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Whittaker JL, Culvenor AG, Juhl CB, Berg B, Bricca A, Filbay SR, Holm P, Macri E, Urhausen AP, Ardern CL, Bruder AM, Bullock GS, Ezzat AM, Girdwood M, Haberfield M, Hughes M, Ingelsrud LH, Khan KM, Le CY, Losciale JM, Lundberg M, Miciak M, Øiestad BE, Patterson B, Räisänen AM, Skou ST, Thorlund JB, Toomey C, Truong LK, Meer BLV, West TJ, Young JJ, Lohmander LS, Emery C, Risberg MA, van Middelkoop M, Roos EM, Crossley KM. OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis. Br J Sports Med 2022; 56:1393-1405. [DOI: 10.1136/bjsports-2022-106299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.
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Eubank BHF, Lackey SW, Slomp M, Werle JR, Kuntze C, Sheps DM. Consensus for a primary care clinical decision-making tool for assessing, diagnosing, and managing shoulder pain in Alberta, Canada. BMC FAMILY PRACTICE 2021; 22:201. [PMID: 34627163 PMCID: PMC8502088 DOI: 10.1186/s12875-021-01544-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/23/2021] [Accepted: 09/17/2021] [Indexed: 11/20/2022]
Abstract
Background Shoulder pain is a highly prevalent condition and a significant cause of morbidity and functional disability. Current data suggests that many patients presenting with shoulder pain at the primary care level are not receiving high quality care. Primary care decision-making is complex and has the potential to influence the quality of care provided and patient outcomes. The aim of this study was to develop a clinical decision-making tool that standardizes care and minimizes uncertainty in assessment, diagnosis, and management. Methods First a rapid review was conducted to identify existing tools and evidence that could support a comprehensive clinical decision-making tool for shoulder pain. Secondly, provincial consensus was established for the assessment, diagnosis, and management of patients presenting to primary care with shoulder pain in Alberta, Canada using a three-step modified Delphi approach. This project was a highly collaborative effort between Alberta Health Services’ Bone and Joint Health Strategic Clinical Network (BJH SCN) and the Alberta Bone and Joint Health Institute (ABJHI). Results A clinical decision-making tool for shoulder pain was developed and reached consensus by a province-wide expert panel representing various health disciplines and geographical regions. This tool consists of a clinical examination algorithm for assessing, diagnosis, and managing shoulder pain; recommendations for history-taking and identification of red flags or additional concerns; recommendations for physical examination and neurological screening; recommendations for the differential diagnosis; and care pathways for managing patients presenting with rotator cuff disease, biceps pathology, superior labral tear, adhesive capsulitis, osteoarthritis, and instability. Conclusions This clinical decision-making tool will help to standardize care, provide guidance on the diagnosis and management of shoulder pain, and assist in clinical decision-making for primary care providers in both public and private sectors. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-021-01544-3.
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Affiliation(s)
- Breda H F Eubank
- Department of Health & Physical Education, Faculty of Health, Community, & Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta, Canada, T3E 6K6.
| | - Sebastian W Lackey
- Alberta Bone and Joint Health Institute, Suite 316, 400 Crowfoot Crescent NW, Calgary, Alberta, Canada, T3G 5H6
| | - Mel Slomp
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street, Edmonton, Alberta, Canada, T5J 3E4
| | - Jason R Werle
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street, Edmonton, Alberta, Canada, T5J 3E4.,Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta, Canada, T2N 1N4
| | - Colleen Kuntze
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street, Edmonton, Alberta, Canada, T5J 3E4.,Access Orthopaedics, 3916 Macleod Trail, Suite 300, Calgary, Alberta, Canada, T2G 2R5
| | - David M Sheps
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Seventh Street Plaza, 14th Floor, North Tower, 10030 - 107 Street, Edmonton, Alberta, Canada, T5J 3E4.,Edmonton Bone and Joint Centre, 9499 - 137 Ave NW, Edmonton, Alberta, Canada, T5E 5R8.,Division of Orthopaedics, Department of Surgery, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, Canada, T6G 2R3.,Faculty of Rehabilitation Medicine, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, Canada, T6G 2R3
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Primeau CA, Zomar BO, Somerville LE, Joshi I, Giffin JR, Marsh JD. Health Economic Evaluations of Hip and Knee Interventions in Orthopaedic Sports Medicine: A Systematic Review and Quality Assessment. Orthop J Sports Med 2021; 9:2325967120987241. [PMID: 34262974 PMCID: PMC8243245 DOI: 10.1177/2325967120987241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/04/2020] [Accepted: 11/24/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The economic burden of musculoskeletal diseases is substantial and growing. Economic evaluations compare costs and health benefits of interventions simultaneously to help inform value-based care; thus, it is crucial to ensure that studies are using appropriate methodology to provide valid evidence on the cost-effectiveness of interventions. This is particularly the case