Discordance between self-report and performance-based outcomes: Contribution of psychosocial factors.

The purpose of this study was to examine the role of psychosocial factors in the discordance between perceived and observed physical disability in patients with osteoarthritis of the hip or knee joint. This was a cross-sectional study of patients seen for consideration of joint arthroplasty surgery. Patients completed a psychosocial outcome measure, a patient self-reported functional scale, and two performance-based tests. Data of 121 patients, mean age, 67 (8), 81 (67%) females were used for analysis. The fear avoidance and positive affect domains had the strongest association with the discordance between the self-report and both performance outcome measures. Age, gender, and severity of osteoarthritis were associated with discordance in relation to walking. Fear avoidance beliefs and positive affect play important roles in perception of pain and function. Age, gender, and severity of arthritis should be taken into consideration for a more holistic approach to arthritis care.

Virtual versus in-person physiotherapy following total knee arthroplasty: a comparative analysis.

PURPOSE: At our centre, we developed and implemented a video-based post-operative physiotherapy program for patients undergoing total knee arthroplasty (TKA). Our aims were to analyse and compare the outcomes of this program to in-person physiotherapy. METHODS: We reviewed the outcomes of 112 patients and captured range-of-motion (ROM) measurements and pain scores (P4 questionnaire). We compared the outcomes to a cohort of 175 patients undergoing in-person therapy. Comparative analysis was performed using a two-tailed Student's t-test. RESULTS: There was no significant difference between the two groups in age, sex, or initial post-operative knee ROM. On discharge from virtual physiotherapy, mean flexion was 122.6° (SD 7.6). There was no significant difference in improvement in knee flexion between the virtual and in-person groups (mean 30.6° vs 34.0°, p = 0.07). There was no significant difference in the proportion of patients achieving ≥ 120° of flexion (85.0% virtual vs 91.3% in-person, p = 0.11) or those achieving an extension deficit of ≤ 5° (96.0% vs 98.3%, p = 0.25). There was no difference in the number of PT visits to discharge (10.5 vs 11.1, p = 0.14) or final pain scores (12.4 vs 11.9, p = 0.61). CONCLUSION: Improvements in knee ROM measures are comparable between virtual and in-person physiotherapy with both groups achieving a good functional range. These findings have implications for the virtual delivery of healthcare, especially among remote populations and patients with mobility limitations.

Virtual performance measure in osteoarthritis: An innovative transformation of patient care.

Objectives: The purpose of this study was to develop and establish reliability and validity of a virtual performance measure (VPM) score that encompassed 10 videos in patients with osteoarthritis of the knee joint. Patients' experience and satisfaction were documented. Design: Forty videos were chosen for 10 functional tasks, with four videos showing increasing difficulty for each task. Patients were requested to choose the video that best reflected their own situation. Clinical and radiological findings and self-report and performance measures were completed. Results: Data of 100 patients, 70 (70%) females, mean age: 65 â€‹± â€‹9 were examined. The Cronbach's alpha coefficient that examined internal consistency of the VPM score was 0.92. The intraclass correlation value of 0.82 was obtained for test-retest reliability. Factor analysis showed three distinct domains. There was moderate correlations between the VPM score and the self-report and actual performance measures ranging from r â€‹= â€‹0.46 to 0.66. The VPM summated score of 10 activities was able to differentiate between candidates and non-candidates for knee arthroplasty, with the area under the curve value of 0.90 indicating excellent predictive validity. The overall patient experience and satisfaction was positive with 67% of participants feeling that virtual care could have an impact on minimizing physical presence in the clinic or hospital. Conclusions: The VPM is a reliable and valid outcome measure in patients with osteoarthritis of the knee joint. This digital tool has the potential to transform osteoarthritis care by providing a valid remote measurement of real-life functional limitations and reduce the burden of time consuming in-person tests.

Assessing Appropriateness for Shoulder Arthroplasty Using a Shared Decision-Making Process.

