly higher confirmed count results than did the reference method for milk, pork, and beef. Test method results were numerically higher than but statistically equivalent to reference method results for cheese, cider, and egg. The test method produced lower repeatability and reproducibility values than did the reference method for most food/inoculation level combinations and values very similar to those of the reference method for the remaining combinations. Overall, 94% of presumptive positive isolates from the test method were confirmed serologically as E. coli 0157:H7, and 98% of these were also biochemically typical of E. coli 0157:H7 (completed test). Corresponding rates for the reference method were 69 and 98%, respectively. On the basis of the results of this collaborative study and the precollaborative study that preceded it, it is recommended that this method be adopted official first action for enumeration of E. coli 0157:H7 in meats, poultry, dairy foods, infant formula, liquid eggs, mayonnaise, and apple cider
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Affiliation(s)
- Phyllis Entis
- QA Life Sciences, Inc., 6645 Nancy Ridge Dr, San Diego, CA 92121
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30
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Feldsine PT, Albo-Nelson MT, Brunelle SL, Forgey RL, Al-Hasani S, Ball C, Beatty S, Blanchfield B, Bowen B, Bremer N, Brookman D, Brookman S, Brushaber M, Bryant J, Bryant D, Bryant R, Chlebowski ET, Copeland F, Culak DA, Dalley E, Destro C, Finkenbiner D, Frissora R, Fung DYC, Garcia GR, Gray MR, Hagen CJ, Harshavardhan T, Hart-Thakur R, Inami G, Johnson S, Kandakai LV, Lessard D, Lin S, Liu V, Matiuck S, McAteer L, Miller L, Moon B, Nasri H, Pack L, Pilot K, Price C, Pruett P, Ramirez C, Richter D, Schmieg JA, Schultz G, Sloan EM, Sprague DM, Tebay D, Tomer J, Tuncan E, Warburton D, Watson M, West D. Visual Immunoprecipitate Assay (VIP) for Detection of Enterohemorrhagic Escherichia coli (EHEC) 0157:H7 in Selected Foods: Collaborative Study. J AOAC Int 2020. [DOI: 10.1093/jaoac/80.3.517] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
Five foods representative of a variety of food products were analyzed by the Visual Immunoprecipitate Assay (VIP) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli 0157: H7. A total of 21 laboratories representing state and federal government agencies, as well as private industry, in the United States and Canada participated. Food types were inoculated with strains of E. coli 0157:H7, with the exception of one lot of poultry, which was naturally contaminated. During this study, a total of 1377 samples and controls were analyzed and confirmed, of which 508 were positive and 867 were negative by both methods. Two samples were positive by BAM and negative by VIP. Because of the study design, it was not possible for the BAM method to produce false-negative or false-positive results. The VIP assay for detection of EHEC in selected foods has been adopted first action by AOAC INTERNATIONAL.
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Affiliation(s)
| | | | | | - Robin L Forgey
- BioControl Systems, Inc., 19805 N. Creek Parkway, Bothell, WA 98011
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Hughes D, Dailianis AE, Hill L, Curiale MS, Gangar V, Arnold D, Barrat C, Baxter T, Bell J, Brooks R, Bryant D, Burke K, Burnie A, Cliffard D, Danisavich T, Daniels K, Deiss K, D’Onorio A, Faucher K, Finkenbiner D, Gasanov U, Gebler J, Gerry A, Graham D, Graham T, Harris P, Hetrick S, Jurgens J, Keating KJ, Klokman R, Le C, Matrozza M, McCarthy R, McCawley C, Munyard S, Pye V, Rajkowski K, Ristov K, Rosinko J, Schneider K, Schubert MJ, Sloan E, Souter, Wilson M, Zuroski K. Salmonella in Foods: New Enrichment Procedure for TECRA Salmonella Visual Immunoassay Using a Single RV(R10) Only, TT Only, or Dual RV(R10) and TT Selective Enrichment Broths (AOAC Official Method 998.09): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.4.775] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Abstract
A collaborative study was conducted to compare a new enrichment procedure for the TECRA® Salmonella Visual Immunoassay (TSVIA) with the reference method given in the U.S. Food and Drug Administration's Bacteriological Analytical Manual (7th Ed.). Three food types (milk powder, pepper, and soy flour) were analyzed in Australia and 3 food types (milk chocolate, dried egg, and raw turkey) were analyzed in the United States. Thirty-eight collaborators participated in the study. The TECRA method was evaluated using both Rappaport-Vassiliadis R10 (RV(R10)) and tetrathionate (TT) broths for selective enrichment. M broth cultures arising from each of the 2 selective enrichment broths were tested in the TSVIA using 2 individual wells, one for each selective broth, and a single well to test the pooled selective enrichment broths. The results for the pooled enrichment broths were reported elsewhere. This study presents the results for the use of single enrichment broths, i.e., RV(R10) only or TT only, with the TSVIA. No significant differences (p > 0.05) were observed for the pairwise comparison of the proportion of positive samples for either RV(R10) or TT used as a single enrichment broth for the TSVIA with that for the reference method.
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Affiliation(s)
- Denise Hughes
- TECRA International, 13 Rodborough Rd, Frenchs Forest, NSW 2086, Australia
| | - Angela E Dailianis
- TECRA International, 13 Rodborough Rd, Frenchs Forest, NSW 2086, Australia
| | - Louise Hill
- TECRA International, 13 Rodborough Rd, Frenchs Forest, NSW 2086, Australia
| | - Michael S Curiale
- Silliker Laboratories Group, Research Services, Halsted St, Chicago Heights, IL 60430
| | - Vidhya Gangar
- Silliker Laboratories Group, Research Services, Halsted St, Chicago Heights, IL 60430
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32
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Hughes D, Dailianis A, Duncan L, Briggs J, McKintyre DA, Silbernagel K, Anderson G, Anderson J, Bannach B, Barratt C, Booyens C, Briggs J, Brooks R, Bryant D, Burnie A, Carver C, Chambers D, Chong J, Clarke D, Coates E, Comontofski G, Deiss K, Destro C, Dillon J, Duncan L, Dundas M, Dymond N, Dziedziczak D, Eglezos S, Gasanov U, Gebler J, Graham T, Haley E, Johnson L, Kurien S, Maczuga J, Matera J, Matthew K, Munyard S, Ramine A, Reed J, Remes A, Subasinghe N, Tan A, Tan J, Tatum M, Taylor M, Torrance H, Twohy C, Vialpando M, Watts K. Modification of Enrichment Protocols for TECRA Listeria Visual Immunoassay Method 995.22: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/86.2.340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A collaborative study was conducted to validate new enrichment methods for the TECRA Listeria Visual Immunoassay (TLVIA). These new methods incorporate a newly formulated medium, TECRA Listeria Enrichment Broth, which does not contain the highly toxic antifungal agent, cycloheximide. The new procedures will provide an alternative to the enrichment procedures described in AOAC Method 995.22. Three food types (raw ground beef, lettuce, and ice cream) were analyzed in the United States, and 2 food types (cooked turkey and cooked fish fillets) were analyzed in Australasia. Thirty collaborators participated in the study, 16 in Australasia and 14 in the United States. With the exception of one batch of ground beef, comparison of the proportion of positive test portions (p ≥ 0.05) showed no significant difference between the TLVIA and the reference method for the 5 foods at 3 inoculation levels. For the one batch of naturally contaminated raw ground beef, the TLVIA gave significantly more confirmed positive results than the reference method.
