Service evaluation: Three subjective questions that aid in identifying frozen shoulder—Within a multi‐centre musculoskeletal physiotherapy department in primary care

From Crossref journal articles via Jisc Publications RouterHistory: received 2024-04-04, accepted 2024-04-10, epub 2024-04-21, issued 2024-04-21, published 2024-04-21Article version: VoRPublication status: PublishedPrateek Rangra - ORCID: 0000-0002-1457-991X https://orcid.org/0000-0002-1457-991XFrozen shoulder is a prevalent condition seen in primary care in the UK, 2%–10% of the general population and up to 20% of the diabetic population (Hanchard et al., 2020; Rae et al., 2019; Walker-Bone et al., 2004). Frozen shoulder is characterised by stiffness, pain, and limitation in function. Frozen shoulder is associated with variable prognosis and management strategies (Pandey & Madi, 2021; Rangan et al., 2020; Rex et al., 2021). It can be difficult to assess, diagnose and differentiate from other shoulder pathologies (Lyne et al., 2022). This is mainly due to commonality in aetiology and subjective findings in people presenting with shoulder pain. Physical examination is an integral part of frozen shoulder diagnosis. Therefore, an early identification is important to deliver good quality of care. The delivery of care in primary care settings is changing in the UK, with remote consultations on first contact becoming more prevalent in MSK settings (Rennie et al., 2022). It is also important to note that telephone assessments remain far more in number than assessments over video-based platforms in primary care settings (Murphy et al., 2021). This presents with a new set of challenges in diagnosing frozen shoulder and may cause delay in delivery of care. There are subjective pain related complaints of frozen shoulder originally described by Codman in the 1930s and more recently by Atkin et al. (2016). These include pain constant in nature, pain on lying on the side at night and no radiating pain below the elbow. With stiffness in the shoulder being a common underlying feature. There has been a lot of research on aetiology, pathophysiology, and physical examination of frozen shoulder. However, there is a gap in the literature on exploring the relationship between key pain related subjective complaints and diagnosis of frozen shoulder. The musculoskeletal physiotherapy service in East Lothian National Health Service, Scotland, consists of a telephone consultation to triage on first contact for self-referring patients. It was noted that pain related questions were regularly asked in these remote consultations when assessing shoulder pain; however, as discussed before, their relevance has not been evaluated in the literature in depth. Therefore, a service evaluation was carried out to investigate the relationship between three questions related to pain (i.e., Is the pain constant? Is there pain lying on the side at night? Does the pain radiate below the elbow?) and a diagnosis of frozen shoulder was made following face to face assessment. Additionally, this may help to provide some insight into whether frozen shoulder and other shoulder pathologies can be differentiated based on these pain related questions.pubpu

A clinical audit of the Emergency Department: Doctors' opinions on the diagnosis and management of cervical spine radiculopathy

From Wiley via Jisc Publications RouterHistory: received 2024-02-15, rev-recd 2024-03-13, accepted 2024-03-18, epub 2024-03-29, ppub 2024-06Article version: VoRPublication status: PublishedPatricia McDonnell - ORCID:0009-0000-4254-2930 https://orcid.org/0009-0000-4254-2930Kavi Jagadamma - ORCID: 0000-0003-2011-0744 https://orcid.org/0000-0003-2011-0744Objective: A clinical audit was carried out on the opinions of doctors working in the Emergency Department (ED) of a large urban hospital regarding the diagnosis and management of cervical spine radiculopathy (CSR). Using international guidelines and current research, it aimed to determine if patients attending this ED were diagnosed and managed in line with best practice, and to identify any discrepancies or areas for improvement in relation to this. Method: Doctors working in this ED were sent an online questionnaire and descriptive analysis was performed on the results to ascertain how they diagnose and manage patients who present with symptoms of CSR. It covered; presentation and definitions of CSR, identification of red flags, clinical tests used, diagnostic test criteria, appropriate management, education and advice given, and the criteria for further management. Additionally, it looked at their opinion on the services' needs. Results: Most agreed that CSR will improve within 4 weeks with non‐operative management; however, there was a lack of consensus regarding the most affected nerve root, differential diagnosis and appropriate diagnostic tests. Opinions aligned regarding the identification of red flags and early management, especially with widespread neurological deficits. However, the management of ongoing pain or new neurological signs, differed between clinicians. Most participants strongly agreed that access to MRIs affected referrals within an ED episode. Conclusion: Overall, the opinions matched recommended guidelines; however, some gaps in knowledge and differing management approaches were identified, indicating the need for ongoing education and standardisation of management.22pubpub

The Influence of Walking Speed and Heel Height on Peak Plantar Pressure in the Forefoot of Healthy Adults: A Pilot Study

Article number: 1000239Background: The body of empirical research is suggestive of the fact that faster walking speed and increasing heel height can both give rise to elevated plantar pressures. However, there is little evidence of the interaction between walking speed and heel height on changes in plantar pressure. Therefore, the aim of this study was to investigate whether the effect of heel height on plantar pressure is the same for different walking speeds Methodology: Eighteen healthy adults, between the ages of 18 and 35 were assessed for changes in peak plantar pressure at walking speeds of 0.5 mph, 0.8 mph, 1.4 mph and 2.4 mph on a treadmill, wearing heels of 2 cm, 3 cm, 6 cm and 9 cm. Both the speed of walking and heels were randomly assigned to each participant. Peak plantar pressure values were determined in the forefoot region using the F-scan system which made use of in-shoe insoles. Data were analysed using two-way ANOVA. Results: Increasing heel height and walking speed resulted in significantly higher peak plantar pressure in the forefoot. Post-hoc analysis also confirmed the findings of two-way ANOVA of significant increase in peak plantar pressure with increments in heel height and walking speed. The two-way ANOVA illustrated significantly higher peak plantar pressures in both the forefeet due to interaction of walking speed and increasing heel heights. Conclusion: This study suggests that an interaction of walking speed and footwear design on distribution of plantar pressure exists. Therefore it is necessary to standardize walking speed and shoe design in future studies evaluating plantar pressures.sch_physch_pod5pub4758pub