Holden, Sinead

Jensen, Martin Bach

Olesen, Jens Lykkegaard

Pourbordbari, Negar

Rathleff, Michael Skovdal

English

    Aalborg UniversitetOne hundred children and adolescents consulting general practice withmusculoskeletal painPourbordbari, Negar; Jensen, Martin Bach; Olesen, Jens Lykkegaard; Holden, Sinead;Rathleff, Michael SkovdalPublished in:BMJ Open Sport & Exercise MedicineDOI (link to publication from Publisher):10.1136/bmjsem-2022-sportskongres.6Creative Commons LicenseCC BY-NC 4.0Publication date:2022Document VersionPublisher's PDF, also known as Version of recordLink to publication from Aalborg UniversityCitation for published version (APA):Pourbordbari, N., Jensen, M. B., Olesen, J. L., Holden, S., & Rathleff, M. S. (2022). One hundred children andadolescents consulting general practice with musculoskeletal pain. BMJ Open Sport & Exercise Medicine,8(Suppl. 1), A2-A3. https://doi.org/10.1136/bmjsem-2022-sportskongres.6General rightsCopyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright ownersand it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights.            - Users may download and print one copy of any publication from the public portal for the purpose of private study or research.            - You may not further distribute the material or use it for any profit-making activity or commercial gain            - You may freely distribute the URL identifying the publication in the public portal -Take down policyIf you believe that this document breaches copyright please contact us at vbn@aub.aau.dk providing details, and we will remove access tothe work immediately and investigate your claim.Conclusion Patient satisfaction is not commonly reported intendinopathy research, and in those studies where it isreported, satisfaction and GROC appear similar and areranked moderately high demonstrating patients generallyperceive exercise therapy for tendinopathy positively. Fur-ther research investigating satisfaction and GROC isrequired to identify moderating factors and improve patient-centred care.27 ‘IT’S SECOND BEST’: MIXED-METHODS EVALUATION OFTHE EXPERIENCES OF PEOPLE WITH MUSCULOSKELETALPAIN TOWARDS PHYSIOTHERAPIST DELIVEREDTELEHEALTH DURING COVID-19 PANDEMIC1,2Allison M Ezzat*, 3Peter Malliaras, 4,5Mark Merolli, 6Cylie Williams, 6,7Terry Haines,1Namita Mehta, 1Christian Barton. 1La Trobe Sport and Exercise Medicine Research Centre,School of Allied Health, Human Services and Sport, La Trobe University, Australia;2Department of Physical Therapy, University of British Columbia, Canada; 3PhysiotherapyDepartment, School of Primary and Allied Health Care, Faculty of Medicine Nursing andHealth Science, Monash University, Australia; 4Centre for Health, Exercise, and SportsMedicine, Department of Physiotherapy, School of Health Sciences, The University ofMelbourne, Australia; 5Centre for Digital Transformation of Health, Melbourne MedicalSchool, The University of Melbourne, Australia; 6School of Primary and Allied Health Care,Faculty of Medicine Nursing and Health Science, Monash University, Australia; 7NationalCentre for Healthy Ageing, Monash University, Australia10.1136/bmjsem-2022-sportskongres.4Introduction Telehealth was rapidly adopted in musculoskeletalphysiotherapy practice during the COVID-19 pandemic, pro-viding a unique opportunity to evaluate the experiences andattitudes of people would not usually engage with theseservices.Materials and Methods A sequential mixed-methods studyrecruited people with musculoskeletal pain conditions accessingprivate practice physiotherapist services in Australia. Partici-pants completed an online survey of telehealth servicesaccessed, treatments, self-reported global change in condition,and attitudes toward telehealth. A subset of survey participantscompleted semi-structured interviews to explore experiencesand attitudes towards telehealth. Data was summarizeddescriptively (quantitative), analyzed using inductive thematicanalysis (qualitative), and integrated facilitating deeperunderstanding.Results 172 participants responded to the survey and 19were interviewed. 95% accessed video-based telehealth, typi-cally via zoom; and 85% reported improvement in their con-dition. 84% agreed it was an efficient use of time, 75%agreed it was financially viable, and 73% agreed their condi-tion was accurately diagnosed. 62% percent believed tele-health should be less expensive than face-to-face services.Qualitative analysis revealed four themes (17 subthemes),including (i) value of telehealth; (ii) challenges; (iii) advan-tages; and (iv) use of technology to support patientexperience.Conclusion Australians with musculoskeletal pain conditionsaccessing physiotherapy via telehealth during the COVID-19 pandemic felt this care was valuable, although less sothan traditional face-to-face care. Key challenges includedthe perception that lack of physical contact preventedaccurate assessment, diagnosis and ‘hands on’ treatment,and requirements for technology to facilitate a qualityservice. Advantages included access to expert care andconvenience.29 MANAGING SERIOUS PATHOLOGY IN LOW BACK PAIN:DEVELOPMENT AND VALIDATION OF A BAYESIANNETWORK DECISION SUPPORT TOOL1Adele Hill*, 1Christopher Joyner, 2Barbaros Yet, 1Chloe Keith-Jopp, 3Ceren Tuncer Sakar,1William Marsh, 1Dylan Morrissey. 