Weight-bearing in Trauma Surgery (WiTS) Study: A national survey of UK Trauma & Orthopaedic multidisciplinary health professionals

INTRODUCTION

Weight-bearing (WB) status following a fracture or surgical fixation is an important determinant of the mechanical environment for healing. In order for healthcare professionals to communicate and understand the extent of bearing weight through a limb, clear terminology must be used. There is widespread variation in the usage and definitions of WB terminology in the literature and clinical practice. This study sought to define the understanding and extent of variation across the United Kingdom.

METHODS

A nationwide online survey of UK-based Trauma & Orthopaedic (T&O) multidisciplinary healthcare professionals was conducted. Participants answered seven questions assessing their usage and understanding of various WB terminology.

RESULTS

A total of 707 responses were received: 48% by doctors, 32% by physiotherapists, 13% by occupational therapists and 7% from other healthcare professionals. In terms of understanding of WB terminology with respect to percentage body weight (BW), 89% of respondents interpret 'full WB' as 100% BW, 97% interpret 'non WB' as 0% BW, 80% interpret 'partial WB' as 50% BW, and 89% interpret 'touch/toe-touch WB' as 10% or 20% BW. There were statistically significant differences between the responses of doctors and therapists for these four terms, with doctors tending to give higher %BW values. 'Protected WB' and 'WB as tolerated' had less consensus and more variability in responses. The majority (68%) of respondents do not usually quantify terminology such as 'partial WB' with a value, and 94% agreed that standardisation of WB terminology would improve communication amongst professionals.

CONCLUSION

This study provides evidence of the substantial variation in the understanding of WB terminology amongst healthcare professionals, which likely results in ambiguous rehabilitation advice. Existing literature has shown that patients struggle to comply with terms such as 'partial weight-bearing'. We recommend consensus within the T&O multidisciplinary community to standardise and define common weight-bearing terminology.

Counterdiagnosis and the critical medical humanities: reading Susanna Kaysen's Girl, Interrupted and Lauren Slater's Lying: A Metaphorical Memoir

This article is about the complicated intersections of mental illness, diagnosis and narrative in life writing. It analyses challenges posed to the authority of diagnosis-both as medical label and mode of reading-within two memoirs about mental illness and celebrates the ensuing literary innovation in each text. As such, this article is situated as part of the continuing move within the critical medical humanities to develop more sophisticated readings of illness narratives and emphasises the importance of the role of literary studies to achieve this aim. Borrowing from and expanding Margaret Price's concept of the counterdiagnostic as a tool that challenges a reader's urge to explain, clarify and contain a narrator with mental disabilities, I will read Susanna Kaysen's Girl, Interrupted (1993) and Lauren Slater's Lying: A Metaphorical Memoir (2001) as two texts that challenge the organising structures of medical authority as they are manifested in diagnostic processes. In so doing I will reflect on the work of illness narratives and the force of the diagnostic moment, understood as a violent misreading of the expressions of mental illness in texts. My readings of these memoirs demonstrate how the material locations and political aesthetics of counterdiagnosis undermine the limited figuration of narrative offered by much work in narrative medicine, and deconstruct diagnosis, both in a medical and literary capacity. Counterdiagnosis is, then, posited as a crucial means of further opening up the analysis of illness narratives, specifically those of mental distress.

Participation motivation of Australian children involved in organized sport

The purpose of the present study was to examine the participation motives of Australian youth involved in a number of sports, determine any sport differences, and compare the results with North American findings. Four hundred and four male and female youths from 8 to 18 years of age and from five sports participated in the study. Subjects responded to a 27-item sport participation motive questionnaire. Responses indicated that the most important reasons for participation in sport were 'to improve skills,' 'be physically fit,' 'compete,' 'learn new skills; and 'to be challenged.' These reasons were similar to North American findings except for the absence of 'fun' in Australian data. Male and female responses were similar, thus supporting previous research. However, significant differences emerged as a function of age and sport. Younger participants endorsed extrinsic and social motives to a greater degree than older participants. Swimmers considered 'having fun,' 'being with friends,' 'action' and 'excitement' as all of significantly less importance than participants from other sports. Factor analyses suggested four dimensions of participation motivation. These were labelled 'team/achievement,' 'situational,' 'status' and 'fitness.' Factor structures varied in several important instances compared with North American data. This study generally supports previous North American findings, but does suggest cultural differences in participation motivation as well as sport and age differences.