in orthopaedic sports medicine, where several interventions of varying costs are available to treat common hip and knee conditions. PURPOSE To summarize and evaluate the quality of economic evaluations in orthopaedic sports medicine for knee and hip interventions and identify areas for quality improvement. STUDY DESIGN Systematic review; Level of evidence, 3. METHODS The Medline, AMED, OVID Health Star, and EMBASE databases were searched from inception to March 1, 2020, to identify economic evaluations that compared ≥2 interventions for hip and/or knee conditions in orthopaedic sports medicine. We assessed the quality of full economic evaluations using the Quality of Health Economic Studies (QHES) tool, which consists of 16 questions for a total score of 100. We classified studies into quartiles based on QHES score (extremely poor quality to high quality) and we evaluated the frequency of studies that addressed each of the 16 QHES questions. RESULTS A total of 93 studies were included in the systematic review. There were 41 (44%) cost analyses, of which 21 (51%) inappropriately concluded interventions were cost-effective. Only 52 (56%) of the included studies were full economic evaluations, although 40 of these (77%) fell in the high-quality quartile. The mean QHES score was 83.2 ± 19. Authors consistently addressed 12 of the QHES questions; questions that were missed or unclear were related to statistical uncertainty, appropriateness of costing methodology, and discussion of potential biases. The most frequently missed question was whether the cost perspective of the analysis was stated and justified. CONCLUSION The number of studies in orthopaedic sports medicine is small, despite their overall good quality. Yet, there are still many highly cited studies based on low-quality or partial economic evaluations that are being used to influence clinical decision-making. Investigators should follow international health economic guidelines for study design and critical appraisal of studies to further improve quality.
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Affiliation(s)
- Codie A. Primeau
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - Bryn O. Zomar
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | | | - Ishita Joshi
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
| | - J. Robert Giffin
- Bone and Joint Institute, Western University, London, Ontario, Canada
- London Health Sciences
Centre, University Hospital, London, Ontario, Canada
- Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada
| | - Jacquelyn D. Marsh
- School of Physical Therapy, Western University, London, Ontario, Canada
- School of Health and Rehabilitation Sciences, Western University, London, Ontario, Canada
- Bone and Joint Institute, Western University, London, Ontario, Canada
- London Health Sciences
Centre, University Hospital, London, Ontario, Canada
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Mohammed HT, Yoon S, Hupel T, Payson LA. Unnecessary ordering of magnetic resonance imaging of the knee: A retrospective chart review of referrals to orthopedic surgeons. PLoS One 2020; 15:e0241645. [PMID: 33137163 PMCID: PMC7605700 DOI: 10.1371/journal.pone.0241645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 10/16/2020] [Indexed: 02/07/2023] Open
Abstract
There is a noticeable increase in the unnecessary ordering of Magnetic Resonance Imaging (MRI) of the knee in older patients. This quality improvement study assessed the frequency of unnecessary pre-consultation knee MRIs and investigated the effect on the outcome of the patients' consultation with the orthopedic surgeon. 650 medical charts of patients aged 55 years or older referred to an orthopedic clinic with knee complaints were reviewed. Patients arriving with a pre-consultation MRI were identified, and the usefulness of the MRI was evaluated using the appropriateness criteria developed to support this study. Of the 650 patient charts reviewed, 225 patients presented with a pre-consultation MRI, 76% of which were not useful for the orthopedic surgeon. The ordered knee MRI scans were considered not useful because they were requested for confirmed meniscal tear for patients ≥55 years, suspected degenerative disorder and ligament/tendon injury, or for patients with severe osteoarthritis without locking or extension. These MRI scans were done despite the absence of signs of effusion, tenderness, soft tissue swelling, decreased range of motion, or difficulty of weight-bearing, a lack of persistent knee joint pain at the time of assessment, or with no x-ray before ordering MRI. Half of the patients with a pre-consult MRI did not present with plain radiographs of their knee, however, 35% of those still required an x-ray to be ordered at the time of the surgical consult. A logistic regression analysis on post-consult disposition found that patients with pre-consult MRI were less likely to be considered for total knee arthroplasty (TKA) (OR 0.424, CI 0.258-0.698, p = 0.001). Patients assessed by an advanced practice physiotherapist prior to referral for surgical consult were 4.47 more likely to have TKA (CI 2.844-7.039, p< 0.000). Most of the pre-consult knee MRIs were deemed as unnecessary for the orthopedic surgeon's clinical decision-making. This study highlights the potential benefits of following a comprehensive model of care within the referral process to reduce the unnecessary high orders of pre-consult MRI scans.
