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Eubank BHF, Sheps DM, Dennett L, Connick A, Bouliane M, Panu A, Harding G, Beaupre LA. A scoping review and best evidence synthesis for treatment of partial-thickness rotator cuff tears. J Shoulder Elbow Surg 2024; 33:e126-e152. [PMID: 38103720 DOI: 10.1016/j.jse.2023.10.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2023] [Revised: 10/24/2023] [Accepted: 10/30/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Rotator cuff disorders include a broad spectrum of pathological conditions including partial-thickness and full-thickness tears. Studies have shown partial-thickness rotator cuff tear (PTRCT) prevalence to be twice that of full-thickness tears. In the working population, PTRCTs are one of the most common causes of shoulder pain and often result in occupational disability due to pain, stiffness, and loss of shoulder function. Treatment of PTRCTs remains controversial. The purpose of this study was to consolidate the existing high-quality evidence on best management approaches in treating PTRCTs using both nonoperative and operative approaches. METHODS A scoping review with best evidence synthesis was performed as per the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews. MEDLINE (OVID), EMBASE (OVID), Cochrane Library (Wiley), SCOPUS, Web of Science Core Collection, CINAHL Plus with Full Text (EBSCOhost), PubMed Central, and Science Direct were searched from 2000 to March 3, 2023. Level 1 studies, and systematic reviews and meta-analyses that included level 1 and 2 studies, were included. RESULTS The search yielded 8276 articles. A total of 3930 articles were screened after removing 4346 duplicates. Application of inclusion criteria resulted in 662 articles that were selected for full-text review. Twenty-eight level 1 studies, 1 systematic review, 4 meta-analyses, and 1 network meta-analyses were included in the best evidence synthesis. Nonoperative strategies included injections (ie, platelet-rich plasma, corticosteroid, prolotherapy, sodium hyaluronate, anesthetic, and atelocollagen), exercise therapy, and physical agents. Operative interventions consisted of débridement, shaving of the tendon and footprint, transtendon repair, and traditional suture anchor repair techniques with and without tear completion. Both nonoperative and operative strategies demonstrated effectiveness at managing pain and functional outcome for PTRCTs. The evidence supports the effectiveness of surgical intervention in treating PTRCTs regardless of arthroscopic technique. CONCLUSION The results of this scoping review do not support superiority of operative over nonoperative management and suggest that both strategies can be effective at managing pain and functional outcome for PTRCTs. Surgery, however, is the most invasive and costly approach, with the highest risk of complications such as infection. Other variables such as patient expectation, treating practitioner bias, or preference may change which modalities are offered and in what sequence.
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Affiliation(s)
- Breda H F Eubank
- Faculty of Health, Community, and Education, Department of Health and Physical Education, Mount Royal University, Calgary, AB, Canada.
| | - David M Sheps
- Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Liz Dennett
- Health Sciences Librarian, University of Alberta, Edmonton, AB, Canada
| | - Abbie Connick
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Martin Bouliane
- Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Anukul Panu
- Division of Radiology & Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Graeme Harding
- Division of Orthopaedics, Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
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Kania-Richmond A, Beaupre LA, Jessiman-Perreault G, Tribo D, Martyn J, Hart DA, Robert J, Slomp M, Jones CA. 'I do hope more people can benefit from it.': The qualitative experience of individuals living with osteoarthritis who participated in the GLA:D™ program in Alberta, Canada. PLoS One 2024; 19:e0298618. [PMID: 38381756 PMCID: PMC10881017 DOI: 10.1371/journal.pone.0298618] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 01/26/2024] [Indexed: 02/23/2024] Open
Abstract
INTRODUCTION The Good Life with osteoArthritis: Denmark (GLA:DTM) is an evidence-based program designed for individuals with symptomatic hip and knee osteoarthritis (OA). This program has reported improvement in pain, quality of life and self-efficacy, as well as delays in joint replacement surgery for adults with moderate to severe hip or knee OA. Evaluations of GLA:DTM implementation in several countries have focused on effectiveness, training, and feasibility of the program primarily from the provider perspective. Our objective was to examine how the GLA:DTM program was perceived and experienced by individuals with hip and knee OA to inform on-going program refinement and implementation. METHODS Thirty semi-structured telephone interviews were conducted with participants who completed the GLA:DTM program in Alberta. An interpretive description approach was used to frame the study and thematic analysis was used to code the data and identify emergent themes and sub-themes associated with participants' experience and perception of the GLA:DTM program. RESULTS Most participants had a positive experience of the GLA:DTM program and particularly enjoyed the group format, although some participants felt the group format prevented one-on-one support from providers. Three emergent themes related to acceptability were identified: accessible, adaptable, and supportive. Participants found the program to be accessible in terms of location, cost, and scheduling. They also felt the program was adaptable and allowed for individual attention and translatability into other settings. Finally, most participants found the group format to be motivating and fostered connections between participants. CONCLUSION The GLA:DTM program was perceived as acceptable by most participants, yet the group format may not be useful for all individuals living with OA. Recommended improvements included adapting screening to identify those suited for the group format, providing program access earlier in the disease progression trajectory, modifying educational content based on participants' knowledge of OA and finally, providing refresher sessions after program completion.
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Affiliation(s)
- Ania Kania-Richmond
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren A. Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Geneviève Jessiman-Perreault
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Danika Tribo
- Rockyview General Hospital, Alberta Health Services, Calgary, Alberta, Canada
| | - Jason Martyn
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - David A. Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill Robert
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - Mel Slomp
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
| | - C. Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Dillane D, Ramadi A, Nathanail S, Dick BD, Bostick G, Chan K, Douglas C, Goplen G, Green J, Halliday S, Hellec B, Rashiq S, Scharfenberger A, Woolsey G, Beaupre LA, Pedersen ME. Correction: Elective surgery in ankle and foot disorders-best practices for management of pain: a guideline for clinicians. Can J Anaesth 2024; 71:306. [PMID: 38114874 DOI: 10.1007/s12630-023-02679-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2023] [Revised: 09/19/2023] [Accepted: 09/20/2023] [Indexed: 12/21/2023] Open
Affiliation(s)
- Derek Dillane
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ailar Ramadi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Nathanail
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - Bruce D Dick
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Geoff Bostick
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kitty Chan
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - Chris Douglas
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gordon Goplen
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - James Green
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Susan Halliday
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Saifee Rashiq
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Angela Scharfenberger
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - Guy Woolsey
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada.
- Departments of Physical Therapy and Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 St., Edmonton, AB, Canada.
| | - M Elizabeth Pedersen
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
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Kania-Richmond A, Jones CA, Martyn J, Hastings S, Ellis K, Jessiman-Perreault G, Hart DA, Robert J, Slomp M, Beaupre LA. Implementing a guideline-based education and exercise program for people with knee and hip osteoarthritis-Practical experiences of providers and clinic leaders: A qualitative study. Musculoskeletal Care 2023; 21:1213-1226. [PMID: 37548530 DOI: 10.1002/msc.1801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 08/08/2023]
Abstract
BACKGROUND The Good Life with osteoArthritis: Denmark (GLA:DTM ) program is an evidence-based education and exercise program designed for individuals with symptomatic hip and knee osteoarthritis. Launched in Denmark, it has been implemented across Europe, Australia, and North America. The authors assessed the feasibility of GLADTM implementation in Canada (Alberta) by applying the RE-AIM framework. An evaluation objective was to identify factors impacting the implementation of the program in both publicly funded and private rehabilitation settings, based on the experience of the initial cohort of providers and clinic leaders who set up and delivered the program. METHODS Semi-structured telephone interviews were conducted with GLA:DTM -trained providers, managers, or directors of clinics across Alberta. Braun and Clarke's thematic approach was used to code the data and identify emergent categories and themes. Those relevant to the implementation were identified and by consensus, categorized as facilitators of and challenges to the implementation process. RESULTS Eighteen GLA:DTM -trained providers and three clinic leaders from a range of clinical settings completed an interview. Seven common themes emerged in relation to implementation across the study settings. Three themes reflect facilitators of implementation (program acceptability by providers, multi-level support mechanisms, and program flexibility) and four implementation challenges (direct and indirect costs, lack of external referrals, program access issues, and lack of suitable space). The initial implementation of the program was exploratory with limited focus on long-term sustainability. CONCLUSIONS The GLA:DTM program is a translatable program that can be implemented with relative ease in both public and private rehabilitation settings; however, costs, space constraints, and having an adequate referral base were noted challenges. Further work is warranted to explore equitable access across public and private settings and program sustainability.