Purpose: The primary purpose of this study was to validate an appropriateness decision-aid tool as a part of engaging patients with glenohumeral arthritis in their surgical management. The associations between the final decision to have surgery and patient characteristics were examined. Materials and Methods: This was an observational study. The demographics, overall health, patient-specific risk profile, expectations, and health-related quality of life were documented. Visual analog scale and the American Shoulder & Elbow Surgeon (ASES) measured pain and functional disability, respectively. Clinical and imaging examination documented clinical findings and extent of degenerative arthritis and cuff tear arthropathy. Appropriateness for arthroplasty surgery was documented by a 5-item Likert response survey and the final decision was documented as ready, not-ready, and would like to further discuss. Results: Eighty patients, 38 women (47.5%), mean age: 72(8) participated in the study. The appropriateness decision aid showed excellent discriminate validity (area under the receiver operating characteristic curve value of 0.93) in differentiating between patients who were "ready" and those who were "not-ready" to have surgery. Gender (P = 0.037), overall health (P = .024), strength in external rotation (P = .002), pain severity (P = .001), ASES score (P < .0001), and expectations (P = .024) were contributing factors to the decision to have surgery. Imaging findings did not play a significant role in the final decision to have surgery. Conclusions: A 5-item tool showed excellent validity in differentiating patients who were ready to have surgery versus those who were not. Patient's gender, expectations, strength, and self-reported outcomes were important factors in reaching the final decision.

Maximizing Muscle Function in Cuff-Deficient Shoulders: A Rehabilitation Proposal for Reverse Arthroplasty.

PURPOSE: The purpose of this review is to describe the role of altered joint biomechanics in reverse shoulder arthroplasty and to propose a rehabilitation protocol for a cuff-deficient glenohumeral joint based on the current evidence.Methods and Materials: The proposed rehabilitation incorporates the principles of pertinent muscle loading while considering risk factors and surgical complications. RESULTS: In light of altered function of shoulder muscles in reverse arthroplasty, scapular plane abduction should be more often utilized as it better activates deltoid, teres minor, upper trapezius, and serratus anterior. Given the absence of supraspinatus and infraspinatus and reduction of external rotation moment arm of the deltoid in reverse arthroplasty, significant recovery of external rotation may not occur, although an intact teres minor may assist external rotation in the elevated position. CONCLUSION: Improving the efficiency of deltoid function before and after reverse shoulder arthroplasty is a key factor in the rehabilitation of the cuff deficient shoulders. Performing exercises in scapular plane and higher abduction angles activates deltoid and other important muscles more efficiently and optimizes surgical outcomes.

An examination of stigmatising attributions about mental illness amongst police custody staff.

Individuals who enter police custody may experience mental illness, making it highly imperative for custody staff to be knowledgeable and competent in this area- however, reports suggest this is not always the case (Leese & Russell, 2017). The present study examined the differences in casual attributions and stereotypes of individuals experiencing mental illnesses, mainly, schizophrenia between police custody staff (n = 77) and members of the general population (n = 85). Using the Attribution Questionnaire (AQ-27; Corrigan, 2004), the current study found that the general population held more negative attitudes towards individuals experiencing mental illnesses than police custody staff. In particular they endorsed the attributions anger, avoidance, dangerousness and fear. Custody staff were found to help vulnerable adults more than the general population. In addition, people who knew a family member or friend experiencing a mental illness scored higher on the help and pity attributions. Furthermore, police custody staff highlighted that additional training around mental health would be beneficial to their job role. Further development of an adequate measurement of attitudes of police custody staff towards mental health needs developing in order to put in place effective training.

myHip&Knee: Improving Patient Engagement and Self-Management Through Mobile Technology.

Given the increasing volume of hip and knee replacement surgery with reduced hospital stays and resources, we explored technology to address gaps in patient care and enhance self-management. The team at the Holland Orthopaedic and Arthritic Centre of Sunnybrook Health Sciences Centre, which performs a high volume of joint replacement surgery, partnered with patients and a health technology company to create a mobile app: myHip&Knee. The results to date demonstrate that the app improves patient experience and reduces follow-up calls to surgeons' offices, ultimately reducing demand on healthcare resources. Early engagement of privacy and legal services, close patient and family collaboration and a well-developed evaluation strategy represent critical steps to successful development.

A qualitative study of patient education needs for hip and knee replacement.