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Affiliation(s)
- Denise Hughes
- TECRA International, 13 Rodborough Rd, French’s Forest, NSW 2086, Australia
| | - Angela Dailianis
- TECRA International, 13 Rodborough Rd, French’s Forest, NSW 2086, Australia
| | - Louise Duncan
- TECRA International, 13 Rodborough Rd, French’s Forest, NSW 2086, Australia
| | - Julie Briggs
- TECRA International, 13 Rodborough Rd, French’s Forest, NSW 2086, Australia
| | | | - Karen Silbernagel
- rtech laboratories, Lexington Ave, N. Arden Hills, Minneapolis, MN 55126
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33
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Lindberg KG, Lindberg KG, Kinneberg KM, Lindberg KG, Batterson D, Bobb R, Boleszczuk P, Brudvig S, Bryant D, Bryce J, Buckner K, Bulthaus M, DeJesus J, Ellis K, Finkenbiner D, Fleming S, Follni-Lieder E, Harper C, Ihrke P, Johnson K, King J, Langridge M, Maycock L, McAteer L, McCann T, Otten N, Robbins R, Sass A, Saunders L, Schop R, Strand S, Tebay D, VanWinkle J, Wolowski C. Dry Rehydratable Film Method for Rapid Enumeration of Coliforms in Foods (3M™ Petrifilm™ Rapid Coliform Count Plate): Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/85.1.56] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
A rehydratable dry-film plating method for coliforms in foods, the 3M™ Petrifilm™ Rapid Coliform Count plate method, was compared with the U.S. Food and Drug Administration's Bacteriological Analytical Manual method for nondairy foods and the American Public Health Association's Standard Methods for the Examination of Dairy Products (SMEDP) method for dairy foods. Six food types, vanilla ice cream, cheddar cheese, fresh refrigerated uncooked pasta, wheat flour, prepared frozen macaroni and cheese, and frozen hash browns, were analyzed for coliforms by 11 collaborating laboratories. For each food product tested, the collaborators received 8 blind samples consisting of a control sample and 3 levels of inoculated sample, each in duplicate. The mean log counts for the methods were comparable. The repeatability and reproducibility variances of the Petrifilm Rapid Coliform Count method at 14 and 24 h were not significantly different from those of the standard methods.
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Bird CB, Hoerner RJ, Restaino L, Anderson G, Birbari W, Bodra L, Brookman D, Bryant D, Campbell C, Degraft-Hanson J, Fetviet D, Forde R, Goins D, Hajkowski S, Haley E, Holland R, Jones J, Joseph JM, Kallewaard N, Keckeissen J, Kirkbride T, Kusch S, Noel D, Nutsch A, Okolo C, Parks K, Raines D, Remes A, Roach V, Robbins R, Rodrick G, Shelef L, Theissen H, Vasavada PC, Wang T. Comparison of the Reveal 20-Hour Method and the BAM Culture Method for the Detection of Escherichia coli O157:H7 in Selected Foods and Environmental Swabs: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.3.737] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
Abstract
Four different food types along with environmental swabs were analyzed by the Reveal for E. coli O157:H7 test (Reveal) and the Bacteriological Analytical Manual (BAM) culture method for the presence of Escherichia coli O157:H7. Twenty-seven laboratories representing academia and private industry in the United States and Canada participated. Sample types were inoculated with E. coli O157:H7 at 2 different levels. Of the 1095 samples and controls analyzed and confirmed, 459 were positive and 557 were negative by both methods. No statistical differences (p <0.05) were observed between the Reveal and BAM methods.
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Affiliation(s)
| | | | - Lawrence Restaino
- R&F Laboratories, 245 W. Roosevelt Rd, Bldg 3, Unit 17, West Chicago, IL 60185
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35
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Bird CB, Hoerner RJ, Restaino L, Anderson G, Birbari W, Bodra L, Brookman D, Bryant D, Campbell C, Degraft-Hanson J, Fetviet D, Forde R, Goins D, Hajkowski S, Haley E, Holland R, Jones J, Joseph JM, Kallewaard N, Keckeissen J, Kirkbride T, Kusch S, Noel D, Nutsch A, Okolo C, Parks K, Raines D, Remes A, Roach V, Robbins R, Rodrick G, Shelef L, Theissen H, Vasavada PC, Wang T. Reveal 8-Hour Test System for Detection of Escherichia coli O157:H7 in Raw Ground Beef, Raw Beef Cubes, and Iceberg Lettuce Rinse: Collaborative Study. J AOAC Int 2019. [DOI: 10.1093/jaoac/84.3.719] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Abstract
Five different food types were analyzed by the Reveal for E. coli O157:H7 8-Hour Test System (Reveal 8) and either the U.S. Food and Drug Administration's Bacteriological Analytical Manual (BAM) culture method or the U.S. Department of Agriculture Food Safety Inspection Service (FSIS) culture method for the presence of E. coli O157:H7. A total of 27 laboratories representing academia and private industry in the United States and Canada participated. Food types were inoculated with E. coli O157:H7 at 2 different levels: a high level where predominantly positive results were expected, and a low level where fractional recovery was anticipated. During this study, 1110 samples and controls were analyzed by both the Reveal 8 and by BAM or FSIS by each of the collaborators (2220 samples in total). For each set of samples, 740 were artificially inoculated with E. coli O157:H7, and 370 were uninoculated controls. The Reveal 8 detected 528 presumptive positives of which 487 were confirmed positive by the BAM culture method. In comparison, BAM and FSIS detected 489 of the 740 artificially contaminated samples as positive. In an additional in-house study performed only on chilled and frozen raw ground beef, 240 artificially inoculated samples were analyzed by both the Reveal 8 and by FSIS. The Reveal 8 detected and confirmed 104 samples as positive compared to 79 confirmed positive by FSIS.