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Affiliation(s)
- Ania Kania-Richmond
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Martyn
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Staci Hastings
- School of Public Health, University of Alberta, Calgary, Alberta, Canada
| | - Kira Ellis
- Rehab Advice Line, Alberta Health Services, Edmonton, Alberta, Canada
| | | | - David A Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Jill Robert
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Mel Slomp
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Edmonton, Alberta, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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5
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Jones CA, Jessiman-Perreault G, Kania-Richmond A(A, Metcalfe A, Hart DA, Beaupre LA. The effect of geographic location and payor type on provincial-wide delivery of the GLA:D program for hip and knee osteoarthritis in Alberta, Canada. Osteoarthr Cartil Open 2023; 5:100398. [PMID: 37649533 PMCID: PMC10463251 DOI: 10.1016/j.ocarto.2023.100398] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2023] [Accepted: 08/09/2023] [Indexed: 09/01/2023] Open
Abstract
Objective The Good Life with osteoArthritis: Denmark (GLA:D™) program for knee and hip osteoarthritis has been shown to be effective, but evaluations have yet to explore whether effectiveness differs by program context. The present study explores whether there are differences in effectiveness of the GLA:D™ program for treatment of hip and knee osteoarthritis across program location (i.e., rural, urban, metro) and program payor (i.e., public, private) within Alberta, Canada. Design The study population was adults with hip or knee osteoarthritis attending the 8-week GLA:D™ supervised exercise and education programme in Alberta between Sep 2017-Mar 2020. Outcomes of interest were joint-related pain and quality of life (HOOS/KOOS), health quality of life (EQ-5D-5L), and performance-based functional (30-s chair stand test; 40-m walk test) measures. Minimally clinically important changes were calculated for each outcome and ANOVA and chi-square tests were used to determine statistical significance by program location or payor. Results Of the 1321 eligible participants, 974 (73.7%) completed the baseline questionnaire, about 50% of participants participated in a metro area and 60% paid privately for the program. There were no statistically significant differences in improvements of joint-related pain, joint-related quality of life, health-related quality of life, or performance-based functional measures by program location or program payor, except for participants who received the program in a publicly covered primary care clinic who experienced significantly larger improvements in joint-related pain. Conclusion The implementation of the GLA:D™ program for the treatment of knee and hip osteoarthritis in Alberta is effective across a range of contexts.
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Affiliation(s)
- C. Allyson Jones
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | | | - Ania (Anna) Kania-Richmond
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Amy Metcalfe
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David A. Hart
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Lauren A. Beaupre
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - the Bone and Joint Health SCN
- Bone and Joint Health Strategic Clinical Network, Alberta Health Services, Calgary, Alberta, Canada
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Obstetrics & Gynecology, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
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6
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Sutton E, Bell JJ, Beaupre LA. Fragility Fracture Network: innovations in healthcare improvement. BMJ Open Qual 2023; 12:e002609. [PMID: 37783516 PMCID: PMC10565168 DOI: 10.1136/bmjoq-2023-002609] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/19/2023] [Indexed: 10/04/2023] Open
Affiliation(s)
- Emma Sutton
- School of Nursing, Allied Health Professionals and Midwifery, University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
- School of Nursing and Midwifery, University of Birmingham College of Medical and Dental Sciences, Birmingham, UK
| | - Jack J Bell
- Allied Health Research Collaborative, The Prince Charles Hospital, Chermside, Queensland, Australia
| | - Lauren A Beaupre
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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7
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Harasym P, Beaupre LA, Juby AG, Kivi P, Majumdar SR, Hanson HM. Cultural Knowledge in Context - People Aged 50 Years and Over Make Sense of a First Fracture and Osteoporosis. J Patient Exp 2023; 10:23743735231151537. [PMID: 36687165 PMCID: PMC9850129 DOI: 10.1177/23743735231151537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Catch a Break (CaB) is a secondary fracture prevention program that uses medical understandings of osteoporosis to assess first fractures and determine appropriateness for secondary fracture prevention. In this study, we interviewed CaB program participants to identify the understandings that patients themselves used to make sense of first fractures and the osteoporosis suggestion as cause. Semi-structured interviews were conducted with female and male participants of the CaB program in Canada. An interpretive practice approach was used to analyze the data. A random sample of 20 individuals, 12 women, and eight men all aged 50 years and over participated. First fractures were produced as meaningful in the context of osteoporosis only for seniors of very advanced age, and for people of any age with poor nutrition. The trauma events that led to a first fracture were produced as meaningful only if perceived as accidents, and having an active lifestyle was produced as beneficial only for mental health and well-being unrelated to osteoporosis. Cultural knowledge shapes, but does not determine, how individuals make sense of their health and illness experiences. Risk prevention program designers should include patients on the design team and be more aware of the presumptive knowledge used to identify individuals at risk of disease.
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Affiliation(s)
- Patricia Harasym
- Cumming School of Medicine, University of
Calgary, Calgary, Alberta, Canada,Heather M Hanson, Cumming School of
Medicine, University of Calgary, 3D10, 3280 Hospital Drive NW, Calgary, Alberta
T2N 4Z6 Canada.
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine,
University of
Alberta, Edmonton, Alberta, Canada,Department of Orthopedics, Faculty of Medicine, University of
Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton, Alberta, Canada
| | - Angela G Juby
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada
| | - Paul Kivi
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada
| | - Sumit R Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry,
University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, Edmonton,
Alberta, Canada,School of Public Health, University of Alberta, 3-300 Edmonton
Clinic Health Academy, Edmonton, Alberta, Canada
| | - Heather M Hanson
- Cumming School of Medicine, University of
Calgary, Calgary, Alberta, Canada,Provincial Seniors Health and Continuing Care, Alberta Health
Services, Calgary, Alberta, Canada
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Goplen CM, Pedersen ME, Ramadi A, Beaupre LA. Opioid prescribing practices prior to elective foot and ankle surgery: a population-based evaluation using health administrative data from a tertiary hospital in Canada. BMC Prim Care 2022; 23:116. [PMID: 35549666 PMCID: PMC9097109 DOI: 10.1186/s12875-022-01722-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/21/2021] [Accepted: 04/22/2022] [Indexed: 11/10/2022]
Abstract
Abstract
Background
Complex elective foot and ankle surgery is known to be painful so most patients are prescribed opioids at the time of surgery; however, the number of patients prescribed opioids while waiting for surgery in Canada is unknown. Our primary objective was to describe the pre and postoperative prescribing practices for patients in Alberta, Canada undergoing complex elective foot and ankle surgery. Secondarily, we evaluated postoperative opioid usage and hospital outcomes.
Methods
In this population-based retrospective analysis, we identified all adult patients who underwent unilateral elective orthopedic foot and ankle surgery at a single tertiary hospital between May 1, 2015 and May 31, 2017. Patient and surgical data were extracted from a retrospective chart review and merged with prospectively collected, individual level drug dispensing administrative data to analyze opioid dispensing patterns, including dose, duration, and prescriber for six months before and after foot and ankle surgery.
Results
Of the 100 patients, 45 had at least one opioid prescription dispensed within six months before surgery, and of these, 19 were long-term opioid users (> 90 days of continuous use). Most opioid users obtained opioid prescriptions from family physicians both before (78%) and after (65%) surgery. No preoperative non-users transitioned to long-term opioid use postoperatively, but 68.4% of the preoperative long-term opioid users remained long-term opioid users postoperatively. During the index hospitalization, preoperative long-term opioid users consumed higher doses of opioids (99.7 ± 120.5 mg/day) compared to opioid naive patients (28.5 ± 36.1 mg/day) (p < 0.001). Long-term opioid users stayed one day longer in hospital than opioid-naive patients (3.9 ± 2.8 days vs 2.7 ± 1.1 days; p = 0.01).
Conclusions
A significant number of patients were dispensed opioids before and after foot and ankle surgery with the majority of prescriptions coming from primary care practitioners. Patients who were prescribed long-term opioids preoperatively were more likely to continue to use opioids at follow-up and required larger in-hospital opioid dosages and stayed longer in hospital. Further research and education for both patients and providers are needed to reduce the community-based prescribing of opioid medication pre-operatively and provide alternative pain management strategies prior to surgery to improve postoperative outcomes and reduce long-term postoperative opioid use.
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Dillane D, Ramadi A, Nathanail S, Dick BD, Bostick G, Chan K, Douglas C, Goplen G, Green J, Halliday S, Hellec B, Rashiq S, Scharfenberger A, Woolsey G, Beaupre LA, Pedersen ME. Elective surgery in ankle and foot disorders-best practices for management of pain: a guideline for clinicians. Can J Anaesth 2022; 69:1053-1067. [PMID: 35581524 DOI: 10.1007/s12630-022-02267-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/14/2022] [Accepted: 03/06/2022] [Indexed: 01/10/2023] Open
Abstract
PURPOSE Complex elective foot and ankle surgeries are often associated with severe pain pre- and postoperatively. When inadequately managed, chronic postsurgical pain and long-term opioid use can result. As no standards currently exist, we aimed to develop best practice pain management guidelines. METHODS A local steering committee (n = 16) surveyed 116 North American foot and ankle surgeons to understand the "current state" of practice. A multidisciplinary expert panel (n = 35) was then formed consisting of orthopedic surgeons, anesthesiologists, chronic pain physicians, primary care physicians, pharmacists, registered nurses, physiotherapists, and clinical psychologists. Each expert provided up to three pain management recommendations for each of the presurgery, intraoperative, inpatient postoperative, and postdischarge periods. These preliminary recommendations were reduced, refined, and sent to the expert panel and "current state" survey respondents to create a consensus document using a Delphi process conducted from September to December 2020. RESULTS One thousand four hundred and five preliminary statements were summarized into 51 statements. Strong consensus (≥ 80% respondent agreement) was achieved in 53% of statements including the following: postsurgical opioid use risk should be assessed preoperatively; opioid-naïve patients should not start opioids preoperatively unless non-opioid multimodal analgesia fails; and if opioids are prescribed at discharge, patients should receive education regarding importance of tapering opioid use. There was no consensus regarding opioid weaning preoperatively. CONCLUSIONS Using multidisciplinary experts and a Delphi process, strong consensus was achieved in many areas, showing considerable agreement despite limited evidence for standardized pain management in patients undergoing complex elective foot and ankle surgery. No consensus on important issues related to opioid prescribing and cessation highlights the need for research to determine best practice.