BACKGROUND: Quality health information is key to patient engagement, self-management and an enhanced healthcare experience. There is strong evidence to support involving patients and their families in the development and evaluation of health-related educational material. These factors were the impetus for our high volume joint replacement centre to undertake a qualitative study to elicit patient experiences to inform the development of effective strategies and education along the care continuum for hip and knee replacement. METHODS: Purposively selected patients from postoperative follow-up clinics were recruited to participate in a focus group or telephone interview. We developed a semi-structured interview guide that addressed four specific aspects of the patient's experience with educational material: pre-surgery, hospital stay, recovery period and future recommendations. The focus groups and interviews continued to the point of saturation and were audio-recorded and transcribed verbatim. Interview transcripts were coded and then inductively organized into larger categories using thematic analysis. RESULTS: Six focus groups and seven telephone interviews were conducted, totalling 32 participants. One of the key themes that emerged was a need for more education concerning pain management post-operatively; specifically, patients wanted more information on expected levels of pain, pain medication usage, management of side effects and guidelines for weaning off the medication. There was surprising variability in patients' descriptions of their pre-surgery, surgery and recovery experiences. These corresponded to an equally diverse range of preferences for educational content, delivery and timing. Many patients reported using the web while others preferred traditional formats for information delivery. There was some interest in receiving education using mobile technology. CONCLUSIONS: Our findings validate the importance of multi-modal patient education tailored to individual preferences and experiences, which may differ according to such characteristics as gender and age. The gap in pain management information is a critical finding for healthcare providers working with patients undergoing joint replacement. Developing pain management education in different formats that addresses frequently asked questions will enhance patient engagement and, their overall experience and recovery.

The Group Experience: Remodelling Outpatient Physiotherapy after Knee Replacement Surgery.

UNLABELLED: Purpose : To estimate responses to short-duration (4-6 weeks) group-based physiotherapy after knee replacement in terms of pain, function, and satisfaction. METHOD: The study used a prospective, observational design. A total of 169 participants (111 women, 58 men) were consecutively recruited to attend a twice-weekly post-operative knee replacement class focused on mobility, strength, balance, and functional retraining. Changes in pain, function, and satisfaction were measured using the P4 pain intensity measure, the Lower Extremity Functional Scale (LEFS), a timed stair test (TST), knee range of motion (ROM), the Patient Specific Functional Scale (PSFS), and the Client Satisfaction Questionnaire (CSQ-8). Using Stata version 12.1, the data were summarized descriptively, and change scores were calculated with 95% CIs. Results : On average, participants were discharged within 11 classes, having achieved their treatment goals. More than 77% exceeded the minimal detectable change at the 90% confidence level (MDC90) on the LEFS, TST, PSFS, and ROM assessments. The mean CSQ-8 score at discharge was 31.8 (SD 1.46); 66.7% recorded a perfect score of 32. Conclusions : Patients attending a short group-based outpatient knee replacement class demonstrated significant improvements in pain and lower extremity function and were highly satisfied with their physiotherapy treatment.

Objectif : Estimer la réaction des patients à un traitement de physiothérapie en groupe de courte durée (de 4 à 6 semaines) à la suite d'une arthroplastie du genou en ce qui concerne la douleur, la fonction et la satisfaction. Méthode : L'étude a utilisé un concept prospectif d'observation. Au total, 169 patients (111 femmes) ayant subi une arthroplastie du genou ont été recrutés de façon consécutive pour assister deux fois par semaine à un cours axé sur la mobilité, la force, l'équilibre et le recyclage fonctionnel. Les changements relatifs à la douleur, à la fonction et à la satisfaction ont été mesurés à l'aide du questionnaire sur l'intensité de la douleur (P4), de l'échelle fonctionnelle des membres inférieurs (EFMI), d'un test de l'escalier chronométré (TEC), d'une mesure de l'amplitude des mouvements (ADM) du genou, de l'échelle fonctionnelle spécifique au client (EFSC) et du questionnaire de satisfaction de la clientèle (CSQ-8). À l'aide de STATA 12.1, les données ont été résumées de façon descriptive et les valeurs numériques des changements ont été calculées avec des intervalles de confiance de 95%. Résultats : En moyenne, les patients ont obtenu leur congé en 11 séances ou moins, leurs objectifs de traitement ayant été atteints. Plus de 77% des participants ont dépassé le seuil de changement détectable à un niveau de confiance de 90% (CDM90) pour les évaluations de l'EFMI, du TEC, de l'EFSC et de l'ADM. La note moyenne au CSQ-8 à l'obtention du congé était de 31,8 (ET 1,46); une note parfaite de 32 a été obtenue dans 66,7% des cas. Conclusions : Les patients ayant participé à un cours de courte durée en service externe après une arthroplastie du genou ont affiché une nette amélioration en ce qui concerne la douleur et la fonction des extrémités inférieures et se sont montrés très satisfaits de leur traitement de physiothérapie.