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Affiliation(s)
| | | | - Lawrence Restaino
- R&F Laboratories, 245 W. Roosevelt Rd, Bldg 3, Unit 17, West Chicago, IL 60185
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Abstract
INTRODUCTION There has been considerable interest in the direct anterior (DA) approach to total hip arthroplasty (THA) recently. To facilitate exposure of the proximal femur it is sometimes necessary to release the conjoint tendon. AIM To prospectively investigate whether release of the conjoint tendon has an impact on gait in the early postoperative period. METHODS We measured gait velocity, stride length, single-limb support and single-limb support symmetry preoperatively, at discharge from the hospital, and 2, 6 and 12 weeks and postoperatively. Participants also completed the Timed Up and Go and a series of questionnaires (WOMAC, SF-12, Harris Hip Score, and pain VAS) at each visit. RESULTS 36 participants undergoing a DA THA with a single surgeon were enrolled in this study. 22 participants had a release of the conjoint tendon during their surgery. We found no differences between the groups for any gait, patient-reported or surgical outcomes (p < 0.05). There was a total of 3 complications reported in the release group, and 1 complication in the group that did not have a release. CONCLUSION Although the conjoint tendon has an important role in the biomechanics of the hip, we found release of the conjoint tendon during the DA approach for THA to have no impact on gait or patient reported outcomes within 12 weeks post-surgery. Therefore, if the exposure of the proximal femur is limited, a low threshold for release of the conjoint tendon is recommended to improve visualisation.
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Affiliation(s)
- Bryn O Zomar
- London Health Sciences Centre, London, ON, Canada.,Western University, London, ON, Canada
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Morcos MW, Lanting BA, Webster J, Howard JL, Bryant D, Teeter MG. Effect of Medial Soft Tissue Releases During Posterior-Stabilized Total Knee Arthroplasty on Contact Kinematics and Patient-Reported Outcomes. J Arthroplasty 2019; 34:1110-1115. [PMID: 30917888 DOI: 10.1016/j.arth.2019.02.026] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/13/2018] [Revised: 02/03/2019] [Accepted: 02/14/2019] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND Minimal to extensive medial soft tissue releases are part of the exposure and achieving adequate varus knee balance in total knee arthroplasty (TKA). However, the effect of these releases on knee kinematics and patient-reported outcomes is unclear. Our objective was to compare the postoperative in vivo tibiofemoral contact kinematics of a posterior-stabilized TKA between patients who received minimal medial soft tissue releases intraoperatively to those who received extensive releases. We also compared these groups using patient-reported outcomes. METHODS A prospective imaging study was performed in a single-center over a 14-month period. Patients with end-stage osteoarthritis and varus deformity undergoing primary TKA were included. Baseline data were collected 1 month before surgery. The radiostereometric analysis imaging took place at least 1 year postoperatively and composed of weight-bearing radiographic stereo examinations of knee flexion starting in full extension and in 20° increments of flexion to a maximum of 120°. Intraoperative medial soft tissue releases were recorded. Patient-reported outcomes used included Short-Form 12, Western Ontario and McMaster Osteoarthritis Index, and Knee Society Score. RESULTS Fifty-one patients were included in the statistical analysis. Demographic characteristics were similar between all. Patients were divided into 3 groups depending on the amount of releases they received. No statistically significant differences in tibiofemoral contact positions or excursions on the medial or lateral condyles were found throughout flexion from 0° to 120°. Postoperative patient-reported outcome scores were not different. CONCLUSION Correcting severe varus deformities with extensive medial soft tissue release largely did not alter knee kinematics or clinical outcome scores compared to those with minimal soft tissue release.
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Affiliation(s)
- Mina W Morcos
- Bone and Joint Institute, Western University, London, Ontario, Canada; Division of Surgery, Department of Orthopaedics, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Brent A Lanting
- Bone and Joint Institute, Western University, London, Ontario, Canada; Division of Surgery, Department of Orthopaedics, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Jared Webster
- Bone and Joint Institute, Western University, London, Ontario, Canada; Division of Surgery, Department of Orthopaedics, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - James L Howard
- Bone and Joint Institute, Western University, London, Ontario, Canada; Division of Surgery, Department of Orthopaedics, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- Bone and Joint Institute, Western University, London, Ontario, Canada; Division of Surgery, Department of Orthopaedics, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Matthew G Teeter
- Bone and Joint Institute, Western University, London, Ontario, Canada; Division of Surgery, Department of Orthopaedics, London Health Sciences Centre, London, Ontario, Canada; Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Getgood A, Bryant D, Firth A. The Stability study: a protocol for a multicenter randomized clinical trial comparing anterior cruciate ligament reconstruction with and without Lateral Extra-articular Tenodesis in individuals who are at high risk of graft failure. BMC Musculoskelet Disord 2019; 20:216. [PMID: 31092226 PMCID: PMC6521537 DOI: 10.1186/s12891-019-2589-x] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2019] [Accepted: 04/25/2019] [Indexed: 12/22/2022] Open
Abstract
Background The purpose of anterior cruciate ligament reconstruction (ACLR) is to restore stability to the knee. Persistent rotational laxity following ACLR has been correlated with poor outcome and graft failure. We hypothesize that anterolateral complex reconstruction by way of a Modified Lemaire Lateral Extra-articular Tenodesis (LET) in combination with single bundle ACLR would reduce the risk of persistent rotatory laxity in young individuals who are deemed as being at high risk of failure. We will conduct a pragmatic, multicenter, randomized clinical trial comparing standard single bundle hamstring ACLR with combined ACLR and LET. Methods Six-hundred patients (300 per group) aged 25 years or less with an ACL deficient knee that meet two of the following three criteria will be included: 1) Grade 2 pivot shift or greater; 2) Returning to high risk cutting or pivoting sports; 3) Generalized ligamentous laxity. Participants will be seen at 3-months, 6-months, 12-months and 24-months post-operatively. The primary outcome measure is graft failure requiring revision ACLR or symptomatic instability associated with a positive asymmetric pivot shift indicating persistent rotational laxity. Patients will complete secondary outcome measures at each follow-up visit including patient-reported outcome measures, functional and biomechanical testing, and magnetic resonance imaging. Discussion This protocol is the first adequately powered randomized clinical trial investigating the effects of augmenting ACLR with an LET in patients at high-risk of graft failure. The successful completion of this trial has the potential to change surgical practice and provide evidence for the role of the LET in ACLR. Trial registration The trial is registered at ClinicalTrials.gov: NCT02018354, 23-12-2013.
