Surgeon – Therapist Communication: Do All Members See Eye-to-Eye?

<div><p></p><p> <i>Background.</i> Poor interprofessional collaboration has been shown to negatively affect patient care within many fields of medicine. Growing evidence is suggesting that improved interprofessional collaboration can positively affect patient care. Postoperative rehabilitation of many orthopedic conditions necessitates the combined efforts of surgeons, and therapists. There is a paucity of literature examining collaboration among orthopedic surgeons and therapists regarding postoperative rehabilitation. <i>Objectives.</i> The following study examines the perceived quality of communications between orthopedic surgeons and therapists employing an online survey. We hypothesized that collaborative practice patterns result in improved perceptions of communication. <i>Methods.</i> Ethics board approval was obtained. Subjects consisted of orthopedic surgeons, licensed physiotherapists and certified athletic therapists. The online survey was distributed through the Canadian Orthopaedic Association (COA), the Canadian Physiotherapy Association (CPA) and the Canadian Athletic Therapists Association (CATA). Data analysis was performed using Stata/IC 12.1 (Stata Corp, College Station, TX, USA). Descriptive statistics were calculated to determine the median responses and ranges. Median responses were compared using the Kruskal–Wallis one-way analysis of variance. Qualitative analysis regarding text responses was performed by three reviewers. <i>Results.</i> Reponses were received from all specialties (COA 164, CPA 524, CATA 163). There were significant differences in the perceived quality of communication by quantitative and qualitative analysis (<i>p</i> < 0.001). Analysis of communication within practice patterns of stand-alone versus collaborative revealed improved perception of communication quality with increased contact. 65.6% of responders that practiced as stand-alone had a negative view of interprofessional communication. 48.4% of responders in a collaborative practice had a positive view of interprofessional communication. Analysis of the preferred form of communication found that orthopedic surgeons felt the most useful referral information was a pre-printed consult sheet (odds ratio [OR] = 1.56, <i>p</i> < 0.001), whereas therapists were more likely to rank consult notes (OR = 1.27, <i>p</i> < 0.042) and operative reports (OR = 1.20, <i>p</i> < 0.092) as a more useful form of communication. <i>Conclusions.</i> Collaborative practice shows improved perceptions of communication between specialties. Orthopedic surgeons perceive a higher quality of communication than therapists. Therapists and orthopedic surgeons also do not agree on the information that should be relayed between the specialties regarding postoperative rehabilitation.</p></div

Localization of Sema3A protein.

<p>Representative micrographs of Sema3A staining in presumptive SCs, located in the satellite position on fibers (arrow indicates nucleus) in control and Supraspinatus (SS) muscle explant cultures at baseline (without ISDN treatment) or with ISDN (as labeled) [a subset of n = 10 participants from the full dataset shown in <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0162494#pone.0162494.g002" target="_blank">Fig 2</a>]. Bar = 20 μm. A. Cells in control muscle ranged from large and activated (left panel) to small and attenuated (middle panel), with low to moderate intensity staining in the cytoplasm. Sema3A staining of an attenuated cell in the satellite position on fibers in ISDN-treated control muscle have dark staining for Sema3A. B. Most SCs in SS muscle at baseline had attenuated moderately-stained cytoplasm (left panel), and were larger with low to moderate intensity staining after ISDN treatment. Right-most panel shows dark Sema3A staining in a Schwann cell close to a NMJ. C. Graph of areal density of Sema3A stain (mean, SEM) in control (C) and supraspinatus (SS) muscle at baseline or after treatment with ISDN. Sema3A staining was higher in SS at baseline than in control muscle at baseline. Asterisk (*) indicates significant difference from control muscle (p = 0.04). D. Graph illustrating the significant correlation of SC areal density after activation by ISDN (y-axis) with that at baseline in the same muscle (control, open diamonds, SS, black diamonds); R2 = 0.4925, p<0.001, N = 10.</p

Table of PCA-2 on data only from the Supraspinatus (SS) muscle, using N = 16 variables, showing correlation coefficients for variables loaded on the 3 PCs extracted from the analysis of data from 27 participants.

