Does pre-operative psychological distress affect patient satisfaction after primary total hip arthroplasty?

<p>Abstract</p> <p>Background</p> <p>There are concerns that pre-operative psychological distress might be associated with reduced patient satisfaction after total hip replacement (THR).</p> <p>Methods</p> <p>We investigated this in a multi-centre prospective study between January 1999 and January 2002. We dichotomised the patients into the mentally distressed (MHS ≤ 56) and the not mentally distressed (MHS > 56) groups based on their pre-operative Mental Health Score (MHS) of SF36.</p> <p>Results</p> <p>448 patients (340 not distressed and 108 distressed) completed the patient satisfaction survey. Patient satisfaction rate at five year was 96.66% (415/448). There was no difference in patient satisfaction or willingness to have the surgery between the two groups. None of pre-operative variables predicted five year patient satisfaction in logistic regression.</p> <p>Conclusions</p> <p>Patient satisfaction after surgery may not be adversely affected by pre-operative psychological distress.</p

Foot orthoses and physiotherapy in the treatment of patellofemoral pain syndrome: A randomised clinical trial

<p>Abstract</p> <p>Background</p> <p>Patellofemoral pain syndrome is a highly prevalent musculoskeletal overuse condition that has a significant impact on participation in daily and physical activities. A recent systematic review highlighted the lack of high quality evidence from randomised controlled trials for the conservative management of patellofemoral pain syndrome. Although foot orthoses are a commonly used intervention for patellofemoral pain syndrome, only two pilot studies with short term follow up have been conducted into their clinical efficacy.</p> <p>Methods/design</p> <p>A randomised single-blinded clinical trial will be conducted to investigate the clinical efficacy and cost effectiveness of foot orthoses in the management of patellofemoral pain syndrome. One hundred and seventy-six participants aged 18–40 with anterior or retropatellar knee pain of non-traumatic origin and at least six weeks duration will be recruited from the greater Brisbane area in Queensland, Australia through print, radio and television advertising. Suitable participants will be randomly allocated to receive either foot orthoses, flat insoles, physiotherapy or a combined intervention of foot orthoses and physiotherapy, and will attend six visits with a physiotherapist over a 6 week period. Outcome will be measured at 6, 12 and 52 weeks using primary outcome measures of usual and worst pain visual analogue scale, patient perceived treatment effect, perceived global effect, the Functional Index Questionnaire, and the Anterior Knee Pain Scale. Secondary outcome measures will include the Lower Extremity Functional Scale, McGill Pain Questionnaire, 36-Item Short-Form Health Survey, Hospital Anxiety and Depression Scale, Patient-Specific Functional Scale, Physical Activity Level in the Previous Week, pressure pain threshold and physical measures of step and squat tests. Cost-effectiveness analysis will be based on treatment effectiveness against resource usage recorded in treatment logs and self-reported diaries.</p> <p>Discussion</p> <p>The randomised clinical trial will utilise high-quality methodologies in accordance with CONSORT guidelines, in order to contribute to the limited knowledge base regarding the clinical efficacy of foot orthoses in the management of patellofemoral pain syndrome, and provide practitioners with high-quality evidence upon which to base clinical decisions.</p> <p>Trial registration</p> <p>Australian Clinical Trials Registry ACTRN012605000463673</p> <p>ClinicalTrials.gov NCT00118521</p

EXACT: EXercise or Advice after ankle fraCTure. Design of a randomised controlled trial