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Affiliation(s)
| | - Samuel Yoon
- Division of Orthopaedic Surgery, University of Toronto, Toronto, Ontario, Canada
| | - Thomas Hupel
- Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Lori-Anne Payson
- eHealth Centre of Excellence, Kitchener, Ontario, Canada
- Department of Family Medicine, McMaster University, Hamilton, Ontario, Canada
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Exploring the Business Case for Improving Quality of Care for Patients With Chronic Rotator Cuff Tears. Qual Manag Health Care 2019; 28:209-221. [PMID: 31567844 DOI: 10.1097/qmh.0000000000000231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND AND OBJECTIVES Currently, management of patients presenting with chronic rotator cuff tears in Alberta is in need of quality improvements. This article explores the potential impact of a proposed care pathway whereby all patients presenting with chronic rotator cuff tears in Alberta would adopt an early, conservative management plan as the first stage of care; ultrasound investigation would be the preferred tool for diagnosing a rotator cuff tear; and only patients are referred for surgery once conservative measures have been exhausted. METHODS We evaluate evidence in support of surgery and conservative management, compare care in the current state with the proposed care pathway, and identify potential solutions in moving toward optimal care. RESULTS A literature search resulted in an absence of indications for either surgical or conservative management. Conservative management has the potential to reduce utilization of public health care resources and may be preferable to surgery. The proposed care pathway has the potential to avoid nearly Can $87 000 in public health care costs in the current system for every 100 patients treated successfully with conservative management. CONCLUSION The proposed care pathway is a low-cost, first-stage treatment that is cost-effective and has the potential to reduce unnecessary, costly surgical procedures.
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Validation of a tool to assess patient satisfaction, waiting times, healthcare utilization, and cost. Prim Health Care Res Dev 2019; 20:e47. [PMID: 32799991 PMCID: PMC6598225 DOI: 10.1017/s1463423619000094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
AIM Patients' experience of the quality of care received throughout their continuum of care can be used to direct quality improvement efforts in areas where they are most needed. This study aims to establish validity and reliability of the Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ) - a tool that collects patients' experience that quantifies aspect of care used to make judgments about quality from the perspective of the Alberta Quality Matrix for Health (AQMH). BACKGROUND The AQMH is a framework that can be used to assess and compare the quality of care in different healthcare settings. The AQMH provides a common language, understanding, and approach to assessing quality. The HAPSQ is one tool that is able to assess quality of care according to five of six AQMH's dimensions. METHODS This was a prospective methodologic study. Between March and October 2015, a convenience sample of patients presenting with chronic full-thickness rotator cuff tears was recruited prospectively from the University of Calgary Sport Medicine Centre in Calgary, Alberta, Canada. Reliability of the HAPSQ was assessed using test-retest reliability [interclass correlation coefficient (ICC)>0.70]. Validity was assessed through content validity (patient interviews, floor and ceiling effects), criterion validity (percent agreement >70%), and construct validity (hypothesis testing). FINDINGS Reliability testing was completed on 70 patients; validity testing occurred on 96 patients. The mean duration of symptoms was three years (SD: 5.0, range: 0.1-29). Only out-of-pocket utilization possessed an ICC<0.70. Patients reported that items were relevant and appropriate to measuring quality of care. No floor or ceiling effects were present. Criterion validity was reached for all items assessed. A priori hypotheses were confirmed. The HAPSQ represents an inexpensive, reliable, and valid approach toward collecting clinical information across a patient's continuum of care.