<p>In the row for each variable, numbers indicate the strength of correlation of that variable with the eigenvector of each PC. When the absolute value of correlation coefficients was ≥ 0.35, they were considered important (bold font) in defining the PC. Variables loaded on the PCs 1–3, appear in the PCA plot (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0162494#pone.0162494.g004" target="_blank">Fig 4B</a>) with an asterisk (*) to indicate they also project upward.</p

Principal component analysis (PCA) biplots.

<p>Biplots show the correlation vectors representing the projection (in 2 dimensions) of loading for each of the variables (for 27 participants) included in the particular PCA. Vectors project onto the 3 axes (dimensions) of the principal components (PCs) 1 (x-axis), 2 (y-axis), and 3 (z-axis, positive is upward, perpendicular to the page). A. PCA-1, on the full dataset (N = 23 variables). B. PCA-2, Supraspinatus variables only (N = 16). C. PCA-3, variables of interest from previous comparisons, including “muscle” as a variable (N = 15 variables). Variables that loaded onto PC3 (as shown in Tables <a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0162494#pone.0162494.t001" target="_blank">1</a>–<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0162494#pone.0162494.t003" target="_blank">3</a>) are indicated with an asterisk (*) to emphasize that the correlation vector projects upward, perpendicular to PC1 and PC2 axes. Variable labels on the vectors are abbreviated as follows: C (control muscle), SS (Supraspinatus muscle), BMI (body mass index), Sx-to-Surg (weeks from symptom onset to surgery), diam (fiber diameter), SS:C diam (ratio of fiber diameter in SS/C), SC-base (baseline SC activation in explant cultures), SC-ISDN (SC activation in explants cultured with ISDN), dystr (expression of dystrophin protein relative to β-actin), mmp9 (level of matrix metalloproteinase 9 protein relative to β-actin), logRed (log-transformation of average maximum Sirius Red staining), γ:ε (γ:ε ratio of AchR subunits), γ (expression of the γ-subunit of AchR protein relative to β-actin), and BvD (vascular density).</p

SC activation in response to ISDN in explant cultures.

<p>A and B. Micrographs of immunofluorescence staining for BrdU and Pax7. Images are as labeled: DIC for orientation to the SC; Cy5 channel used to visualize anti-BrdU staining; GFP channel used to visualize anti-Pax7 staining; and a merge of Cy5 and GFP to show any overlap. A. shows staining of a Pax7+/BrdU- cell. B shows a Pax7+/BrdU+ SC where merge of Cy5 and GFP is yellow. C. Graph of the proportion (mean, SEM) of active BrdU+/Pax7+ SCs of the total number of Pax7+ SCs observed in sections of control or supraspinatus (SS) muscles, after culturing for 40 hours in the presence of BrdU, with isosorbide dinitrate (ISDN) or at baseline (no treatment). At baseline, SS had a lower proportion of activated SCs than control muscle. ISDN increased the number of BrdU+ SCs in SS but not control muscle. Asterisk (*) indicates significant difference from untreated SS (p = 0.01, N = <i>27</i>) from a total of 7661 Pax7+ satellite cells.</p

Principal Component Analysis (PCA) table of the full dataset on N = 23 variables, showing correlation coefficients for variables loaded on the 3 PCs extracted from the analysis of data from 27 participants.

<p>In the row for each variable, numbers indicate the strength of correlation of that variable with the eigenvector of each PC. When the absolute value of correlation coefficients was ≥ 0.3, they were considered important (bold font) in defining the PC. Variables loaded on PCs 1–3 below, appear in the PCA plot (<a href="http://www.plosone.org/article/info:doi/10.1371/journal.pone.0162494#pone.0162494.g004" target="_blank">Fig 4A</a>) with an asterisk (*) to indicate they also project upward (since PC3 is perpendicular to axes for PCs 1 and 2).</p

Changes in the level of the γ-AchR subunit.

<p>A. Graph of the optical density (OD) of bands from western blots probed for the γ-AchR subunit (relative to β-actin) in SS compared to control muscle. The amount of the γ-AchR subunit protein, typically expressed in denervated and fetal muscle, was assessed in protein extracts prepared from homogenized SS and control deltoid muscle (* indicates significant difference, p<<0.001, N = 19 paired samples). B. A representative western blot prepared from protein extracts loaded into lanes for control (C) and Supraspinatus (SS) muscles from different participants, probed to detect the γ-AchR subunit and then re-probed to detect β-actin (as a loading control).</p