<p>Abstract</p> <p>Background</p> <p>Ankle fractures are common. Management of ankle fractures generally involves a period of immobilisation followed by rehabilitation to reduce pain, stiffness, weakness and swelling. The effects of a rehabilitation program are still unclear. However, it has been shown that important components of rehabilitation programs may not confer additional benefits over exercise alone. The primary aim of this trial is to determine the effectiveness and cost-effectiveness of an exercise-based rehabilitation program after ankle fracture, compared to advice alone.</p> <p>Methods/Design</p> <p>A pragmatic randomised trial will be conducted. Participants will be 342 adults with stiff, painful ankles after ankle fracture treated with immobilisation. They will be randomly allocated using a concealed randomisation procedure to either an <it>Advice </it>or <it>Rehabilitation </it>group. Participants in the <it>Advice </it>group will receive verbal and written advice about exercise at the time of removal of immobilisation. Participants in the <it>Rehabilitation </it>group will be provided with a 4-week rehabilitation program that is designed, monitored and progressed by a physiotherapist, in addition to verbal and written advice. Outcomes will be measured by a blinded assessor at 1, 3 and 6 months. The primary outcomes will be activity limitation and quality-adjusted life years.</p> <p>Discussion</p> <p>This pragmatic trial will determine if a rehabilitation program reduces activity limitation and improves quality of life, compared to advice alone, after immobilisation for ankle fracture.</p

Effectiveness of joint mobilisation after cast immobilisation for ankle fracture: a protocol for a randomised controlled trial [ACTRN012605000143628]

BACKGROUND: Passive joint mobilisation is a technique frequently used by physiotherapists to reduce pain, improve joint movement and facilitate a return to activities after injury, but its use after ankle fracture is currently based on limited evidence. The primary aim of this trial is to determine if adding joint mobilisation to a standard exercise programme is effective and cost-effective after cast immobilisation for ankle fracture in adults. METHODS/DESIGN: Ninety participants will be recruited from the physiotherapy departments of three teaching hospitals and randomly allocated to treatment or control groups using a concealed procedure. All participants will perform an exercise programme. Participants in the treatment group will also receive joint mobilisation twice a week for four weeks. Blinded follow-up assessments will be conducted four, 12 and 24 weeks after randomisation. The primary outcome measures will be the Lower Extremity Functional Scale and the Assessment of Quality of Life. Secondary outcomes will include measures of impairments, activity limitation and participation. Data on the use of physiotherapy services and participants' out-of-pocket costs will be collected for the cost-effective and cost-utility analyses. To test the effects of treatment, between-group differences will be examined with analysis of covariance using a regression approach. The primary conclusions will be based on the four-week follow-up data. DISCUSSION: This trial incorporates features known to minimise bias. It uses a pragmatic design to reflect clinical practice and maximise generalisability. Results from this trial will contribute to an evidence-based approach for rehabilitation after ankle fracture

Development of a Clinician-Rated Drop Vertical Jump Scale for Patients Undergoing Rehabilitation After Anterior Cruciate Ligament Reconstruction: A Delphi Approach

STUDY DESIGN: Delphi panel study. BACKGROUND: Biomechanical parameters measured during a drop vertical jump task are risk factors for anterior cruciate ligament (ACL) injury and are targeted during rehabilitation after ACL reconstruction. A clinically feasible tool that quantifies observed performance on the drop vertical jump would help inform treatment efforts. The content and scoring of such a tool should be deliberated on by a group of experts throughout its development. OBJECTIVES: To establish consensus on the content and scoring of a clinician-rated drop vertical jump scale (DVJS) for use during rehabilitation after ACL reconstruction. METHODS: Using a modified Delphi process, a panel of experts (researchers and clinicians) on the risk factors, prevention, treatment, and biomechanics of ACL injury anonymously critiqued versions of a DVJS. The DVJS was developed iteratively, based on the feedback from the panel, using Likert scale responses to questions and providing written comments. Three to 5 rounds were planned a priori, with a requirement of 75% agreement on included items after the final round. RESULTS: Twenty of the 31 invited experts (65%) participated. Approximately 93% agreement was achieved after the fourth round. Final items on the scale included the rating of knee valgus collapse (no collapse to extreme collapse) and the presence of other undesirable movements, including lateral trunk lean, insufficient knee flexion, and limb-to-limb asymmetry. CONCLUSION: The Delphi process resulted in a beta version of a DVJS. Expert consensus was achieved on its content and scoring to support further clinical testing of the scale