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Affiliation(s)
- Alan Getgood
- Orthopaedic Sport Medicine Fellowship Director, Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, 1151 Richmond St., London, ON, N6A 3K7, Canada
| | - Dianne Bryant
- Faculty of Health Sciences, Elborn College, University of Western Ontario, Room 1438, 1201 Western Rd, London, ON, N6C 1H1, Canada
| | - Andrew Firth
- Fowler Kennedy Sport Medicine Clinic, 3M Centre, University of Western Ontario, 1151 Richmond St, London, ON, N6A 3K7, Canada.
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Siddiqi A, Forte SA, Docter S, Bryant D, Sheth NP, Chen AF. Perioperative Antibiotic Prophylaxis in Total Joint Arthroplasty: A Systematic Review and Meta-Analysis. J Bone Joint Surg Am 2019; 101:828-842. [PMID: 31045673 DOI: 10.2106/jbjs.18.00990] [Citation(s) in RCA: 57] [Impact Index Per Article: 11.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The 2017 U.S. Centers for Disease Control and Prevention (CDC) guidelines for the prevention of surgical site infection (SSI) recommended against continuation of antibiotics postoperatively after total joint arthroplasty. This is disconcerting, as the revised guidelines are based on only 6 orthopaedic studies, of which 83% (5 of 6) were published from 1987 to 1991. The purpose of the current study was to conduct a systematic review and meta-analysis of the literature regarding the efficacy and duration of surgical antibiotic prophylaxis (SAP) in total joint arthroplasty. METHODS PubMed, Ovid MEDLINE, and Ovid Embase were screened for "surgical antimicrobial prophylaxis orthopedic," in accordance with PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines, without a specified time frame with respect to publication date. A total of 693 studies were screened, and 32 studies were evaluated. Data were extracted regarding antibiotic type, number of doses, and duration. Prospective and retrospective studies examining perioperative antibiotics with subsequent SSI and periprosthetic joint infection (PJI) rates in total joint arthroplasty were included. RESULTS Twenty-three randomized controlled trials (RCTs) and 2 prospective cohort, 3 retrospective cohort, and 4 case-control studies with a total of 51,627 patients were included in this review. The overall pooled effect for the comparison between a single preoperative dose of antibiotic and continued (preoperative plus postoperative) administration was 0.96 (95% confidence interval [CI], 0.73 to 1.26), suggesting no difference in effect. However, the 95% CI for the relative risk would include a reduction of approximately 27% in either group. The overall pooled effect from the comparison between SAP of ≤24 and >24 hours postoperatively demonstrated no difference in effect. All included studies were underpowered and heterogenous regarding type of antibiotic used and duration. CONCLUSIONS Our review confirms the benefit of SAP utilization in total joint arthroplasty. The available evidence does not show added benefit of postoperative SAP or continuation beyond 24 hours. However, the overall GRADE (Grading of Recommendations Assessment, Development and Evaluation) of evidence of the available literature was low (high risk of bias, high risk of publication bias, and low precision). The findings of this study demonstrate the need for Level-I studies with adequate power to evaluate the safety of shortened SAP duration after total joint arthroplasty and its effect on SSI/PJI prior to widespread implementation. LEVEL OF EVIDENCE Therapeutic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Ahmed Siddiqi
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Salvador A Forte
- Department of Orthopaedic Surgery, Philadelphia College of Osteopathic Medicine, Philadelphia, Pennsylvania
| | - Shgufta Docter
- School of Physical Therapy (S.D. and D.B.) and Department of Surgery, Schulich School of Medicine & Dentistry (D.B.), Western University, London, Ontario, Canada
| | - Dianne Bryant
- School of Physical Therapy (S.D. and D.B.) and Department of Surgery, Schulich School of Medicine & Dentistry (D.B.), Western University, London, Ontario, Canada.,Department of Health Research Methods, Evidence, and Impact, Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Neil P Sheth
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Antonia F Chen
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Churchill L, Pollock M, Lebedeva Y, Pasic N, Bryant D, Howard J, Lanting B, Laliberte Rudman D. Optimizing outpatient total hip arthroplasty: perspectives of key stakeholders. Can J Surg 2019; 61:370-376. [PMID: 30265638 DOI: 10.1503/cjs.016117] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Advances in surgical techniques combined with multimodal analgesia and early rehabilitation have potentiated early mobilization in patients undergoing total hip arthroplasty (THA). Given an increasing push from patients to accelerate recovery and health care budgetary limitations, there has been growing interest in the implementation of outpatient THA in selected patients. Understanding the patient and primary caregiver experience of outpatient THA is important to optimize care. We aimed to gain insight into patient and caregiver perspectives regarding the perceived advantages and disadvantages of same-day discharge to identify areas of care that can be improved. METHOD Using a qualitative descriptive approach, we conducted in-depth semistructured interviews with patient-primary caregiver dyads who experienced same-day discharge or standard care after primary THA with the direct anterior approach in 2016-2017. Two members of the research team coded the data independently, implementing a thematic and content analysis. RESULTS Twenty-eight participants (16 same-day discharge, 12 standard care) were included. Both groups experienced high levels of satisfaction with their care pathway. Concerns and challenges identified in both groups pertained to mobility, pain, self-care and caregiver support. Challenges and concerns unique to same-day discharge were identified regarding expectations for recovery, medications and their impact on mobility, the timing of postoperative education and the availability of formal care. CONCLUSION Outpatient THA can be implemented with high patient and caregiver satisfaction. Preoperative education, clarification of recovery processes and expectations, and proactively addressing concerns related to caregiving are important.