1Queen Mary University of London, Bancroft Road, UK;2Middle East Technical University, Turkey; 3Hacettepe University, Turkey10.1136/bmjsem-2022-sportskongres.5Introduction A key decision for assessment of Low back pain(LBP) is identifying serious underlying conditions such asCauda Equina Syndrome, infection, fracture or space-occupy-ing lesions. Previous decision support tools for LBP deployedrule-based recommendations, yet Artificial Intelligence hasenabled ‘intelligent’ decision support tools, with Bayesian Net-works particularly suitable for complex conditions such asLBP. This study aimed to test whether clinical knowledgecould be elicited to construct a Bayesian Network to supportclinicians’ detection of serious pathology masquerading as LBP.Methods A modified-RAND appropriateness procedure elicitedknowledge from 16 domain experts from General Practice,Rheumatology and Musculoskeletal specialties. This compriseda four-stage process using bespoke online tools interleavedwith face-to-face meetings; 1) Variable elicitation, 2) Structureelicitation, 3) Probability elicitation 4) Validation. Independentexperts in spinal pathology reviewed the initial tool and itsoutputs.Results The tool includes background risk factors (e.g. trauma,age), signs and symptoms (e.g. bladder disturbance, inflamma-tory symptoms) and derived judgement factors (e.g. cord com-pression, fracture). The tool has an interactive onlineinterface, requiring real-time patient inputs from the subjectiveassessment, then gives a judgement comparing baseline to thecurrent patient. Content validation suggested no missing ele-ments to the model, but may require more detail for clinicalunderstanding of terms. Face validation exposed some incon-sistency in clinical reasoning, particularly for spinal infectionsand fractures.Conclusion The structured elicitation method yielded a reason-ing model using expert clinician knowledge, establishing con-sensus amongst participants about its content. Furtheriterations to expand this to common LBP presentations shouldfollow.30 ONE HUNDRED CHILDREN AND ADOLESCENTSCONSULTING GENERAL PRACTICE WITHMUSCULOSKELETAL PAIN1Negar Pourbordbari*, 1Martin Bach Jensen, 1Jens Lykkegaard Olesen, 1,2Sinead Holden,1,2Michael Skovdal Rathleff. 1Center For General Practice at Aalborg University, Aalborg,Fyrkildevej 7, 1st. floor, Denmark; 2Department of Health Science and Technology, AalborgUniversity, Frederik Bajers vej 7, Denmark10.1136/bmjsem-2022-sportskongres.6Introduction Each year, 8% of children and adolescents con-sult their general practitioner (GP) due to musculoskeletal con-ditions, with pain the most frequent symptom. There isAbstractsA2 BMJ Open Sp Ex Med 2022;8(Suppl 1):A1–A15Protected by copyright. on February 2, 2022 by guest.http://bmjopensem.bmj.com/BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2022-sportskongres.6 on 20 January 2022. Downloaded from limited knowledge about this care-seeking population. Thepurpose of this study is to describe children and adolescentsconsulting their GP due to musculoskeletal pain.Materials and Methods This is a cross-sectional studyembedded in the child and adolescent musculoskeletal paincohort study, carried out in 17 Danish general practice clinics.Patients aged 8–19 years with musculoskeletal pain when con-sulting general practice completed a questionnaire on demo-graphics, physical activity, pain impact, psychosocial factors,and expectations of their general practitioner.Results One hundred participants were included (54% female,median age 13 [IQR: 12–16] years). The most frequent regionof activity-limiting pain was the knee (56%), followed by theback (20%), ankle (19%), and neck (13%). The primary rea-son for (63%) consulting their GP was inability to use theirbody as usual due to pain. Median pain duration on consulta-tion was 5 months [IQR: 3 weeks-1 year]. Over a third werenervous (34%), worried/anxious (33%), and took pain medica-tion (33%). Pain negatively impacted sport activities at school(79%) and leisure time activities (88%). Pain made concentra-tion (58%) and falling asleep (38%) difficult. Only 38%expected a pain free long-term future.Conclusion This study demonstrates the bio-psycho-socialimpact of musculoskeletal pain in care-seeking children andadolescents in general practice. Demographics, pain characteris-tics, psychosocial characteristics, and physical characteristicsshould be considered when consulting children and adolescentswith musculoskeletal pain.31 UNDERLOADING, NOT OVERLOADING, OF THEPATELLOFEMORAL JOINT INCREASES THE RISK OFEARLY OSTEOARTHRITIS AFTER ACL RECONSTRUCTION1Adam Culvenor*, 1Anthony Schache, 1Prasanna Sritharan, 1Brooke Patterson,2Ali Guermazi, 3Luke Perraton, 4Adam Bryant, 1Kay Crossley. 