ABSTRACT
Purpose: Evidence suggests that a physiotherapist-led chronic pain self-management programme in primary health care (PHC) improves function for people living with chronic pain; however, implementing a new approach to care can be difficult. In this study, we sought to understand the experiences of physiotherapists who had implemented the ChrOnic pain self-ManageMent support with pain science EducatioN and exerCisE (COMMENCE) programme; its perceived barriers, facilitators, benefits, and drawbacks; and how the physiotherapists tailored the programme to their own clinical contexts. Method: This interpretive description qualitative study used semi-structured interviews with physiotherapists who had implemented the COMMENCE programme in PHC. Results: Themes from 11 interviews included experiences of personal and professional growth, increasing confidence with experience, and changing the culture of pain management. Barriers and drawbacks to implementation included resource intensiveness, balancing programme demands with other clinical work, and challenges with patient attendance and participation. Facilitators included training, programme design and materials, supportive teams, and previous knowledge. Benefits included offering group and individualized support, evidence-based content, and sparking interest in learning more about pain management. The participants made small changes to tailor the programme content and delivery to their context. Conclusions: This study provides a rich understanding of the experiences, barriers, facilitators, benefits, drawbacks, and tailoring related to the COMMENCE programme in PHC. The results will facilitate future implementation of this intervention in PHC settings.
Objectif : selon les données probantes, un programme d'autogestion de la douleur chronique dirigé par un physiothérapeute en soins primaires améliore la fonction des personnes qui vivent avec la douleur chronique, mais il peut être difficile de mettre en Åuvre une nouvelle approche des soins. La présente étude visait à comprendre les expériences des physiothérapeutes qui avaient créé le programme COMMENCE (acronyme anglais pour soutien pour l'autoprise en charge de la douleur chronique par l'éducation et l'exercice de la science de la douleur), les obstacles perçus, les incitations, les avantages et les inconvénients, de même que l'adaptation du programme aux contextes cliniques. Méthodologie : étude qualitative par description interprétative faisant appel à des entrevues semi-structurées auprès de physiothérapeutes qui avaient mis en Åuvre le programme COMMENCE en soins primaires. Résultats : les thèmes des 11 entrevues portaient sur les expériences de croissance personnelle et professionnelle, l'augmentation de la confiance grâce à l'expérience et le changement de la culture de gestion de la douleur. Les obstacles ou les écueils de mise en Åuvre incluaient l'intensité de ressources nécessaires, l'équilibre entre les exigences du programme et le reste du travail clinique et les difficultés relatives à l'assiduité et à la participation des patients. Les incitations incluaient la formation, la conception et le matériel du programme, les équipes solidaires et les connaissances antérieures. Les avantages incluaient l'offre d'un soutien collectif et individuel, le contenu fondé sur des données probantes et l'intérêt à en apprendre davantage sur la gestion de la douleur. Les participants ont apporté de petits changements pour adapter le contenu et la prestation du programme à leur contexte personnel. Conclusions : la présente étude fournit de riches données sur les expériences, les obstacles, les incitations, les avantages, les écueils et l'adaptation du programme COMMENCE en soins primaires. Les résultats faciliteront la future mise en Åuvre de cette intervention en soins primaires.
ABSTRACT
PURPOSE: The purpose of this study was to examine the safety of an arthroscopic technique for acromioclavicular joint (ACJ) reconstruction by investigating its proximity to important neurovascular structures. METHODS: Six shoulders from 4 cadaveric specimens were used for ACJ reconstruction in this study. The procedure consists of performing an arthroscopic acromioclavicular (AC) reduction with a double button construct, followed by coracoclavicular ligament reconstruction without drilling clavicular tunnels. Shoulders were subsequently dissected in order to identify and measure distances to adjacent neurovascular structures. RESULTS: The suprascapular artery and nerve were the closest neurovascular structures to implanted materials. The mean distances were 8.2 (standard deviation [SD] = 3.6) mm to the suprascapular nerve and 5.6 (SD = 4.2) mm to the suprascapular artery. The mean distance of the suprascapular nerve from implants was found to be greater than 5 mm (P = .040), while the distance to the suprascapular artery was not (P > .5). Neither difference was statistically significant (P = .80 for artery; P = .08 for nerve). CONCLUSIONS: Mini-open, arthroscopically assisted ACJ reconstruction safely avoids the surrounding nerves, with no observed damage to any neurovascular structures including the suprascapular nerve and artery, and may be a viable alternative to open techniques. However, surgeons must remain cognizant of possible close proximity to the suprascapular artery. CLINICAL RELEVANCE: This study represents an evaluation of the safety and feasibility of a minimally invasive ACJ reconstruction as it relates to the proximity of neurovascular structures.
