ABSTRACT
Aims: Flexor tendon injuries are debilitating with rupture of repair leading to significant morbidity. The SARS-CoV-2 pandemic has led to a shift to out-of-theatre operating, with many flexor tendon repairs being performed on The same day as initial assessment in our outpatient Department (OpD) procedure room. We aimed to compare The rupture rates before and after The start of The pandemic to assess The safety of this change in practice. Method(s): Patients who underwent repair of one or more flexor tendons were included from two six-month periods: July to December 2019 and April to September 2020. Patient records were reviewed to identify operation location, number of flexor tendons repaired per patient and rupture incidence. In The second period, patients whose operation was performed in theatre were excluded. Result(s): 28 patients were included for The initial period with a total of 49 flexor tendons injured. All repairs were performed in theatre and 3 ruptures were recorded (6%). 17 patients underwent flexor tendon repair during The second period. 11 patients were operated on in The OpD with a total of 16 flexor tendons injured. 1 rupture was recorded (6%). Conclusion(s): The rupture rate of OpD operating is comparable to that of The traditional theatre pathway. OpD operating also allowed us to circumvent theatre waiting lists and thus avoid costly delays to patient care. This project demonstrates maintained safety for patients and of fers a platform for further Research to confirm OpD operating as a viable and sustainable alternative for future practice.
ABSTRACT
OBJECTIVE: To explore the subjective experiences of student circus arts performers with atraumatic shoulder instability undertaking a 12-week shoulder rehabilitation program during the COVID-19 pandemic lockdown, in Melbourne, Australia. METHODS: Using a qualitative design, 14 circus arts students from the National Institute of Circus Arts (Australia) were individually interviewed via teleconsultation. All interviews were recorded, transcribed, and analysed using inductive thematic analysis. RESULTS: Five overarching themes were identified: (i) impact (physical and mental), (ii) opportunity, (iii) developing routine, (iv) client-therapist relationship, and (v) transformation. All participants reported positive physical changes to their shoulder including increases in strength, stability, range of motion, less pain, "clicking" and "clunking," improved posture, muscle memory, as well as carry-over to functional circus activities. The pandemic's mental impact varied across the cohort, with positive and negative experiences described in relation to cognitive, social, and affective factors. Most performers felt the pandemic provided an opportunity to focus on rehabilitation of their shoulder. The program effects were also underpinned by positive client-therapist relationships and a progressive transformation of learning where students gained knowledge of their condition, developed tools to manage their current shoulder impairment, and learned how to apply this new knowledge to future management of their condition. CONCLUSION: A shoulder exercise intervention delivered via teleconsultation during the COVID-19 pandemic resulted in subjective reports of positive physical changes to the participants' shoulder health complaint. This was facilitated through client-physiotherapist relationships, providing structure during uncertain times, and by providing education to help in understanding their condition and its future management.