Postoperative Rehabilitation of Anterior Glenohumeral Joint Instability Surgery: A Systematic Review.

Anterior glenohumeral instability is the most common form of shoulder instability. The systematic review summarizes the latest research on rehabilitation after Bankart repair. Inclusion criteria included postoperative rehabilitation and published in English between 2000 and 2019. Studies were excluded if they were addresses, comments, or editorials, or included other shoulder injuries or cadaver models. Two rounds of review using Rayyan QCRI software were performed for screening and full text search, and the articles were graded for levels of evidence. Of the 1982 articles, 14 articles were included with levels of evidence 1 through 4. Both arthroscopic and open Bankart repair have demonstrated improving functional outcomes and reducing recurrence rates of anterior shoulder instability. Accelerated postoperative rehabilitation may be comparable to a conventional protocol for arthroscopic repair, and the subscapularis musculature involvement during open repair can impact the timeframe. Strong evidence supports 4 phases of rehabilitation and future clinical trials are needed to compare different programs.

Paramedic-supplied 'Take Home' Naloxone: protocol for cluster randomised feasibility study.

INTRODUCTION: 'Take Home' Naloxone (THN) kits for use by peers in the event of an opioid overdose may reduce further overdose and deaths, but distribution through Drugs Services may not reach those at highest risk. Attendance by paramedics at emergency calls for patients who have suffered an overdose presents an opportunity to distribute THN kits. In this feasibility study we will assess the acceptability of this intervention, and gather data to inform definitive trial planning. METHODS AND ANALYSIS: Cluster randomised trial with staggered allocation of paramedics (clusters) to groups. We will invite paramedics in an urban area of south Wales, UK to take part. We will randomly allocate those that accept to training sessions during the first 4 months of the trial. Patients attended by paramedics who have been trained and issued THN kits will fall into the intervention group. Patients attended by paramedics following usual practice (until they receive their training and THN kits) will fall into the control group. We will gather data about processes and outcomes of care: numbers of patients eligible for intervention, offered and accepted THN, attended emergency department, suffered further overdose, died within 3 months and about follow-up rates: numbers of patients consented, completed (postal or telephone) questionnaire. We will gather qualitative data about acceptability to patients and paramedics through interviews and focus groups. ETHICS AND DISSEMINATION: Ethical approval for this study was granted on 7 December 2011, by South East Wales Research Ethics Committee, Panel C. Results of this study will be reported through peer-reviewed scientific journals, conference presentations and internal organisational report. We will also seek to report our findings through local and national substance misuse networks and publications. TRIAL REGISTRATION NUMBER: ISRCTN98216498.