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Affiliation(s)
- Derek Dillane
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Ailar Ramadi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Nathanail
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - Bruce D Dick
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Geoff Bostick
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada
| | - Kitty Chan
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - Chris Douglas
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Gordon Goplen
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - James Green
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Susan Halliday
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | | | - Saifee Rashiq
- Department of Anesthesia and Pain Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Angela Scharfenberger
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - Guy Woolsey
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada.
- Departments of Physical Therapy and Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 St., Edmonton, AB, Canada.
| | - M Elizabeth Pedersen
- Collaborative Orthopaedic REsearch (CORe), University of Alberta, Edmonton, AB, Canada
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10
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Ramadi A, Ezeugwu VE, Weber S, Funabashi M, Lima CA, Perracini MR, Beaupre LA. Progressive Resistance Training Program Characteristics in Rehabilitation Programs Following Hip Fracture: A Meta-Analysis and Meta-Regression. Geriatr Orthop Surg Rehabil 2022; 13:21514593221090799. [PMID: 35514534 PMCID: PMC9067046 DOI: 10.1177/21514593221090799] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2022] [Revised: 02/08/2022] [Accepted: 03/09/2022] [Indexed: 11/17/2022] Open
Abstract
Introduction: Older adults often experience incomplete recovery after a hip fracture. Rehabilitation programs with progressive resistance training are associated with improved functional recovery. This systematic review and meta-analysis with meta-regression a) evaluated resistance training characteristics reported in hip fracture rehabilitation programs, b) performed meta-analysis of resistance training impact on strength (primary outcome), gait and physical activity (secondary outcomes), and c) explored resistance training program characteristics associated with improved outcomes using meta-regression. Materials and Methods: Medline, EMBASE, CINAHLPLUS, and Web of Science Core Collection databases were searched (January2000–February2021). Randomized controlled trials including progressive resistance training rehabilitation programs after hip fracture surgery in adults ≥50 years old were included. Meta-analyses and exploratory meta-regression were performed. Results: Meta-analysis showed significant increases in strength (10 trials-728 participants; Standardized Mean Difference (SMD) [95%CI]; .40 [.02, .78]) immediately following program completion in intervention relative to control participants. Meta-analysis on 5 trials (n = 384) with extended follow up found no significant group differences (SMD = .47 [-.28, 1.23]) in strength. Center-based relative to home-based programs were associated with significantly greater improvements in strength (P < .05) as were programs where resistance training intensity was prescribed using one-repetition maximum relative to other exercise prescription methods (P < .05). In gait meta-analysis (n = 10 trials-704 participants), gait speed in intervention participants immediately after the program was significantly higher than control (SMD = .42 [.08, .76]) but this finding was not maintained in extended follow-up (n = 5 trials-240 participants; SMD = .6 [-.26, .38]). Higher resistance training intensity was associated with significant improvements in gait speed (P < .05). No meta-analysis was performed for the 3 heterogeneous studies reporting physical activity. Discussion: Progressive resistance training improved muscle strength and gait speed after hip fracture surgery in adults ≥50years old immediately after the program ended, but the longer-term impact may be more limited. Conclusions: Higher resistance training intensity and center-based programs may be associated with more improvement, but require further research.
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Affiliation(s)
- Ailar Ramadi
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Victor E Ezeugwu
- Department of Pediatrics, University of Alberta, Edmonton, AB, Canada
| | - Sydnie Weber
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | | | | | | | - Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
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Ramadi A, Beaupre LA, Heinrichs L, Pedersen ME. Recovery and Return to Activity 1 Year After Ankle Fracture Managed With Open Reduction and Internal Fixation: A Prospective Longitudinal Cohort Study. Foot & Ankle Orthopaedics 2022; 7:24730114221091806. [PMID: 35464787 PMCID: PMC9021494 DOI: 10.1177/24730114221091806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Background: Ankle fractures are common and frequently managed with open reduction and internal fixation (ORIF). Although these fractures can occur at any age, they are most common in younger individuals with high-energy trauma or older adults with lower-energy trauma. Our investigation focused on those aged 65 years or younger. Our primary objective was to describe recovery over the first postfracture year in (1) functional dorsiflexion using the weightbearing lunge test (WBLT), (2) patient-reported functional outcomes using the Olerud Molander Ankle Score (OMAS), (3) return to prefracture activity levels, and (4) return to work. Secondarily, we examined patient and clinical factors (including the WBLT and OMAS) associated with return to prefracture activities, including sports. Methods: Using a prospective inception cohort of 142 patients between 18 and 65 years old who underwent ORIF after ankle fracture and attended follow-up visits, we collected information from participants and their medical charts. We assessed functional dorsiflexion (using side-to-side difference in WBLT), patient-reported functional outcome (OMAS), and self-reported return to prefracture activity levels and work at 6 weeks, 6 months and 1 year postoperatively. Results: The WBLT, OMAS, and return to prefracture activity and work improved significantly over time ( P < .001). However, at 1 year postoperation, the mean side-to-side difference in the WBLT was 3.22±2.68 cm, 69 (72%) reported ankle stiffness, and only 49 (52%) had returned to prefracture activity levels. Of those who were working, 97% had returned to work by 1 year postoperation. Only the OMAS ( P < .001) and side-to-side difference in WBLT ( P = .011) were significantly associated with return to prefracture activity levels. Conclusion: Although participants improved significantly over the first postoperative year in all outcomes, many reported limitations in functional dorsiflexion and return to prefracture activities. Those with higher OMAS scores and smaller side-to-side difference in WBLT were more likely to return to prefracture activity levels by 1 year postoperatively. Level of Evidence: Level II, prognostic study.
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Affiliation(s)
- Ailar Ramadi
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren A. Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
- Lauren A. Beaupre, PT, PhD, Departments of Physical Therapy and Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 St, Edmonton, AB T6G 2B7, Canada.
| | - Luke Heinrichs
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - M. Elizabeth Pedersen
- Division of Orthopaedic Surgery, Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
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Bergman JW, Silveira A, Chan R, Lapner M, Hildebrand KA, Le ILD, Sheps DM, Beaupre LA, Lalani A. Is Immobilization Necessary for Early Return to Work Following Distal Biceps Repair Using a Cortical Button Technique?: A Randomized Controlled Trial. J Bone Joint Surg Am 2021; 103:1763-1771. [PMID: 34166263 DOI: 10.2106/jbjs.20.02047] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Improvements in surgical fixation to repair distal biceps tendon ruptures have not fully translated to earlier postoperative mobilization; it is unknown whether earlier mobilization affords earlier functional return to work. This parallel-arm randomized controlled trial compared the impact of early mobilization versus 6 weeks of postoperative immobilization following distal biceps tendon repair. METHODS One hundred and one male participants with a distal biceps tendon rupture that was amenable to a primary repair with use of a cortical button were randomized to early mobilization (self-weaning from sling and performance of active range of motion as tolerated during first 6 weeks) (n = 49) or 6 weeks of immobilization (splinting for 6 weeks with no active range of motion) (n = 52). Follow-up assessments were performed by a blinded assessor at 2 and 6 weeks and at 3, 6, and 12 months. At 12 months, distal biceps tendon integrity was verified with ultrasound. The primary outcome was return to work. Secondary outcomes were pain, range of motion, strength, shortened Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) score, and tendon integrity. Intention-to-treat analysis was performed. A linear mixed model for repeated measures was used to compare pain, range of motion, strength, and QuickDASH between the groups over time; return to work was assessed with use of independent t tests. RESULTS The groups were similar preoperatively (p ≥ 0.16). The average age (and standard deviation) was 44.7 ± 8.6 years. Eighty-three participants (82%) were followed to 12 months. There were no differences between the groups in terms of return to work (p ≥ 0.83). Participants in the early mobilization group had significantly more passive forearm supination (p = 0.04), with passive forearm pronation (p = 0.06) and active extension and supination (p = 0.09) trending toward significantly greater range of motion in the early mobilization group relative to the immobilization group. Participants in the early mobilization group had significantly better QuickDASH scores over time than those in the immobilization group (p = 0.02). There were no differences between the groups in terms of pain (p ≥ 0.45), active range of motion (p ≥ 0.09), or strength (p ≥ 0.70). Two participants (2.0%, 1 in each group) had full-thickness tears on ultrasound at 12 months (p = 0.61). Compliance was not significantly different between the groups (p = 0.16). CONCLUSIONS Early motion after distal biceps tendon repair with cortical button fixation is well tolerated and does not appear to be associated with adverse outcomes. No clinically important group differences were seen. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Joseph W Bergman
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Anelise Silveira
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Robert Chan
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Michael Lapner
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Kevin A Hildebrand
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Ian L D Le
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - David M Sheps
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
| | - Lauren A Beaupre
- Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Aleem Lalani
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,Western Upper Limb Facility, Sturgeon Community Hospital, St. Albert, Alberta, Canada
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13
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Hanson HM, Harasym P, Juby AG, Kivi P, Beaupre LA, Majumdar SR. Accounts of health risk assessment survey administration in the Catch a Break Program: the social construction of osteoporosis risk identification and need for intervention. Arch Osteoporos 2021; 16:136. [PMID: 34535837 DOI: 10.1007/s11657-021-00994-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Accepted: 08/22/2021] [Indexed: 02/03/2023]
Abstract
UNLABELLED Catch a Break staff conducting the organizational work of delivering secondary fracture prevention screening conversations drew on cultural and organizational resources to determine eligibility of individuals. They encountered and navigated their way through interactional troubles as they requested participation, assessed trauma risk, and provided lifestyle information. PURPOSE We investigated delivery of a population-based type C fracture liaison service for non-hip fractures. The purpose of this study was to examine accounts of how osteoporosis health risk screening interactions were delivered. METHODS A pre-determined sample of 5 organizational representatives (program staff) were interviewed by telephone. We analyzed the qualitative data through the lens of interpretive inquiry, informed by discourse analysis, to examine staff's "talk" about conducting the program risk screening conversations. RESULTS A dominant finding emerging from CAB staff's accounts of program delivery was the conversational work required to include only those individuals deemed appropriate for the program while managing the survey interaction. Staff talked about specific examples of interactional troubles they experienced as barriers to the smooth and successful risk screening conversation. They drew on cultural and organizational resources as interpretive frameworks to make decisions about individuals and groups at risk and in need of further investigation. They drew on larger ideas about ageism and genderism, judging as inappropriate for participation the oldest old adults, men involved in high risk occupations, and adults aged 50 to 70. Staff also employed interactional resources useful in managing problems in the conversation during the request to participate, trauma risk assessment, and lifestyle/health information provision sequences of the risk screening call. CONCLUSION We uncovered areas in the screening interaction that were talked about by staff as problematic to achieving the program objective of identifying and enrolling individuals in the secondary fracture prevention program. By highlighting areas for improvement in program delivery, this study may help to reduce the interactional troubles staff negotiate as they deliver this type of program.