1La Trobe University, La TrobeSport and Exercise Medicine Research Centre, Australia; 2Boston University, Department ofRadiology, USA; 3Monash University, Department of Physiotherapy, Australia; 4TheUniversity of Melbourne, School of Physiotherapy, Australia10.1136/bmjsem-2022-sportskongres.7Introduction Patellofemoral joint osteoarthritis is common fol-lowing anterior cruciate ligament reconstruction (ACLR) andmay be linked with altered joint loading. We aimed to deter-mine if altered patellofemoral joint loading is associated withprevalent and worsening early patellofemoral osteoarthritis fol-lowing ACLR.Materials and Methods Forty-six participants (mean age 27±5years) one-year following primary ACLR (hamstring-tendonautograft) underwent magnetic resonance imaging (MRI) andbiomechanical assessment of their reconstructed knee. Trunkand lower-limb kinematics plus ground reaction forces wererecorded during the landing phase of a standardised forwardhop task. These data were input into an established musculos-keletal model to calculate patellofemoral contact force. Fol-low-up MRI was acquired on 32 participants at five-yearspost-ACLR. Generalised linear models (Poisson) assessed therelationship between patellofemoral loading and prevalentearly patellofemoral osteoarthritis (i.e., presence of a patellofe-moral cartilage lesion one-year post-ACLR) and worseningpatellofemoral osteoarthritis (i.e., incident/progressive patellofe-moral cartilage lesion at 5-years post-ACLR).Results Those with a lower peak patellofemoral contact forcewere more likely to have early patellofemoral osteoarthritis at1-year post-ACLR (n=14 (30%); prevalence ratio 1.37; 95%CI 1.02 to 1.85). A lower peak patellofemoral contact forceincreased the risk of worsening patellofemoral osteoarthritis at5-years post-ACLR (n=9 (28%); risk ratio 1.55, 95%CI 1.13to 2.11).Conclusion Young adults following ACLR who underload theirpatellofemoral joint during a hopping task are at high risk ofearly patellofemoral osteoarthritis onset and progression withinthe first 5-years after ACLR. These findings challenge tradi-tional thinking that joint overloading drives post-traumaticosteoarthritis, and provides new targets for osteoarthritisprevention.32 SPONTANEOUS HEALING OF THE RUPTURED ANTERIORCRUCIATE LIGAMENT: OBSERVATIONS FROM THEKANON TRIAL1Stephanie Filbay*, 2,3Frank Roemer, 4Stefan Lohmander, 4Aleksandra Turkiewicz, 5EwaM Roos, 4Richard Frobell, 2,4Martin Englund. 1Centre for Health, Exercise and SportsMedicine; Department of Physiotherapy; University Of Melbourne, Australia; 2School ofMedicine, Boston University, USA; 3Friedrich-Alexander University of Erlangen-Nürnberg,Germany; 4Orthopedics, Department of Clinical Sciences, Lund University, Sweden;5Department of Sports and Clinical Biomechanics, University of Southern Denmark, Denmark10.1136/bmjsem-2022-sportskongres.8Introduction It is often assumed that an acutely ruptured ACLcannot heal. We evaluated ACL healing using MRI within 5years of ACL rupture; described 2- and 5-year outcomesstratified by healing status and treatment; and investigated therelationship between ACL healing, sport/recreational functionand quality of life (QOL) at 2- and 5-years following ACLinjury.Materials and Methods Secondary analysis of KANON Trialdata following randomisation to rehabilitation and optionaldelayed ACL reconstruction (ACLR), or early-ACLR. Out-comes included Knee Injury and Osteoarthritis Outcome Score(KOOS) subscales, activity level, mechanical stability, andosteoarthritis. Mixed linear regression estimated the relation-ship between healing status, KOOS-Sports/Rec and KOOS-QOL, adjusted for age, sex, smoking and unmeasured person-specific time-invariant confounding.Results Following management with rehabilitation-alone at 5-years (n=26), 56% had a healed-ACL at 2-years and 58% at5-years. One in twenty-three (4%) had a healed ACL beforeundergoing delayed-ACLR. People with a healed-ACL reportedhigh KOOS scores at 2-years and 63–93% met the patientacceptable symptomatic state criteria, compared to 31–61% inthe non-healed or reconstructed groups. Two-year KOOSSport/Rec and QOL scores were worse in the non-healed(mean difference (95% CI) -21.9(-38.8, -5.0); -26.9(-41.7, -12.1)), delayed-ACLR (-25.0 (-39.8, -10.1); -19.4(-32.3, -6.4))and early-ACLR (-18.0(-31.5, -4.5); -13.9(-25.6, -2.1)) groupscompared to the healed-ACL group, or findings excluded thepossibility of better findings in the reconstructed groups.Conclusion There was a high rate of ACL healing in patientsmanaged with rehabilitation alone and these individualsreported better patient-reported outcomes compared to thenon-healed and reconstructed groups.AbstractsBMJ Open Sp Ex Med 2022;8(Suppl 1):A1–A15 A3Protected by copyright. on February 2, 2022 by guest.http://bmjopensem.bmj.com/BMJ Open Sport Exerc Med: first published as 10.1136/bmjsem-2022-sportskongres.6 on 20 January 2022. 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One hundred children and adolescents consulting general practice with musculoskeletal pain

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