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Eubank BHF, Lafave MR, Preston Wiley J, Sheps DM, Bois AJ, Mohtadi NG. Evaluating quality of care for patients with rotator cuff disorders. BMC Health Serv Res 2018; 18:569. [PMID: 30029658 PMCID: PMC6053822 DOI: 10.1186/s12913-018-3375-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2017] [Accepted: 07/10/2018] [Indexed: 11/25/2022] Open
Abstract
Background Measuring quality in healthcare is vital in evaluating patient outcomes and system performance. The availability of reliable and valid information about the quality of care for patients presenting with rotator cuff disorders (RCD) in Alberta, Canada is scarce. The objective of this study is to measure quality of care for patients with RCD in order to identify areas of improvement. Methods This study employs descriptive survey research design. Between March 2015 and November 2016, a convenience sample of patients presenting with chronic, full-thickness rotator cuff tears to two sport medicine centres in Calgary and Edmonton, Alberta completed two questionnaires: the Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ) and the Rotator Cuff Quality-of-Life Index (RC-QOL). Data collected using both questionnaires were used to make judgments about quality of care. Quality of care was evaluated using six dimensions of quality defined by the Alberta Quality Matrix for Health: accessibility, acceptability, efficiency, effectiveness, appropriateness, and safety. Data was also used to compare current patient clinical pathways to ideal clinical pathway algorithms and used to make judgments about the appropriateness and safety of healthcare practices. Results One hundred seventy-one patients participated in the study. The longest mean waiting times for medical services in Alberta were for magnetic resonance imaging (MRI) received in the public sector (103 days) and consultation by orthopaedic surgeon (172 days). Patient satisfaction with respect to quality of care was lowest for emergency room physician and highest for orthopaedic surgeon visits. Patients were treated by a mean of 2.5 physicians (SD: 0.77, range: 2–7). The total aggregate average cost per patient was $4541.19. The mean RC-QOL score for all patients was 42 (SD: 22). Only 54 patients (64%) requiring surgery were able to consult with a surgeon within benchmark timeframes. A comparison of current to ideal clinical pathway algorithms found that 38 patients (22%) experienced indirect clinical pathways, whereby care was fragmented and patients received care from multiple and often, redundant healthcare professionals. Conclusion There is a discrepancy between current and ideal clinical pathways whereby some patients are experiencing quality of care that is inefficient, disjointed, and less than ideal.
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Affiliation(s)
- Breda H F Eubank
- Department of Health and Physical Education, Faculty of Health, Community, and Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta, T3E 6K6, Canada.
| | - Mark R Lafave
- Department of Health and Physical Education, Faculty of Health, Community, and Education, Mount Royal University, 4825 Mount Royal Gate SW, Calgary, Alberta, T3E 6K6, Canada
| | - J Preston Wiley
- Sport Medicine Centre, Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - David M Sheps
- Division of Orthopaedics, Department of Surgery, University of Alberta, 116 St & 85 Ave, Edmonton, Alberta, T6G 2R3, Canada
| | - Aaron J Bois
- Division of Shoulder and Elbow Surgery, Section of Orthopaedic Surgery, Cumming School of Medicine, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
| | - Nicholas G Mohtadi
- Sport Medicine Centre , Faculty of Kinesiology, University of Calgary, 2500 University Drive NW, Calgary, Alberta, T2N 1N4, Canada
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Décary S, Fallaha M, Pelletier B, Frémont P, Martel-Pelletier J, Pelletier JP, Feldman DE, Sylvestre MP, Vendittoli PA, Desmeules F. Diagnostic validity and triage concordance of a physiotherapist compared to physicians' diagnoses for common knee disorders. BMC Musculoskelet Disord 2017; 18:445. [PMID: 29137611 PMCID: PMC5686957 DOI: 10.1186/s12891-017-1799-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 11/01/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Emergence of more autonomous roles for physiotherapists warrants more evidence regarding their diagnostic capabilities. Therefore, we aimed to evaluate diagnostic and surgical triage concordance between a physiotherapist and expert physicians and to assess the diagnostic validity of the physiotherapist's musculoskeletal examination (ME) without imaging. METHODS This is a prospective diagnostic study where 179 consecutive participants consulting for any knee complaint were independently diagnosed and triaged by two evaluators: a physiotherapist and one expert physician (orthopaedic surgeons or sport medicine physicians). The physiotherapist completed only a ME, while the physicians also had access to imaging to make their diagnosis. Raw agreement proportions and Cohen's kappa (k) were calculated to assess inter-rater agreement. Sensitivity (Se) and specificity (Sp), as well as positive and negative likelihood ratios (LR+/-) were calculated to assess the validity of the ME compared to the physicians' composite diagnosis. RESULTS Primary knee diagnoses included anterior cruciate ligament injury (n = 8), meniscal injury (n = 36), patellofemoral pain (n = 45) and osteoarthritis (n = 79). Diagnostic inter-rater agreement between the physiotherapist and physicians was high (k = 0.89; 95% CI:0.83-0.94). Inter-rater agreement for triage recommendations of surgical candidates was good (k = 0.73; 95% CI:0.60-0.86). Se and Sp of the physiotherapist's ME ranged from 82.0 to 100.0% and 96.0 to 100.0% respectively and LR+/- ranged from 23.2 to 30.5 and from 0.03 to 0.09 respectively. CONCLUSIONS There was high diagnostic agreement and good triage concordance between the physiotherapist and physicians. The ME without imaging may be sufficient to diagnose or exclude common knee disorders for a large proportion of patients. Replication in a larger study will be required as well as further assessment of innovative multidisciplinary care trajectories to improve care of patients with common musculoskeletal disorders.