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Affiliation(s)
- Heather M Hanson
- Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, 3D10T2N 4Z6, Canada. .,Provincial Seniors Health and Continuing Care, Alberta Health Services, 10301 Southport Lane SW, Calgary, AB, T2W 1S7, Canada.
| | - Patricia Harasym
- Cumming School of Medicine, University of Calgary, 3280 Hospital Drive NW, Calgary, AB, 3D10T2N 4Z6, Canada
| | - Angela G Juby
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Paul Kivi
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, 2-50 Corbett Hall, 8205 114 St. NW, Edmonton, AB, T6G 2G4, Canada.,Department of Orthopedics, Faculty of Medicine, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada
| | - Sumit R Majumdar
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 2J2.00 WC Mackenzie Health Sciences Centre, 8440 112 St. NW, Edmonton, AB, T6G 2R7, Canada.,School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave NW, Edmonton, AB, T6G 1C9, Canada
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Beaupre LA, Kang SH, Jhangri GS, Boettcher T, Jones CA. Impact of Depressive Symptomology on Pain and Function during Recovery after Total Joint Arthroplasty. South Med J 2021; 114:450-457. [PMID: 34345922 DOI: 10.14423/smj.0000000000001285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
OBJECTIVES To determine the effect of preoperative depressive symptoms on patient-reported function and pain following total joint arthroplasty (TJA) after controlling for potential confounding factors; how depressive symptoms changed after TJA; and the impact of postoperative depressive symptoms on recovery. METHODS A prospective cohort study undertaken in a metropolitan region in Canada enrolled 710 participants; 622 (87%) had complete 6-month data. Participants completed standardized measures preoperatively and at 1, 3, and 6 months postoperatively. The primary outcome was Western Ontario McMaster Osteoarthritis Index (WOMAC) pain and function. Three groups were created: depressive symptoms absent (n = 573, 82%), possible depressive symptoms (n = 58, 8%), and probable depressive symptoms (n = 68, 10%) using the Center for Epidemiologic Scale for Depression score. Risk-adjusted analyses examined the association between WOMAC change and the preoperative Center for Epidemiologic Scale for Depression score. RESULTS After risk adjustment, preoperative possible and probable depressive symptomology was associated with postoperative WOMAC pain scores that were 7.6 and 11.7 points, respectively, worse and WOMAC function scores that were 8.8 and 14.3 points, respectively, worse than those without preoperative depressive symptoms. Depressive symptoms improved postoperatively; by 6 months post-TJA, only 34 (5%) participants screened as having probable depressive symptoms, whereas only 13(2%) had possible depressive symptoms. Postoperative WOMAC pain and function scores improved, but they were negatively affected by possible and probable depressive symptoms. CONCLUSIONS Although depressive symptoms improve postoperatively, preoperative depressive symptoms, especially for those with probable depressive symptomology, may negatively affect postoperative pain and functional recovery even after risk adjustment.
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Affiliation(s)
- Lauren A Beaupre
- From the Department of Physical Therapy, Division of Orthopaedic Surgery, and School of Public Health. University of Alberta, and the Alberta Bone and Joint Health Institute, Alberta, Edmonton, Canada
| | - Sung H Kang
- From the Department of Physical Therapy, Division of Orthopaedic Surgery, and School of Public Health. University of Alberta, and the Alberta Bone and Joint Health Institute, Alberta, Edmonton, Canada
| | - Gian S Jhangri
- From the Department of Physical Therapy, Division of Orthopaedic Surgery, and School of Public Health. University of Alberta, and the Alberta Bone and Joint Health Institute, Alberta, Edmonton, Canada
| | - Tyson Boettcher
- From the Department of Physical Therapy, Division of Orthopaedic Surgery, and School of Public Health. University of Alberta, and the Alberta Bone and Joint Health Institute, Alberta, Edmonton, Canada
| | - C Allyson Jones
- From the Department of Physical Therapy, Division of Orthopaedic Surgery, and School of Public Health. University of Alberta, and the Alberta Bone and Joint Health Institute, Alberta, Edmonton, Canada
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15
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Chan H, Beaupre LA, Teshima TL, Bouliane MJ. Corrigendum to: "Injury of the suprascapular nerve during arthroscopic repair of superior labral tears: an anatomic study [J Shoulder Elbow Surg 2010;19:709-715]". J Shoulder Elbow Surg 2021; 30:e543. [PMID: 34294358 DOI: 10.1016/j.jse.2021.04.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
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Goplen CM, Kang SH, Randell JR, Jones CA, Voaklander DC, Churchill TA, Beaupre LA. Effect of preoperative long-term opioid therapy on patient outcomes after total knee arthroplasty: an analysis of multicentre population-based administrative data. Can J Surg 2021; 64:E135-E143. [PMID: 33666382 PMCID: PMC8064248 DOI: 10.1503/cjs.007319] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
Background Up to 40% of patients are receiving opioids at the time of total knee arthroplasty (TKA) in the United States despite evidence suggesting opioids are ineffective for pain associated with arthritis and have substantial risks. Our primary objective was to determine whether preoperative opioid users had worse knee pain and physical function outcomes 12 months after TKA than patients who were opioid-naive preoperatively; our secondary objective was to determine the prevalence of opioid use before and after TKA in Alberta, Canada. Methods In this retrospective analysis of population-based data, we identified adult patients who underwent TKA between 2013 and 2015 in Alberta. We used multivariable linear regression to examine the association between preoperative opioid use and Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain and physical function scores 12 months after TKA, adjusting for potentially confounding variables. Results Of the 1907 patients, 592 (31.0%) had at least 1 opioid dispensed before TKA, and 124 (6.5%) were classified as long-term opioid users. Long-term opioid users had worse adjusted WOMAC pain and physical function scores 12 months after TKA than patients who were opioid-naive preoperatively (pain score β = 7.7, 95% confidence interval [CI] 4.0 to 11.6; physical function score β = 7.8, 95% CI 4.0 to 11.6; p < 0.001 for both). The majority (89 ([71.8%]) of patients who were long-term opioid users preoperatively were dispensed opioids 180–360 days after TKA, compared to 158 (12.0%) patients who were opioid-naive preoperatively. Conclusion A substantial number of patients were dispensed opioids before and after TKA, and patients who received opioids preoperatively had worse adjusted pain and functional outcome scores 12 months after TKA than patients who were opioid-naive preoperatively. These results suggest that patients prescribed opioids preoperatively should be counselled judiciously regarding expected outcomes after TKA.