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Affiliation(s)
- Laura Churchill
- From Western University, London, Ont. (Churchill, Pollock, Lebedeva); the School of Physical Therapy, Western University, London, Ont. (Bryant); the Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Howard, Lanting, Pasic); and the School of Occupational Therapy, Western University, London, Ont. (Laliberte Rudman)
| | - Michael Pollock
- From Western University, London, Ont. (Churchill, Pollock, Lebedeva); the School of Physical Therapy, Western University, London, Ont. (Bryant); the Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Howard, Lanting, Pasic); and the School of Occupational Therapy, Western University, London, Ont. (Laliberte Rudman)
| | - Yekaterina Lebedeva
- From Western University, London, Ont. (Churchill, Pollock, Lebedeva); the School of Physical Therapy, Western University, London, Ont. (Bryant); the Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Howard, Lanting, Pasic); and the School of Occupational Therapy, Western University, London, Ont. (Laliberte Rudman)
| | - Nicholas Pasic
- From Western University, London, Ont. (Churchill, Pollock, Lebedeva); the School of Physical Therapy, Western University, London, Ont. (Bryant); the Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Howard, Lanting, Pasic); and the School of Occupational Therapy, Western University, London, Ont. (Laliberte Rudman)
| | - Dianne Bryant
- From Western University, London, Ont. (Churchill, Pollock, Lebedeva); the School of Physical Therapy, Western University, London, Ont. (Bryant); the Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Howard, Lanting, Pasic); and the School of Occupational Therapy, Western University, London, Ont. (Laliberte Rudman)
| | - James Howard
- From Western University, London, Ont. (Churchill, Pollock, Lebedeva); the School of Physical Therapy, Western University, London, Ont. (Bryant); the Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Howard, Lanting, Pasic); and the School of Occupational Therapy, Western University, London, Ont. (Laliberte Rudman)
| | - Brent Lanting
- From Western University, London, Ont. (Churchill, Pollock, Lebedeva); the School of Physical Therapy, Western University, London, Ont. (Bryant); the Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Howard, Lanting, Pasic); and the School of Occupational Therapy, Western University, London, Ont. (Laliberte Rudman)
| | - Debbie Laliberte Rudman
- From Western University, London, Ont. (Churchill, Pollock, Lebedeva); the School of Physical Therapy, Western University, London, Ont. (Bryant); the Division of Orthopaedic Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ont. (Howard, Lanting, Pasic); and the School of Occupational Therapy, Western University, London, Ont. (Laliberte Rudman)
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Seselgyte R, Bryant D, Demetriou C, Ishida M, Peskett E, Moreno N, Morrogh D, Sell D, Lees M, Farrall M, Moore GE, Sommerlad B, Pauws E, Stanier P. Disruption of FOXF2 as a Likely Cause of Absent Uvula in an Egyptian Family. J Dent Res 2019; 98:659-665. [PMID: 30917284 DOI: 10.1177/0022034519837245] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
This study investigated the genetic basis of an unusual autosomal dominant phenotype characterized by familial absent uvula, with a short posterior border of the soft palate, abnormal tonsillar pillars, and velopharyngeal insufficiency. Cytogenetic analysis and single-nucleotide polymorphism-based linkage analysis were investigated in a 4-generation family with 8 affected individuals. Whole exome sequencing data were overlaid, and segregation analysis identified a single missense variant, p.Q433P in the FOXF2 transcription factor, that fully segregated with the phenotype. This was found to be in linkage disequilibrium with a small 6p25.3 tandem duplication affecting FOXC1 and GMDS. Notably, the copy number imbalances of this region are commonly associated with pathologies that are not present in this family. Bioinformatic predictions with luciferase reporter studies of the FOXF2 missense variant indicated a negative impact, affecting both protein stability and transcriptional activation. Foxf 2 is expressed in the posterior mouse palate, and knockout animals develop an overt cleft palate. Since mice naturally lack the structural equivalent of the uvula, we demonstrated FOXF2 expression in the developing human uvula. Decipher also records 2 individuals with hypoplastic or bifid uvulae with copy number variants affecting FOXF2. Nevertheless, given cosegregation with the 6p25.3 duplications, we cannot rule out a combined effect of these gains and the missense variant on FOXF2 function, which may account for the rare palate phenotype observed.
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Affiliation(s)
- R Seselgyte
- 1 Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - D Bryant
- 1 Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - C Demetriou
- 1 Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - M Ishida
- 1 Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - E Peskett
- 1 Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - N Moreno
- 2 Developmental Biology and Cancer, UCL GOS Institute of Child Health, London, UK
| | - D Morrogh
- 3 NE Thames Regional Genetics Service Laboratory, Great Ormond Street Hospital NHS Trust, London, UK
| | - D Sell
- 4 North Thames Cleft Centre, St Andrew's Centre, Broomfield Hospital, Chelmsford, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - M Lees
- 4 North Thames Cleft Centre, St Andrew's Centre, Broomfield Hospital, Chelmsford, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK.,5 Department of Clinical Genetics, Great Ormond Street Hospital NHS Trust, London, UK
| | - M Farrall
- 6 Wellcome Trust Centre for Human Genetics, University of Oxford, Oxford, UK
| | - G E Moore
- 1 Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
| | - B Sommerlad
- 4 North Thames Cleft Centre, St Andrew's Centre, Broomfield Hospital, Chelmsford, UK; Great Ormond Street Hospital for Children NHS Foundation Trust, London, UK
| | - E Pauws
- 2 Developmental Biology and Cancer, UCL GOS Institute of Child Health, London, UK
| | - P Stanier
- 1 Genetics and Genomic Medicine, UCL GOS Institute of Child Health, London, UK
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Marriott K, Birmingham TB, Pinto R, Primeau C, Bryant D, Degen R, Giffin JR. Gait biomechanics after combined HTO-ACL reconstruction versus HTO alone: A matched cohort study. J Orthop Res 2019; 37:124-130. [PMID: 30303555 DOI: 10.1002/jor.24157] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 09/24/2018] [Indexed: 02/04/2023]
Abstract
The purpose of the present study was to compare bilateral external knee moments during gait in patients with concomitant medial compartment knee OA, varus alignment and chronic anterior cruciate ligament (ACL) deficiency who underwent either medial opening-wedge high tibial osteotomy alone (HTO) or simultaneous HTO and ACL reconstruction (HTO-ACLR). Fifty-two patients (26 matched pairs) completed 3D gait analysis preoperatively and at a minimum 5 years postoperatively. Patients were matched for preoperative age, sex, body mass index and magnitude of correction. Primary outcomes selected a priori were the peak knee adduction moment (KAM) and knee flexion (KFM) moment during stance. Moments were compared using mixed model repeated measures analysis of variance (ANOVA). For the peak KAM, there was a significant time by limb interaction. For both groups, there were similar reductions in the peak KAM 5 years postoperatively in the surgical limb only [-1.34 %BW × Ht (-1.71, -0.96) and -1.72 %BW × Ht (-1.99, -1.44) for HTO and HTO-ACLR, respectively]. For the peak KFM, there was a significant time by group by limb interaction. There was a decrease in the peak KFM 5 years postoperatively in the HTO group [-0.88 %BW × Ht (-1.45, -0.31)] but not in the HTO-ACLR group [0.03 %BW × Ht (-0.43, 0.48)]. These results suggest that individuals with medial knee OA, varus alignment and chronic ACL deficiency who undergo simultaneous medial opening-wedge HTO and ACL reconstruction may not experience the same long-term (5 year) changes in sagittal plane knee biomechanics observed in patients undergoing HTO alone. © 2018 Orthopaedic Research Society. Published by Wiley Periodicals, Inc. J Orthop Res.