Assessing the patient-specific functional scale's ability to detect early recovery following total knee arthroplasty.

BACKGROUND: The Patient-Specific Functional Scale (PSFS) has received considerable attention over the last 2 decades; however, validation studies have not examined its performance in patients after total knee arthroplasty (TKA). OBJECTIVE: The purpose of this study was to investigate the ability of the PSFS to detect change in patients post-TKA by comparing PSFS change scores with Lower Extremity Functional Scale (LEFS) and pooled impairment change scores. METHODS: One hundred thirty-three patients participating in a post-TKA exercise class were assessed at their initial and discharge visits. Initial assessments occurred within 28 days of arthroplasty; follow-up assessments occurred within 80 days of surgery. At both assessments, participants completed the PSFS, LEFS, and the P4 pain measure, and their knee range of motion (ROM) and extensor strength were measured. The ability to detect change was expressed as the standardized response mean (SRM) and as a correlation between the PSFS change scores and 2 reference standards: (1) LEFS change scores and (2) pooled impairment change scores. The pooled impairment measure consisted of pain, ROM, and strength change scores. RESULTS: The SRMs were PSFS 4.60 (95% confidence interval [CI]=4.00, 5.36) for the PSFS and 2.28 (95% CI=2.04, 2.60) for the LEFS. The correlation between the PSFS and pooled impairment change scores was 0.12 (95% CI=-0.04, 0.25), and the correlation between the PSFS and LEFS changes scores was 0.18 (0.02, 0.34). LIMITATIONS: The order of measure administration was not standardized, and fixed activity set does not reflect clinical application in many instances. CONCLUSIONS: The results suggest that the PSFS is adept at detecting improvement in patients post-TKA but that the PSFS, like other patient-specific measures, is likely to be of limited value in distinguishing different levels of change among patients.

An example of end-digit preference in physiotherapy practice.

PURPOSE: Standardizing and improving the validity of range of motion (ROM) measurements is of clinical relevance to physiotherapists. The purpose of this study was to assess whether end-digit preference exists in the measurement of knee ROM in people after knee replacement. METHOD: Following total knee replacement, 100 people underwent active-assisted knee ROM measurements using a goniometer calibrated in 1° increments. RESULTS: The data showed strong end-digit preferences for 0s and 5s (p<0.001). CONCLUSIONS: End-digit preference does exist in the measurement of knee ROM. This has the potential to influence both the validity of ROM measurements and clinical decisions.

Objectif : Normaliser et améliorer la validité des mesures d'amplitude des mouvements (ADM) est particulièrement pertinent sur le plan clinique pour les physiothérapeutes. L'objectif de cette étude est d'évaluer si une préférence quant au dernier chiffre existe dans la mesure de l'ADM du genou chez les personnes qui ont subi un remplacement du genou. Méthodologie : À la suite d'un remplacement total du genou, 100 personnes ont subi des mesures actives assistées de l'ADM du genou à l'aide d'un goniomètre calibré selon des échelons de 1°. Résultats : Les données ont démontré une préférence marquée quant au dernier chiffre pour les 0 et les 5 (p<0,001). Conclusions : Il existe effectivement une préférence quant au dernier chiffre dans la mesure de l'ADM du genou. Cette préférence pourrait avoir une influence sur la validité des mesures d'ADM et sur les décisions cliniques.