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Affiliation(s)
- C Michael Goplen
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Goplen, Beaupre, Churchill); the School of Public Health, University of Alberta, Edmonton, Alta. (Randell, Jones, Voaklander); the Department of Physical Therapy, University of Alberta, Edmonton, Alta. (Randell, Jones, Beaupre); and the Alberta Bone and Joint Institute, Calgary, Alta. (Kang)
| | - Sung Hyun Kang
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Goplen, Beaupre, Churchill); the School of Public Health, University of Alberta, Edmonton, Alta. (Randell, Jones, Voaklander); the Department of Physical Therapy, University of Alberta, Edmonton, Alta. (Randell, Jones, Beaupre); and the Alberta Bone and Joint Institute, Calgary, Alta. (Kang)
| | - Jason R Randell
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Goplen, Beaupre, Churchill); the School of Public Health, University of Alberta, Edmonton, Alta. (Randell, Jones, Voaklander); the Department of Physical Therapy, University of Alberta, Edmonton, Alta. (Randell, Jones, Beaupre); and the Alberta Bone and Joint Institute, Calgary, Alta. (Kang)
| | - C Allyson Jones
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Goplen, Beaupre, Churchill); the School of Public Health, University of Alberta, Edmonton, Alta. (Randell, Jones, Voaklander); the Department of Physical Therapy, University of Alberta, Edmonton, Alta. (Randell, Jones, Beaupre); and the Alberta Bone and Joint Institute, Calgary, Alta. (Kang)
| | - Donald C Voaklander
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Goplen, Beaupre, Churchill); the School of Public Health, University of Alberta, Edmonton, Alta. (Randell, Jones, Voaklander); the Department of Physical Therapy, University of Alberta, Edmonton, Alta. (Randell, Jones, Beaupre); and the Alberta Bone and Joint Institute, Calgary, Alta. (Kang)
| | - Thomas A Churchill
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Goplen, Beaupre, Churchill); the School of Public Health, University of Alberta, Edmonton, Alta. (Randell, Jones, Voaklander); the Department of Physical Therapy, University of Alberta, Edmonton, Alta. (Randell, Jones, Beaupre); and the Alberta Bone and Joint Institute, Calgary, Alta. (Kang)
| | - Lauren A Beaupre
- From the Department of Surgery, University of Alberta, Edmonton, Alta. (Goplen, Beaupre, Churchill); the School of Public Health, University of Alberta, Edmonton, Alta. (Randell, Jones, Voaklander); the Department of Physical Therapy, University of Alberta, Edmonton, Alta. (Randell, Jones, Beaupre); and the Alberta Bone and Joint Institute, Calgary, Alta. (Kang)
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Beaupre LA, Menon MR, Almaazmi K, Kang SH, Dieleman S, Tsui B. Preoperative nerve blocks for hip fracture patients: A pilot randomized trial. Injury 2021; 52:548-553. [PMID: 33051072 DOI: 10.1016/j.injury.2020.10.029] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 09/08/2020] [Accepted: 10/06/2020] [Indexed: 02/02/2023]
Abstract
PURPOSE To determine the: 1) impact of pre-operative femoral nerve block(PreopFNB) on: a) pain; b) opioid use; and c) early post-operative mobilization relative to usual care(CONTROL) and 2) feasibility of a definitive randomized clinical trial(RCT). METHODS This pilot RCT, performed in a Canadian tertiary center, compared PreopFNB to CONTROL in 73 participants aged ≥65 years, who a) were ambulatory pre-hip fracture, b) had Mini Mental Status Examination(MMSE) score ≥13 and c) provided consent(direct/proxy). Participants were randomized to PreopFNB or CONTROL using 2 PreopFNB:1 CONTROL(48 PreopFNB:25 CONTROL) allocation. Pain, opioid use and early post-operative mobilization were compared between groups. Inclusion of those with cognitive impairment and PFNB treatment fidelity were also assessed. RESULTS The PreopFNB group was slightly older than CONTROL(mean ±SD: 79.9 ± 8.9 versus 76.8 ± 9.0; p = 0.15) with more males(21[42%] versus 5[22%]; p = 0.04). The overall mean MMSE score was ≥24. Mean pain scores were not significantly different between groups at rest(p = 0.17), with activity(p = 0.21) or non-verbal assessment(p = 0.79). Opioid use(oral morphine equivalents) was non-significantly higher and more variable in CONTROL than PreopFNB pre-operatively(Median [25,75 quartiles] 13.1[0,398] versus 7.5[0,125]) and post-operatively(15.0[0,950] versus 10.0[0,260])(p = 0.28). On day 1 post-operative, 40(87%) PFNB and 17(71%) CONTROL participants mobilized(p = 0.10). CONCLUSION We found similar reported pain between groups. Although not significant, opioid use was higher and more variable in CONTROL and more PreopFNB patients mobilized day 1 post-operatively. Participants with cognitive impairment were not frequently enrolled. With modification, a definitive RCT is feasible and would inform pain management after hip fracture.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada, T6G 2G3; Department of Surgery, University of Alberta, Edmonton, Canada, T6G 2G3.
| | - Matthew R Menon
- Department of Surgery, University of Alberta, Edmonton, Canada, T6G 2G3.
| | - Khalid Almaazmi
- Department of Surgery, University of Alberta, Edmonton, Canada, T6G 2G3.
| | - Sung H Kang
- Alberta Bone and Joint Health Institute, Edmonton, Canada, T6G 2G3.
| | - Sherry Dieleman
- Alberta Health Services, 112 St and 84 Ave, Edmonton, Canada, T6G 2G4.
| | - Ban Tsui
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada, T6G 2G3.
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Beaupre LA, Lier D, Magaziner JS, Jones CA, Johnston DWC, Wilson DM, Majumdar SR. An Outreach Rehabilitation Program for Nursing Home Residents After Hip Fracture May Be Cost-Saving. J Gerontol A Biol Sci Med Sci 2021; 75:e159-e165. [PMID: 32215562 DOI: 10.1093/gerona/glaa074] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND We compared the cost-effectiveness of 10 weeks of outreach rehabilitation (intervention) versus usual care (control) for ambulatory nursing home residents after hip fracture. METHODS Enrollment occurred February 2011 through June 2015 in a Canadian metropolitan region. Seventy-seven participants were allocated in a 2:1 ratio to receive a 10-week rehabilitation program (intervention) or usual care (control) (46 intervention; 31 control). Using a payer perspective, we performed main and sensitivity analyses. Health outcome was measured by quality-adjusted life years (QALYs), using the EQ5D, completed at study entry, 3-, 6-, and 12-months. We obtained patient-specific data for outpatient visits, physician claims, and inpatient readmissions; the trial provided rehabilitation utilization/cost data. We estimated incremental cost and incremental effectiveness. RESULTS Groups were similar at study entry; the mean age was 87.9 ± 6.6 years, 54 (71%) were female and 58 (75%) had severe cognitive impairment. EQ5D QALYs scores were nonsignificantly higher for intervention participants. Inpatient readmissions were two times higher among controls, with a cost difference of -$3,350/patient for intervention participants, offsetting the cost/intervention participant of $2,300 for the outreach rehabilitation. The adjusted incremental QALYs/patient difference was 0.024 favoring the intervention, with an incremental cost/patient of -$621 for intervention participants; these values were not statistically significant. A sensitivity analysis reinforced these findings, suggesting that the intervention was likely dominant. CONCLUSION A 10-week outreach rehabilitation intervention for nursing home residents who sustain a hip fracture may be cost-saving, through reduced postfracture hospital readmissions. These results support further work to evaluate postfracture rehabilitation for nursing home residents.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Doug Lier
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - Jay S Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | | | - Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Canada
- Faculty of Education and Health Sciences, University of Limerick, Ireland
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Beaupre LA, Hammal F, Stiegelmar R, Masson E, Finegan B. A community-based pharmacist-led smoking cessation program, before elective total joint replacement surgery, markedly enhances smoking cessation rates. Tob Induc Dis 2020; 18:78. [PMID: 33013274 PMCID: PMC7528266 DOI: 10.18332/tid/126405] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2020] [Revised: 07/21/2020] [Accepted: 08/14/2020] [Indexed: 01/15/2023] Open
Abstract
INTRODUCTION We compared smoking cessation outcomes between those who used a pharmacist-led community-based smoking cessation intervention and those who did not, prior to total joint replacement (TJR) surgery. Also, we examined intervention characteristics (e.g. number/duration of sessions attended, recommended therapy) and smoking cessation outcomes. METHODS This prospective evaluation was nested within a comparative study from a centralized clinic that prepares over 3000 patients annually for TJR and focused on participants referred to the community-based smoking cessation program preoperatively. Pharmacists offered an individualized evidence-based intervention and collected visit, duration and intervention data. Smoking cessation, the primary outcome, was ascertained independently of participating pharmacists at 6 weeks post-operative using exhaled CO monitoring and at 6 months post-recruitment via telephone interview. RESULTS Of 286 eligible candidates, 104 agreed to participate, with one subsequently withdrawing (n=103). At 6 weeks post-operatively, 66/103 (64%) participants returned for study re-assessment while 63/103 (61%) participants completed the post-recruitment interview at 6 months; non-respondents to study follow-up were considered smokers. Of 103 participants, 58 (56%) consulted with a pharmacist; those who did not consult a pharmacist (n=45) were slightly younger (p=0.02) with significantly higher CO level (p=0.02) on study entry. Validated 7-day point prevalence abstinence (PPA) at 6 weeks post-operative was 11/58 (19%) in pharmacist-compliant participants compared to 2/45 (4%) in non-compliant participants (p=0.04). At 6 months post-recruitment, 19/58 (33%) pharmacistcompliant participants self-reported a 7-day PPA compared to 2/45 (4%) by non-compliant participants (p<0.001). For pharmacist-compliant participants, 33/58 (54%) saw the pharmacist 4 times; the mean overall pharmacist time was 71.8±24.4 minutes/patient with 26/58 (45%) and 19/58 (33%) prescribed nicotine replacement therapy and varenicline, respectively, and 13/58 (22%) not using medication; post hoc analysis suggested varenicline was marginally more effective for smoking cessation than no medication (p=0.04). CONCLUSIONS Community-based pharmacist-led smoking cessation programs are an effective addition to usual preoperative care for smokers awaiting elective TJR. Using existing community resources led to higher smoking cessation rates in smokers waiting for TJR relative to those not using these resources.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada.,Department of Surgery, University of Alberta, Edmonton, Canada
| | - Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | | | - Edward Masson
- Department of Surgery, University of Alberta, Edmonton, Canada
| | - Barry Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
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Wozniak LA, Rowe BH, Ingstrup M, Johnson JA, McAlister FA, Bellerose D, Beaupre LA, Majumdar SR. Patients' Experiences of Nurse Case-Managed Osteoporosis Care: A Qualitative Study. J Patient Exp 2020; 7:251-257. [PMID: 32851148 PMCID: PMC7427371 DOI: 10.1177/2374373519827340] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Osteoporosis is a chronic condition that is often left untreated. Nurse case-managers can double rates of appropriate treatment in those with new fractures. However, little is known about patients’ experiences of a nurse case-managed approach to osteoporosis care. Objective: Our aim was to describe patients’ experiences of nurse case-managed osteoporosis care. Methods: A qualitative, descriptive design was used. We recruited patients enrolled in a randomized controlled trial of a nurse case-management approach. Individual semi-structured interviews were conducted which were transcribed and analyzed using content analysis. Data were managed with ATLAS.ti version 7. Results: We interviewed 15 female case-managed patients. Most (60%) were 60-years or older, 27% had previous fracture, 80% had low bone mineral density tests, and 87% had good osteoporosis knowledge. Three major themes emerged from our analysis: acceptable information to inform decision-making; reasonable and accessible care provided; and appropriate information to meet patient needs. Conclusions: This study provides important insights about older female patients’ experiences with nurse case-managed care for osteoporosis. Our findings suggest that this model to osteoporosis clinical care should be sustained and expanded in this setting, if proven effective. In addition, our findings point to the importance of applying patient-centered care across all dimensions of quality to better enhance the patients’ experience of their health care.