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Affiliation(s)
- Kendal Marriott
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada
| | - Trevor B Birmingham
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Ryan Pinto
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Codie Primeau
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada
| | - Dianne Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - Ryan Degen
- The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
| | - J Robert Giffin
- Wolf Orthopaedic Biomechanics Laboratory, Fowler Kennedy Sport Medicine Clinic, University of Western Ontario, London, Ontario, Canada.,The Bone and Joint Institute, University of Western Ontario, London, Ontario, Canada.,Schulich School of Medicine and Dentistry, University of Western Ontario, London, Ontario, Canada
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Beattie WS, Wijeysundera DN, Chan MTV, Peyton PJ, Leslie K, Paech MJ, Sessler DI, Wallace S, Myles PS, Galagher W, Farrington C, Ditoro A, Baulch S, Sidiropoulos S, Bulach R, Bryant D, O’Loughlin E, Mitteregger V, Bolsin S, Osborne C, McRae R, Backstrom M, Cotter R, March S, Silbert B, Said S, Halliwell R, Cope J, Fahlbusch D, Crump D, Thompson G, Jefferies A, Reeves M, Buckley N, Tidy T, Schricker T, Lattermann R, Iannuzzi D, Carroll J, Jacka M, Bryden C, Badner N, Tsang MWY, Cheng BCP, Fong ACM, Chu LCY, Koo EGY, Mohd N, Ming LE, Campbell D, McAllister D, Walker S, Olliff S, Kennedy R, Eldawlatly A, Alzahrani T, Chua N, Sneyd R, McMillan H, Parkinson I, Brennan A, Balaji P, Nightingale J, Kunst G, Dickinson M, Subramaniam B, Banner-Godspeed V, Liu J, Kurz A, Hesler B, Fu AY, Egan C, Fiffick AN, Hutcherson MT, Turan A, Naylor A, Obal D, Cooke E. Implication of Major Adverse Postoperative Events and Myocardial Injury on Disability and Survival. Anesth Analg 2018. [DOI: 10.1213/ane.0000000000003310] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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Zomar BO, Bryant D, Hunter S, Howard JL, Vasarhelyi EM, Lanting BA. A randomised trial comparing spatio-temporal gait parameters after total hip arthroplasty between the direct anterior and direct lateral surgical approaches. Hip Int 2018; 28:478-484. [PMID: 29781289 DOI: 10.1177/1120700018760262] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Total hip arthroplasty (THA) is a successful procedure for relieving symptoms of severe osteoarthritis. Surgical approach is a key factor in early recovery and although controversial, little has been written about the direct anterior (DA) approach using objective early measures. METHODS 78 participants were prospectively enrolled to undergo a THA through either a DA or direct lateral (DL) surgical approach. Outcome measures were collected preoperatively and at discharge from the hospital, and 2-, 6- and 12-weeks. Outcome measures included the GAITRite® system to measure gait velocity, stride length, single-limb support and single-limb support symmetry. At each time point participants also completed the Timed Up and Go (TUG), the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), 12-Item Short-Form Survey (SF-12), Harris Hip Score, and pain visual analog scale (VAS). RESULTS We found statistically significant differences in gait velocity at discharge, 2-weeks and 6-weeks in favour of the DA group (all p < 0.01). We also found significant differences in favour of the DA group for single-limb support symmetry at 6-weeks ( p < 0.01) and 12-weeks ( p < 0.01). The time to complete the TUG test was also significantly shorter in the DA group at 2-weeks ( p < 0.01) and 6-weeks ( p < 0.01) compared to the DL group. However, there were no statistically significant differences in any of the patient-reported outcomes. CONCLUSION The DA surgical approach was found to offer significant early advantages in function compared to the DL group, with no differences in quality of life or pain.
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Affiliation(s)
- Bryn O Zomar
- 1 London Health Sciences Centre, London, Ontario, Canada.,2 Western University, London, Ontario, Canada
| | | | | | - James L Howard
- 1 London Health Sciences Centre, London, Ontario, Canada
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Murphy CA, Houghton P, Brandys T, Rose G, Bryant D. The effect of 22.5 kHz low-frequency contact ultrasound debridement (LFCUD) on lower extremity wound healing for a vascular surgery population: A randomised controlled trial. Int Wound J 2018; 15:460-472. [PMID: 29334176 PMCID: PMC7949649 DOI: 10.1111/iwj.12887] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2017] [Revised: 11/27/2017] [Accepted: 12/04/2017] [Indexed: 12/19/2022] Open
Abstract
The aim of this study was to compare changes in wound size and appearance and health complication rates in patients with vasculopathy and lower-extremity wounds treated with or without low-frequency contact ultrasound debridement (LFCUD) This study was a randomised controlled trial. The study was conducted in a vascular surgery service, including outpatient wound clinic and inpatient ward, in a tertiary care academic centre. In total, 70 patients with vasculopathy and lower-extremity wounds of mixed aetiology were enrolled in the trial; 68 completed the study. Patients were randomised to receive LFCUD plus usual care (n = 33) or usual care (n = 37) at 4 weekly visits, and were followed thereafter for up to 12 wk. The main outcome measures included closed wounds, change in wound surface area (WSA), and wound appearance by the revised Photographic Wound Assessment Tool (revPWAT). After 4 weekly LFCUD treatments, patients in the LFCUD group had significantly better wound appearance (total revPWAT score) compared with the control group treated only with usual care (P = <0.05). LFCUD-treated wounds also had a significant reduction in WSA over 4 wk that was not found in the UC group. LFCUD treatment was also associated with a greater number of healed wounds, odds ratio 5.00 (95% CI 1.24-20.25), and fewer instances of wound deterioration. Weekly LFCUD applications to patients with significant vasculopathy resulted in superior healing outcomes when compared with current usual wound care practice.