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Affiliation(s)
- S. Décary
- 0000 0001 2292 3357grid.14848.31School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal, Montreal, QC Canada
| | - M. Fallaha
- 0000 0001 2292 3357grid.14848.31Department of Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada. Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal, Montreal, QC Canada
| | - B. Pelletier
- 0000 0001 2292 3357grid.14848.31Department of Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada. Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal, Montreal, QC Canada
| | - P. Frémont
- 0000 0004 1936 8390grid.23856.3aDepartment of Rehabilitation, Faculty of Medicine, Laval University, Quebec City, QC Canada
| | - J. Martel-Pelletier
- 0000 0001 0743 2111grid.410559.cOsteoarthritis Research Unit, University of Montreal Hospital Research Center (CRCHUM), Montreal, QC Canada
| | - J.-P. Pelletier
- 0000 0001 0743 2111grid.410559.cOsteoarthritis Research Unit, University of Montreal Hospital Research Center (CRCHUM), Montreal, QC Canada
| | - D. E. Feldman
- 0000 0001 2292 3357grid.14848.31School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC Canada
| | - M.-P. Sylvestre
- 0000 0001 2292 3357grid.14848.31Department of Social Preventive Medicine, School of Public Health, Université de Montréal, Montreal, QC Canada
| | - P.-A. Vendittoli
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal, Montreal, QC Canada
- 0000 0001 2292 3357grid.14848.31Department of Surgery, Maisonneuve-Rosemont Hospital, University of Montreal, Montreal, QC, Canada. Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal, Montreal, QC Canada
| | - F. Desmeules
- 0000 0001 2292 3357grid.14848.31School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC Canada
- Orthopaedic Clinical Research Unit, Maisonneuve-Rosemont Hospital Research Center, Centre intégré universitaire de santé et de services sociaux de l’Est-de-l’Île-de-Montréal, Montreal, QC Canada
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Kopka M, Mohtadi N, Naylor A, Walker R, Donald M, Frank C. The use of magnetic resonance imaging in acute knee injuries can be reduced by non-physician expert clinics. PHYSICIAN SPORTSMED 2015; 43:30-6. [PMID: 25625472 DOI: 10.1080/00913847.2015.1009354] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The routine use of magnetic resonance imaging (MRI) for the assessment of acute knee injuries is controversial. The goal of this study is to present an audit of patients seen in a dedicated Acute Knee Injury Clinic (AKIC) to determine the frequency and appropriateness of MRI utilization. METHODS A retrospective review identified all patients who had an MRI and a randomly selected control group without MRI. The MRI was classified based on whether it was ordered by the AKIC team or by an external clinician. The consensus-based 'Indications for Urgent MRI in Acute Soft Tissue Knee Problems' were applied to both groups. An MRI was considered appropriate if any of the indications were met. RESULTS The overall MRI utilization rate was 23% (142/611). Of the MRIs performed, 32% (46/142) met the indications. About 94% (33/35) of the MRIs ordered by the AKIC experts met the indications, compared to only 12% (13/107) of those ordered externally. No patients in the control group met the indications. Diagnoses were similar between groups. DISCUSSION These results suggest that application of guidelines by experts in knee evaluation can significantly reduce expensive MRI utilization in patients with acute knee injuries without negatively impacting the appropriate diagnosis and disposition.
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Affiliation(s)
- Michaela Kopka
- Orthopedic Surgery, University of Calgary , 731 35th St NW, Calgary, Alberta T2N 2Z6 , Canada
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