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Affiliation(s)
- Lisa A Wozniak
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Brian H Rowe
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada.,Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Meghan Ingstrup
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Finlay A McAlister
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, Canada
| | - Debbie Bellerose
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
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Beaupre LA, Magaziner JS, Jones CA, Jhangri GS, Johnston DWC, Wilson DM, Majumdar SR. Rehabilitation After Hip Fracture for Nursing Home Residents: A Controlled Feasibility Trial. J Gerontol A Biol Sci Med Sci 2020; 74:1518-1525. [PMID: 30753303 DOI: 10.1093/gerona/glz031] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND This study compared functional outcomes at 3 months after hip fracture surgery between nursing home residents participating in a 10-week outreach rehabilitation program and those receiving usual care. Function, health-related quality of life, and mortality were also compared over 12 months, and outreach program feasibility was assessed. METHODS A feasibility trial was undertaken in Canadian nursing homes; of 77 participants, 46 were allocated to Outreach and 31 to Control prior to assessing function or cognition. Outreach participants received 10 weeks of rehabilitation (30 sessions), and Control participants received usual posthospital fracture care in their nursing homes. The primary outcome was the Functional Independence Measure Physical Domain (FIMphysical) score 3 months post-fracture; we also explored FIM Locomotion and Mobility. Secondary outcomes were FIM scores, EQ-5D-3L scores, and mortality over 12 months. Program feasibility was also evaluated. RESULTS The mean age was 88.7 ± 7.0 years, 55 (71%) were female, and 58 (75%) had severe cognitive impairment with no significant group differences (p > .14). Outreach participants had significantly higher FIM Locomotion than usual care (p = .02), but no significant group differences were seen in FIMphysical or FIM Mobility score 3 months post-fracture. In adjusted analyses, Outreach participants reported significant improvements in all FIM and EQ-5D-3L scores compared with Control participants over 12 months (p < .05). Mortality did not differ by group (p = .80). Thirty (65%) Outreach participants completed the program. CONCLUSIONS Our feasibility trial demonstrated that Outreach participants achieved better locomotion by 3 months post-fracture compared with participants receiving usual postfracture care; benefits were sustained to 12 months post-fracture. In adjusted analyses, Outreach participants also showed sustained benefits in physical function and health-related quality of life.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada.,Department of Surgery, University of Alberta, Edmonton, Canada
| | - Jay S Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Baltimore
| | - C Allyson Jones
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Gian S Jhangri
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | - Donna M Wilson
- Faculty of Nursing, University of Alberta, Edmonton, Canada.,Faculty of Education and Health Sciences, University of Limerick, Ireland
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Beaupre LA, Moradi F, Khong H, Smith C, Evens L, Hanson HM, Juby AG, Kivi P, Majumdar SR. Implementation of an in-patient hip fracture liaison services to improve initiation of osteoporosis medication use within 1-year of hip fracture: a population-based time series analysis using the RE-AIM framework. Arch Osteoporos 2020; 15:83. [PMID: 32488730 DOI: 10.1007/s11657-020-00751-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2019] [Accepted: 05/05/2020] [Indexed: 02/03/2023]
Abstract
UNLABELLED A hip fracture liaison service that was implemented in 2 hospitals in Alberta, Canada, co-managed by a nurse and physician, was effective for improving initiation of osteoporosis medication following hip fracture. PURPOSE To examine implementation of an in-patient hip fracture liaison service (H-FLS) to improve osteoporosis medication use after hip fracture using the RE-AIM framework (reach, effectiveness, adoption, implementation, maintenance). METHODS Using population-based administrative data from 7 quarters before and up to 7 quarters after H-FLS implementation, we examined new starts, continued use, and overall use (new starts + continued use) of osteoporosis medication after hip fracture. A total of 1427 patients 50 years and older that underwent hip fracture surgery at 1 of 2 tertiary hospitals in a Canadian province and survived to 12 months post-fracture were included. We also compared treatment initiation rates by sex and hospital. RESULTS Of the 1427 patients, 1002 (70.2%) were female (mean age = 79.3 ± 11.9 years) and 425 (29.8%) were male (mean age = 73.8 ± 13.8 years). Based on pre-fracture residence within the health zone, 1101 (69%) were considered eligible (Reach). New starts of osteoporosis medication increased from 24.7% pre- to 43.9% post-implementation of the H-FLS (p < 0.001) (effectiveness). The proportion of patients prescribed osteoporosis medication prior to a hip fracture remained consistent (15.1% pre-; 14.7% post-implementation; p = 0.88) with a resultant improvement in overall medication use from 39.8% pre- to 58.6% post-implementation (p < 0.001). Both sites significantly improved medication initiation (site 1: 27.9% pre- to 40.3% post-implementation; site 2: 19.6% pre- to 50.0% post-implementation; p < 0.001 for both) (adoption). Medication initiation in females improved from 26.0% pre- to 43.4% post-implementation while initiation in males improved from 21.7% pre- to 45.1% post-implementation (p < 0.001[females]; p = 0.001[males]) (implementation). Post-implementation, elevated initiation rates were retained over the 7 quarters (p = 0.81) (maintenance). CONCLUSIONS An H-FLS based in two tertiary hospital sites significantly improved use of osteoporosis medications after hip fracture in both males and females.
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Affiliation(s)
- L A Beaupre
- University of Alberta (Physical Therapy), 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - F Moradi
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - H Khong
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - C Smith
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - L Evens
- Alberta Bone and Joint Health Institute, Calgary, AB, Canada
| | - H M Hanson
- Seniors Health Strategic Clinical Network™, Alberta Health Services and University of Calgary (Medicine), Calgary, AB, Canada
| | - A G Juby
- University of Alberta (Geriatric Medicine), Edmonton, AB, Canada
| | - P Kivi
- University of Alberta (Family Medicine), Edmonton, AB, Canada
| | - S R Majumdar
- University of Alberta (Medicine), Edmonton, AB, Canada
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Chepeha JC, Silveira A, Sheps D, Beaupre LA. Evaluating the Uptake and Acceptability of Standardized Postoperative Rehabilitation Guidelines Using an Online Knowledge Translation Approach. Phys Ther 2020; 100:225-237. [PMID: 31750521 DOI: 10.1093/ptj/pzz161] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/21/2019] [Revised: 02/14/2019] [Accepted: 06/30/2019] [Indexed: 11/14/2022]
Abstract
BACKGROUND Providing physical therapists with evidence-based and consensus-derived guidelines to manage postoperative shoulder patients is essential; these guidelines should be readily available and provide clinically applicable information. Knowledge translation (KT) initiatives that encourage interaction between clinicians and researchers, that have multifaceted components and use a variety of strategies, can significantly change practice. OBJECTIVE The objective of this study was to determine the uptake and acceptability of standardized postoperative shoulder guidelines with an accompanying online KT resource through evaluation of website analytics and a quantitative survey. DESIGN A multi-pronged approach was used to assess uptake and acceptability of the guidelines and online KT resource. METHODS Website analytics of usage and geographical location of users was measured as were physical therapist survey responses. RESULTS Website analytics revealed that 5406 individuals used the online resource between October 2012 and September 2013 with the average visit lasting 8 minutes; only 47% of users were within the guideline developers' surgical referral region. Physical therapists who used the new shoulder guidelines were very satisfied or satisfied (96%) with the guidelines, reporting they promoted patient-specific clinical decision-making extremely or very well (68%). They viewed the online KT resource positively, with 79% rating it as "very useful" or "quite useful." Physical therapists from regions beyond those expected to use the new shoulder guidelines were also aware of the website and also rated it as very useful. LIMITATIONS The survey sample was relatively small and did not directly assess patient outcomes. CONCLUSIONS An online KT web resource developed in conjunction with standardized postoperative shoulder guidelines was perceived as useful based on website analytics and survey responses. Active KT strategies such as this can improve uptake and dissemination of best practice in physical therapy.