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Affiliation(s)
- Christine Anne Murphy
- The Ottawa Hospital: Limb Preservation ProgramOttawaCanada
- Faculty of Health Rehabilitation SciencesWestern UniversityLondonCanada
| | - Pamela Houghton
- Faculty of Health Rehabilitation SciencesWestern UniversityLondonCanada
| | - Tim Brandys
- The Ottawa Hospital: Limb Preservation ProgramOttawaCanada
| | - Gregory Rose
- The Ottawa Hospital: Limb Preservation ProgramOttawaCanada
- Faculty of Health Rehabilitation SciencesWestern UniversityLondonCanada
| | - Dianne Bryant
- Faculty of Health Rehabilitation SciencesWestern UniversityLondonCanada
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Brouwer B, Bryant D, Garland SJ. Effectiveness of Client-Centered "Tune-Ups" on Community Reintegration, Mobility, and Quality of Life After Stroke: A Randomized Controlled Trial. Arch Phys Med Rehabil 2018; 99:1325-1332. [PMID: 29412167 DOI: 10.1016/j.apmr.2017.12.034] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/21/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To explore the effectiveness of a 2-week client-centered rehabilitation intervention (tune-up) delivered 6 months after inpatient discharge on community reintegration at 1 year in people with stroke. DESIGN A multicenter randomized controlled trial with 2 groups: an intervention ("tune-up") group and a control group having the same exposure to assessment. SETTING Three research laboratories. PARTICIPANTS Participants (N=103) with hemiparetic stroke recruited from inpatient rehabilitation units at the time of discharge. INTERVENTIONS Participants randomized to the tune-up group received 1-hour therapy sessions in their home 3times/wk for 2 weeks at 6 months postdischarge focusing on identified mobility-related goals. A second tune-up was provided at 12 months. MAIN OUTCOME MEASURES Community reintegration measured by the Subjective Index of Physical and Social Outcome at 12 months and secondary outcomes included the Berg Balance Scale and measures of mobility and health-related quality of life up to 15 months. RESULTS At 12 months, both groups showed significant improvement in community reintegration (P<.05), a trend evident at all time points, with no difference between groups (mean difference, -0.5; 95% confidence interval, -1.8 to 2.7; P=.68). Similarly, a main effect of time reflected improvement in mobility-related and quality of life outcomes for both groups (P≤.0.5), but no group differences (P≥.30). CONCLUSIONS All participants in the tune-up group met or exceeded at least 1 mobility-related goal; however, the intervention did not differentially improve community reintegration. The improvements in mobility and quality of life over the 15-month postdischarge period may be secondary to high activity levels in both study groups and exposure to regular assessment.
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Affiliation(s)
- Brenda Brouwer
- School of Rehabilitation Therapy, Queen's University, Kingston, Ontario, Canada.
| | - Dianne Bryant
- School of Physical Therapy, Western University, London, Ontario, Canada
| | - S Jayne Garland
- School of Physical Therapy, Western University, London, Ontario, Canada; Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
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Varahra A, Rodrigues IB, MacDermid JC, Bryant D, Birmingham T. Exercise to improve functional outcomes in persons with osteoporosis: a systematic review and meta-analysis. Osteoporos Int 2018; 29:265-286. [PMID: 29306984 DOI: 10.1007/s00198-017-4339-y] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/31/2017] [Accepted: 12/04/2017] [Indexed: 11/29/2022]
Abstract
UNLABELLED Osteoporosis affects many aspects of daily life. The aim of this systematic review was to assess the effects of exercise interventions on functional outcomes in persons with osteoporosis, in comparison with controls. METHODS Four databases were searched and yielded 1587 citations. Two reviewers independently determined study eligibility, rated risk of bias, appraised methodological quality of studies, and resolved discordance by consensus. RESULTS A total of 28 studies examining 2113 participants met inclusion criteria; 25 studies were suitable for meta-analyses. Four categories of exercise were identified using the ProFaNE taxonomy. After removing studies with high risk of bias and sorting them into intervention sub-types, we were able to sufficiently reduce the heterogeneity. The standardized mean difference (SMD) favored multicomponent exercise for mobility (- 0.56, 95% CI [- 0.81, - 0.32], p = 0.06, I2 = 51%); balance (0.50, 95% CI [0.27, 0.74], p = 0.28, I2 = 21%); and self-reported measures of functioning (- 0.69, 95% CI [- 1.04, - 0.34], p = 0.02, I2 = 61%). Trials were judged at low or unclear risk of selection bias, indicating inadequate reporting and at high risk of performance bias due to lack of participant blinding. The mean methodological quality rating of the studies was 63.5% indicating moderate quality. CONCLUSIONS A multicomponent exercise program of high-speed training combined with simulated functional tasks is promising to enhance functional outcomes. Due to substantial clinical heterogeneity of the target groups and specific demands of exercise modes, it is unclear which exercise program is optimal.
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Affiliation(s)
- A Varahra
- University of Western Ontario Health and Rehabilitation Sciences, 1151 Richmond St., London, ON, N6A 3K7, Canada.
