Awareness of state legislation on naloxone accessibility associated with willingness to prescribe naloxone.

BACKGROUND: Increasing rates of opioid-related deaths, state naloxone legislation changes, and negativity prompted investigation of predictive factors associated with willingness to prescribe naloxone to populations at risk of overdose, including knowledge of risk factors, assessment of persons at risk, awareness of legislative changes, perceptions of professional responsibility, and confidence around naloxone prescribing and distribution. METHODS: Cross-sectional, Web-based, anonymous, voluntary survey to prescribers of 2 regional health care systems serving urban and rural North Dakota, northern Minnesota, and northwestern Wisconsin. Human subject research was approved by university and health care systems' institutional review boards. RESULTS: Overall, 203 of 1586 prescribers responded; however, not all prescribers completed each survey item. A majority (89.4%, n = 127/142) of respondents had never prescribed naloxone for overdose prevention. Willingness to prescribe naloxone for 4 patient care scenarios involving substantial opioid overdose risk ranged from 43.4% to 70.5%. Knowledge mean score was 15.5 (SD = 2.9) out of 22 with median 15 (range: 5-22). Naloxone legislation awareness score was 8.8 (SD = 3.8) out of 15 with median 8 (range: 3-15). There was a statistically significant but modest correlation between willingness to prescribe naloxone and the other variables, including awareness of state naloxone-related legislation (r = 0.43, P < .0001), level of self-confidence about dosing, prescribing, and writing protocols for naloxone (r = 0.37, P < .0001), general knowledge (r = 0.24, P = .0032), and perception of professional responsibility (r = 0.19, P = .03). Multivariate regression analysis indicated willingness to prescribe naloxone was associated with statistically significant predictors, including awareness of the naloxone laws (P = .0016) and self-confidence about dosing, prescribing, and writing protocols (P = .0011). CONCLUSIONS: Prescribers who are more aware of state laws regarding naloxone and confident in their knowledge of dosing, administration, and writing protocols may be more willing to prescribe naloxone.

Graded group exercise and fear avoidance behavior modification in the treatment of chronic low back pain.

BACKGROUND: Approaches in the treatment of general chronic low back pain (CLBP) are multifaceted relative to specific interventions. In the past, passive interventions have commonly been employed with little evidence to support their effectiveness. Recent reviews suggest a focus on active exercises programs that includes pain education and cognitive behavioral therapy. OBJECTIVE: To investigate the outcomes of CLBP patients and describe the approach in persons undergoing a group spinal rehabilitation program using graded exercise, and operant conditioning. METHODS: Adult patients with CLBP participated in a twice weekly 90 minute exercise sessions for 8-weeks (n= 201). The program consisted of behavioral education, stretching, aerobic exercises, graded progressive resistance exercise, MedX isotonic strengthening, and functional bending lifting task exercises. RESULTS: A total of 201 patient records were evaluated where the overall ODI improvement was 13.2% (± 14.0) (p< 0.001). There were significant and clinically meaningful improvements in flexibility, VAS, functional lifting tasks (p< 0.001), and lumbar extension strength (p= 0.01) at 8-week follow-up. Questionnaires were delivered via mail with a 21% return rate revealed sustained improvements. CONCLUSION: CLBP patients undergoing an 8-week intensive exercise approach incorporating both behavioral and physical conditioning principles showed both significant and clinically significant improvements in this observational case series. Long-term benefits were also seen in both the 6 and 12 month follow-up questionnaires although further investigation is warranted due to limited survey return rate and study design.

Reducing lost workdays after work-related injuries: the utilization of athletic trainers in a health system transitional work program.

OBJECTIVE: To determine if an internal employee health program (IEHP), including transitional work, with early access to physical medicine and rehabilitation provided by athletic trainers, will reduce missed workdays following work-related injury. METHODS: A retrospective review of health system workers' compensation data were conducted for injuries sustained 23-month period preceding (PP) (N = 713) and following IEHP implementation (N = 661). RESULTS: Sixty-two PP and 128 IEHP events resulted in lost workdays (LWDs), P < 0.001. For LWDs events, mean days lost decreased from 100.3 ± 119.7 PP to 44.6 ± 69.0 IEHP, P = 0.001, with 2.2 (95% confidence interval [CI]: 1.1-4.2) IEHP 3-week odds of returning to work. CONCLUSIONS: Internal employee health program reduced LWDs. Internal employee health program was associated with more than 10% increase in LWDs events, but LWDs event mean days lost decreased by more than 50%, with 3-week odds of returning to work more than 2.0.

Popliteomeniscal fascicle tears causing symptomatic lateral compartment knee pain: diagnosis by the figure-4 test and treatment by open repair.

BACKGROUND: Injuries to the popliteomeniscal fascicles of the lateral meniscus are difficult to identify from physical examination and magnetic resonance imaging scans. To our knowledge, there have been no described physical examination techniques to identify symptomatic isolated popliteomeniscal fascicle tears. The popliteomeniscal fascicles have been demonstrated to be important for lateral meniscus stability, and it has been reported that tears can lead to painful symptoms. HYPOTHESIS: Popliteomeniscal fascicle tears cause symptomatic lateral compartment knee pain and can be diagnosed by physical examination. Surgical repair can improve patient function. STUDY DESIGN: Case series; Level of evidence, 4. METHODS: Six patients with isolated tears of the popliteomeniscal fascicles, which caused lateral joint line knee pain, were identified by positive figure-4 test results. RESULTS: All patients were found to have replication of their symptoms while placing the affected knee in the figure-4 position and were found to have lateral meniscal hypermobility due to tears of the popliteomeniscal fascicles on arthroscopic examination. All patients had an open repair of the popliteomeniscal fascicles of the lateral meniscus with complete resolution of their symptoms at a mean follow-up of 3.8 years postoperatively. CONCLUSIONS: The figure-4 test was found to be useful in identifying the source of lateral compartment knee pain due to popliteomeniscal fascicle tears. Open repair of isolated popliteomeniscal fascicle tears was also found to be effective in resolving lateral compartment knee pain due to popliteomeniscal fascicle tears.