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Affiliation(s)
- Judy C Chepeha
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, 2-50 Corbett Hall, University of Alberta, 8205-114 Street NW, Edmonton, Alberta, T6G 2G4, Canada
| | - Anelise Silveira
- Department of Surgery, Alberta Health Services, Edmonton, Alberta, Canada
| | - David Sheps
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta
| | - Lauren A Beaupre
- Department of Physical Therapy, University of Alberta and Department of Surgery, Alberta Health Services
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24
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Dobbe A, Beaupre LA, Almansoori KA, Fung TS, Scharfenberger AV. Functional Outcomes of Isolated Infrasyndesmotic Fibula Fractures. Foot & Ankle Orthopaedics 2020; 5:2473011419892227. [PMID: 35097357 PMCID: PMC8564941 DOI: 10.1177/2473011419892227] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Background: Ankle fractures are among the most common injuries encountered by orthopedic surgeons, with an incidence ranging from 71 to 187 per 100 000 people. Few studies have reliably investigated injuries involving isolated fractures of the distal fibula below the level of the ankle syndesmosis. Therefore, this study details on the patient-reported outcomes of nonoperatively managed isolated infrasyndesmotic fibula (ISF) fractures with a minimum 3-year follow-up. Methods: A retrospective population-based cohort study was undertaken across all emergency departments serving a major urban population. Among 159 consecutive patients meeting inclusion criteria, 108 agreed to participate. Clinical information, functional outcomes, and radiographic measurements were collected from electronic medical records and 3 validated outcome measures: the American Academy of Orthopaedic Surgeons (AAOS) Foot & Ankle Scale (FAS), the AAOS Shoe-Comfort Scale (SCS), and a general questionnaire. Results: An incidence of 22 ISF fractures per 100 000 people/year was found with FAS (91.2 ± 12.9) and SCS scores (76.8 ± 27.7), similar to reported population norms. Approximately 40% of patients (n = 43) reported continuing symptoms including pain (81.8%), stiffness (68.1%), and/or instability (39.0%). Less than 13% (n = 14) reported “severe” disabilities, and no patients required operative intervention within the follow-up period. Less-favorable outcomes were reported among work-related injuries, female patients, and “avulsion-type” fractures less than 10 mm in height (P < .01). No relationships were identified between age, degree of articular-incongruity, fracture-displacement, and self-reported outcomes. Conclusions: The majority of patients with nonoperatively managed ISF fractures reported good-to-excellent early functional outcomes. Less-favorable outcomes were reported among work-related injuries, female patients, and “avulsion-type” fractures. Level of Evidence: Level III, comparative series.
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Affiliation(s)
- Ashlee Dobbe
- Department of Orthopedic Surgery, University of British Columbia, Kelowna, British Columbia, Canada
| | - Lauren A. Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | | | - Tak-Shing Fung
- Department of Information Technology, University of Calgary, Calgary, Canada
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25
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Goplen CM, Randall JR, Kang SH, Vakilian F, Jones CA, Voaklander DC, Beaupre LA. The Influence of Allowable Refill Gaps on Detecting Long-Term Opioid Therapy: An Analysis of Population-Based Administrative Dispensing Data Among Patients with Knee Arthritis Awaiting Total Knee Arthroplasty. J Manag Care Spec Pharm 2019; 25:1064-1072. [PMID: 31556825 PMCID: PMC10401997 DOI: 10.18553/jmcp.2019.25.10.1064] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
BACKGROUND It is challenging to detect long-term opioid therapy (LTOT) using administrative data, as refill gaps can disrupt opioid utilization episodes. Previous studies have used various methods to define LTOT and allowable refill gaps with little supporting evidence. OBJECTIVE To describe the effect of allowable refill gaps on detecting LTOT among a cohort of patients with arthritis awaiting total knee arthroplasty (TKA) using 3 different methods. METHODS A retrospective analysis of multicenter population-based data between January 1, 2012, and December 31, 2016, identified patients prescribed opioids before TKA in Alberta, Canada. We described 3 methods to detect LTOT based on a (1) fixed number of days between prescriptions; (2) fraction of the preceding prescription length; and (3) combination method that selected whichever refill gap was greatest. We then compared the number of patients classified as long-term opioid users by varying the number of days between prescriptions from 1-90 days (fixed method) or 0.04-3.2 times the duration (fraction method) for each method and refill gap. RESULTS Of the 14,252 patients included in our cohort, 4,393 patients (31%) had an opioid prescription within 180 days before TKA. Detection of LTOT varied from 4.4% to 14.6% (fixed method), 4.2% to 13.2% (fraction method), and 4.5% to 15.1% (mixed method) as refill gaps varied from minimum to maximum. As refills gaps increased, the dose and duration of opioids in the utilization episode decreased for all 3 methods. CONCLUSIONS The allowable refill gap between opioid prescriptions can influence the estimated rate of LTOT when using administrative pharmaceutical dispensing data. Definitional parameters should be carefully considered when using administrative data to define consistent opioid use. DISCLOSURES This work was supported by the Department of Surgery's Clinical Research Grant at the University of Alberta (RES0039945). The authors have no potential conflicts of interest.
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Affiliation(s)
| | - Jason R. Randall
- School of Public Health, University of Alberta, Edmonton, Canada
| | - Sung Hyun Kang
- Alberta Bone and Joint Institute, Calgary, Alberta, Canada
| | - Fatemeh Vakilian
- School of Public Health, University of Alberta, Edmonton, Canada
| | | | | | - Lauren A. Beaupre
- Department of Surgery and Department of Physical Therapy, University of Alberta, Edmonton, Canada
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Majumdar SR, Lier DA, McAlister FA, Johnson JA, Rowe BH, Beaupre LA. Cost-Effectiveness of Osteoporosis Interventions to Improve Quality of Care After Upper Extremity Fracture: Results From a Randomized Trial (C-STOP Trial). J Bone Miner Res 2019; 34:1220-1228. [PMID: 30779861 DOI: 10.1002/jbmr.3699] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 01/18/2019] [Accepted: 02/10/2019] [Indexed: 01/13/2023]
Abstract
We assessed the cost-effectiveness of two models of osteoporosis care after upper extremity fragility fracture using a high-intensity Fracture Liaison Service (FLS) Case-Manager intervention versus a low-intensity FLS (ie, Active Control), and both relative to usual care. This analysis used data from a pragmatic patient-level parallel-arm comparative effectiveness trial of 361 community-dwelling participants 50 years or older with upper extremity fractures undertaken at a Canadian academic hospital. We used a decision-analytic Markov model to evaluate the cost-effectiveness of the three treatment alternatives. The perspective was health service payer; the analytical horizon was lifetime; costs and health outcomes were discounted by 3%. Costs were expressed in 2016 Canadian dollars (CAD) and the health effect was measured by quality adjusted life years (QALYs). The average age of enrolled patients was 63 years and 89% were female. Per patient cost of the Case Manager and Active Control interventions were $66CAD and $18CAD, respectively. Compared to the Active Control, the Case Manager saved $333,000, gained seven QALYs, and averted nine additional fractures per 1000 patients. Compared to usual care, the Case Manager saved $564,000, gained 14 QALYs, and incurred 18 fewer fractures per 1000 patients, whereas the Active Control saved $231,000, gained seven QALYs, and incurred nine fewer fractures per 1000 patients. Although both interventions dominated usual care, the Case Manager intervention also dominated the Active Control. In 5000 probabilistic simulations, the probability that the Case Manager intervention was cost-effective was greater than 75% whereas the Active Control intervention was cost-effective in less than 20% of simulations. In summary, although the adoption of either of these approaches into clinical settings should lead to cost savings, reduced fractures, and increased quality-adjusted life for older adults following upper extremity fracture, the Case Manager intervention would be the most likely to be cost-effective. © 2019 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Douglas A Lier
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
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Sheehan KJ, Fitzgerald L, Hatherley S, Potter C, Ayis S, Martin FC, Gregson CL, Cameron ID, Beaupre LA, Wyatt D, Milton-Cole R, DiGiorgio S, Sackley C. Inequity in rehabilitation interventions after hip fracture: a systematic review. Age Ageing 2019; 48:489-497. [PMID: 31220202 DOI: 10.1093/ageing/afz031] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2018] [Revised: 01/18/2019] [Accepted: 03/13/2019] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVE to determine the extent to which equity factors contributed to eligibility criteria of trials of rehabilitation interventions after hip fracture. We define equity factors as those that stratify healthcare opportunities and outcomes. DESIGN systematic search of MEDLINE, Embase, CINHAL, PEDro, Open Grey, BASE and ClinicalTrials.gov for randomised controlled trials of rehabilitation interventions after hip fracture published between 1 January 2008 and 30 May 2018. Trials not published in English, secondary prevention or new models of service delivery (e.g. orthogeriatric care pathway) were excluded. Duplicate screening for eligibility, risk of bias (Cochrane Risk of Bias Tool) and data extraction (Cochrane's PROGRESS-Plus framework). RESULTS twenty-three published, eight protocol, four registered ongoing randomised controlled trials (4,449 participants) were identified. A total of 69 equity factors contributed to eligibility criteria of the 35 trials. For more than 50% of trials, potential participants were excluded based on residency in a nursing home, cognitive impairment, mobility/functional impairment, minimum age and/or non-surgical candidacy. Where reported, this equated to the exclusion of 2,383 out of 8,736 (27.3%) potential participants based on equity factors. Residency in a nursing home and cognitive impairment were the main drivers of these exclusions. CONCLUSION the generalisability of trial results to the underlying population of frail older adults is limited. Yet, this is the evidence base underpinning current service design. Future trials should include participants with cognitive impairment and those admitted from nursing homes. For those excluded, an evidence-informed reasoning for the exclusion should be explicitly stated. PROSPERO CRD42018085930.