| | - I B Rodrigues
- University School of Rehabilitation Science, 1400 Main Street W, IAHS 308, Hamilton, ON, L8S 4K1, Canada
| | - J C MacDermid
- School of Physical Therapy, 1151 Richmond St., London, ON, N6A 3K7, Canada
| | - D Bryant
- School of Physical Therapy, 1151 Richmond St., London, ON, N6A 3K7, Canada
| | - T Birmingham
- School of Physical Therapy, 1151 Richmond St., London, ON, N6A 3K7, Canada
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Birmingham TB, Moyer R, Leitch K, Chesworth B, Bryant D, Willits K, Litchfield R, Fowler PJ, Giffin JR. Changes in biomechanical risk factors for knee osteoarthritis and their association with 5-year clinically important improvement after limb realignment surgery. Osteoarthritis Cartilage 2017; 25:1999-2006. [PMID: 28888904 DOI: 10.1016/j.joca.2017.08.017] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2016] [Revised: 07/18/2017] [Accepted: 08/30/2017] [Indexed: 02/02/2023]
Abstract
OBJECTIVE To evaluate 5-year outcomes after lower limb realignment and test the hypothesis that surgery-induced changes in selected biomechanical risk factors for medial knee osteoarthritis (OA) are associated with clinically important improvements. DESIGN We prospectively evaluated patient-reported outcomes, full-limb standing radiographs and gait biomechanics before, 6 months (surgery-induced change) and 5 years after medial opening wedge high tibial osteotomy (HTO) in 170 patients (46.4 ± 8.9 years, 135 males) with knee OA and varus alignment. Logistic regression tested the associations of 6-month changes in mechanical axis angle and knee adduction moment with achieving an increase of ≥10 points in the Knee injury and Osteoarthritis Outcome Score (KOOS)4 at 5 years, with and without adjusting for covariates. Gait data were also compared to existing data from healthy controls. RESULTS Mean 5-year changes (95% confidence interval (CI)) were: KOOS4: +14.2 (10.8, 17.6); mechanical axis angle: +8.21° (7.58, 8.83); knee adduction moment: -1.49 %BW*Ht (-1.35, -1.63). The postoperative knee adduction moments were typically lower than values for healthy controls. When divided into quartiles, although all strata improved significantly, patients with reductions in knee adduction moment of 1.14-1.74 %BW*Ht (neither largest nor smallest changes) had highest 5-year KOOS4 scores. The 6-month change in knee adduction moment (odds ratios (OR) = 0.38; 95% CI: 0.22, 0.67), preoperative KOOS4 (OR = 0.96; 95% CI: 0.94, 0.99) and preoperative medial tibiofemoral narrowing grade (OR = 0.62; 95% CI: 0.37, 1.00) were negatively associated with having a 5-year clinically important improvement (C-statistic = 0.70). CONCLUSIONS Substantial improvements in biomechanical risk factors and patient-reported outcomes are observed 5 years after medial opening wedge HTO. The surgery-induced change in load distribution during walking is significantly associated with long-term clinically important improvement.
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Affiliation(s)
- T B Birmingham
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - R Moyer
- School of Physiotherapy, Faculty of Health Professions, Dalhousie University, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - K Leitch
- Department of Physiology and Pharmacology, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - B Chesworth
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - D Bryant
- School of Physical Therapy, Faculty of Health Sciences, University of Western Ontario, Canada; Department of Epidemiology and Biostatistics, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - K Willits
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - R Litchfield
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - P J Fowler
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
| | - J R Giffin
- Department of Surgery, Schulich School of Medicine and Dentistry, University of Western Ontario, Canada; Fowler Kennedy Sport Medicine Clinic, London Health Sciences Centre, Ontario, Canada; Bone and Joint Institute, University of Western Ontario, Canada.
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Somerville LE, Willits K, Johnson AM, Litchfield R, LeBel ME, Moro J, Bryant D. Clinical Assessment of Physical Examination Maneuvers for Superior Labral Anterior to Posterior Lesions. Surg J (N Y) 2017; 3:e154-e162. [PMID: 29018839 PMCID: PMC5629079 DOI: 10.1055/s-0037-1606829] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2016] [Accepted: 08/08/2017] [Indexed: 01/02/2023] Open
Abstract
Purpose
Shoulder pain and disability pose a diagnostic challenge owing to the numerous etiologies and the potential for multiple disorders to exist simultaneously. The evidence to support the use of clinical tests for superior labral anterior to posterior complex (SLAP) is weak or absent. The purpose of this study is to determine the diagnostic validity of physical examination maneuvers for SLAP lesions by performing a methodologically rigorous, clinically applicable study.
Methods
We recruited consecutive new shoulder patients reporting pain and/or disability. The physician took a history and indicated their certainty about each possible diagnosis (“certain the diagnosis is absent/present,” or “uncertain requires further testing”). The clinician performed the physical tests for diagnoses where uncertainty remained. Magnetic resonance imaging arthrogram and arthroscopic examination were the gold standards. We calculated sensitivity, specificity, and likelihood ratios (LRs) and investigated whether combinations of the top tests provided stronger predictions.
Results
Ninety-three patients underwent physical examination for SLAP lesions. When using the presence of a SLAP lesion (Types I–V) as disease positive, none of the tests was sensitive (10.3–33.3) although they were moderately specific (61.3–92.6). When disease positive was defined as repaired SLAP lesion (including biceps tenodesis or tenotomy), the sensitivity (10.5–38.7) and specificity (70.6–93.8) of tests improved although not by a substantial amount. None of the tests was found to be clinically useful for predicting repairable SLAP lesions with all LRs close to one. The compression rotation test had the best LR for both definitions of disease (SLAP tear present = 1.8 and SLAP repaired = 1.67). There was no optimal combination of tests for diagnosing repairable SLAP lesions, with at least two tests positive providing the best combination of measurement properties (sensitivity 46.1% and specificity 64.7%).
Conclusion
Our study demonstrates that the physical examination tests for SLAP lesions are poor diagnostic indicators of disease. Performing a combination of tests will likely help, although the magnitude of the improvement is minimal. These authors caution clinicians placing confidence in the physical examination tests for SLAP lesions rather we suggest that clinicians rely on diagnostic imaging to confirm this diagnosis.
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Affiliation(s)
- Lyndsay E Somerville
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Kevin Willits
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Andrew M Johnson
- School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada
| | - Robert Litchfield
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Marie-Eve LeBel
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada
| | - Jaydeep Moro
- Department of Surgery, Division of Orthopaedic Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Dianne Bryant
- Department of Surgery, Schulich School of Medicine & Dentistry, The University of Western Ontario, London, Ontario, Canada.,School of Health Studies, Faculty of Health Sciences, The University of Western Ontario, London, Ontario, Canada.,Department of Clinical Epidemiology & Biostatistics, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Lording T, Corbo G, Bryant D, Burkhart TA, Getgood A. Erratum to: Rotational Laxity Control by the Anterolateral Ligament and the Lateral Meniscus Is Dependent on Knee Flexion Angle: A Cadaveric Biomechanical Study. Clin Orthop Relat Res 2017; 475:2613. [PMID: 28770530 PMCID: PMC5599418 DOI: 10.1007/s11999-017-5459-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
| | - Gillian Corbo
- Anatomy and Cell Biology, Schulich School of Medicine and Dentistry, Western University, London, ON, Canada
| | - Dianne Bryant
- Faculty of Health Sciences, Western University, London, ON, Canada
| | - Timothy A Burkhart
- Lawson Health Research Institute, London, ON, Canada
- Departments of Surgery and Mechanical Engineering, Western University, London, ON, Canada
| | - Alan Getgood
- Fowler Kennedy Sport Medicine Clinic, Western University, 3M Centre, 1151 Richmond Street, London, ON, N6A 3K7, Canada.
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