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Affiliation(s)
- K J Sheehan
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - L Fitzgerald
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - S Hatherley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C Potter
- Department of Physiotherapy, Guy’s and St. Thomas’s National Health Service Foundation Trust, UK
| | - S Ayis
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - F C Martin
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C L Gregson
- Translational Health Sciences, Musculoskeletal Research Unit, Bristol Medical School, University of Bristol, UK
| | - I D Cameron
- Faculty of Medicine and Health, John Walsh Centre for Rehabilitation Research, Kolling Institute of Medical Research, University of Sydney, Australia
| | - L A Beaupre
- Department of Physical Therapy and Division of Orthopaedic Surgery, University of Alberta, Canada
| | - D Wyatt
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, NIHR Biomedical Research Centre, Guy’s and St. Thomas’ NHS Foundation Trust and King’s College London, UK
| | - R Milton-Cole
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - S DiGiorgio
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
| | - C Sackley
- Department of Population Health Sciences, School of Population Health and Environmental Sciences, King’s College London, UK
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Goplen CM, Verbeek W, Kang SH, Jones CA, Voaklander DC, Churchill TA, Beaupre LA. Preoperative opioid use is associated with worse patient outcomes after Total joint arthroplasty: a systematic review and meta-analysis. BMC Musculoskelet Disord 2019; 20:234. [PMID: 31103029 PMCID: PMC6525974 DOI: 10.1186/s12891-019-2619-8] [Citation(s) in RCA: 124] [Impact Index Per Article: 24.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2019] [Accepted: 05/08/2019] [Indexed: 12/21/2022] Open
Abstract
Background A significant number of patients use opioids prior to total joint arthroplasty (TJA) in North America and there is growing concern that preoperative opioid use negatively impacts postoperative patient outcomes after surgery. This systematic review and meta-analysis evaluated the current evidence investigating the influence of preoperative opioid use on postoperative patient-reported outcomes (PRO) after total joint arthroplasty. Methods A systematic search was performed using Ovid, Embase, Cochrane Library, Scopus, Web of Science Core Collection, CINAHL on February 15th, 2018. Studies reporting baseline and postoperative PRO among those prescribed preoperative opioids and those who were not prior to total knee and hip arthroplasty were included. Standardized mean differences (SMD) in absolute difference and relative change in PRO measures between the two groups was calculated using random effect models. Results Six studies were included (n = 7356 patients); overall 24% of patients were prescribed preoperative opioids. Patients with preoperative opioid use had worse absolute postoperative PRO scores when compared to those with no preoperative opioid use (standardized mean difference (SMD) -0.53, 95% Confidence interval (CI) -0.75, − 0.32, p < 0.0001). When relative change in PRO score was analyzed, as measured by difference between postoperative and preoperative PRO scores, there was no group differences (SMD -0.26, 95% CI -0.56, 0.05, p = 0.10). Conclusion Patients prescribed preoperative opioids may attain worse overall pain and function benefits after TJA when compared to opioid-naïve patients, but do still benefit from undergoing TJA. These results suggest preoperative opioid users should be judiciously counselled regarding potential postoperative pain and function improvements after TJA. Electronic supplementary material The online version of this article (10.1186/s12891-019-2619-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Michael Goplen
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada.
| | - Wesley Verbeek
- Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, T6G 2R7, Canada
| | - Sung Hyun Kang
- Alberta Bone and Joint Institute, Calgary, Alberta, T2N 4Z6, Canada
| | - C Allyson Jones
- Department of Physical Therapy, University of Alberta, Edmonton, AB, T6G 2G4, Canada.,School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Donald C Voaklander
- School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Thomas A Churchill
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada
| | - Lauren A Beaupre
- Department of Surgery, University of Alberta, Edmonton, AB, T6G 2B7, Canada.,Department of Physical Therapy, University of Alberta, Edmonton, AB, T6G 2G4, Canada
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Stiegelmar C, Li Y, Beaupre LA, Pedersen ME, Dillane D, Funabashi M. Perioperative pain management and chronic postsurgical pain after elective foot and ankle surgery: a scoping review. Can J Anaesth 2019; 66:953-965. [PMID: 31020631 DOI: 10.1007/s12630-019-01370-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2018] [Revised: 01/27/2019] [Accepted: 02/16/2019] [Indexed: 01/11/2023] Open
Abstract
PURPOSE Chronic postsurgical pain (CPSP) can occur after elective mid/hindfoot and ankle surgery. Effective treatment approaches to prevent the development of CPSP in this population have not been extensively investigated. The impact of multimodal strategies to prevent CPSP following elective mid/hindfoot surgery is unknown because of both the heterogeneity of acute pain management and the lack of a recognized definition particular to this surgery. This review aimed to identify and evaluate current pain management strategies after elective mid/hindfoot and ankle surgery. SOURCES Manual and electronic searches (MEDLINE, Embase, and Cochrane Library) were conducted of literature published between 1990 and July 2017. Comparative studies of adults undergoing elective mid/hindfoot and ankle surgery were included. Two reviewers independently reviewed studies and assessed their methodological quality. PRINCIPAL FINDINGS We found seven randomized-controlled trials meeting our inclusion criteria. Interventions focused on regional anesthesia techniques such as continuous popliteal sciatic and femoral nerve blockade. Participants were typically followed up to 48 hr postoperatively. Only one study assessed pain six months following elective mid/hindfoot and ankle surgery. CONCLUSION There is an overwhelming lack of evidence regarding CPSP and its management for patients undergoing elective mid/hindfoot and ankle surgery. The lack of a recognized and standard definition of CPSP after this group of surgeries precludes accurate and consistent evaluation.
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Affiliation(s)
| | - Yibo Li
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Lauren A Beaupre
- Faculty of Rehabilitation Medicine, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 St, Edmonton, AB, T6G 2B7, Canada.
| | - M Elizabeth Pedersen
- Department of Surgery, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Derek Dillane
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, AB, Canada
| | - Martha Funabashi
- Collaborative Orthopaedic Research, Alberta Health Services, Edmonton, AB, Canada.,Division of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
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Beaupre LA, Hammal F, DeSutter C, Stiegelmar RE, Masson E, Finegan BA. Impact of a standardized referral to a community pharmacist-led smoking cessation program before elective joint replacement surgery. Tob Induc Dis 2019; 17:14. [PMID: 31582925 PMCID: PMC6751968 DOI: 10.18332/tid/101600] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/14/2018] [Accepted: 12/14/2018] [Indexed: 12/22/2022] Open
Abstract
INTRODUCTION Smokers undergoing total joint replacement (TJR) are more likely to develop infections and be re-admitted than non-smokers. The primary purpose of this study was to evaluate the effectiveness of standardized preoperative referral to a community-based pharmacist-led smoking cessation program compared to usual care for patients undergoing TJR. Secondarily, we evaluated the use of the smoking cessation program. METHODS A pre-post quasi-experimental study was conducted at a central intake clinic that prepares approximately 3000 TJR patients annually. Participants were recruited at a mean of 13±11.1 weeks preoperatively and provided informed consent. Participants in the ‘pre’ observational phase (OP) received usual care for smoking cessation. For ‘post’ intervention phase (IP) participants, a referral was sent to a community-based pharmacist-led smoking cessation program. Smoking status was validated on study entry using exhaled carbon monoxide. Participants’ smoking status was re-assessed using self-reported point prevalence abstinence at 6 months post-recruitment. RESULTS We enrolled 120/150 (80%) potential OP candidates and 104/286 (36%) potential IP candidates. The groups were similar on study entry; overall, the mean age of participants was 58.7±9.1 years and 103 (47%) were male. They reported medium nicotine dependence with 37±11.6 mean years smoked. At 6 months post-recruitment, 8 (7%) OP participants self-reported 30-day point prevalence abstinence compared to 21 (20%) IP participants (p=0.003). Only 58 (56%) IP participants complied with the pharmacist referral, with 19 (33%) of those seeing the pharmacist reporting point prevalence abstinence at 6 months compared to only 2 (4%) of the 45 participants who did not see the pharmacist (p<0.001). CONCLUSIONS Referral to a community smoking cessation program as preoperative standard of care is feasible and can enhance long-term quit rates, but voluntary participation led to low recruitment to the program.
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Affiliation(s)
- Lauren A Beaupre
- Collaborative Orthopaedic Research (CORe), Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - Fadi Hammal
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
| | - Chrisopher DeSutter
- Collaborative Orthopaedic Research (CORe), Department of Surgery, University of Alberta, Edmonton, Canada
| | - Robert E Stiegelmar
- Collaborative Orthopaedic Research (CORe), Department of Surgery, University of Alberta, Edmonton, Canada
| | - Edward Masson
- Collaborative Orthopaedic Research (CORe), Department of Surgery, University of Alberta, Edmonton, Canada
| | - Barry A Finegan
- Department of Anesthesiology and Pain Medicine, University of Alberta, Edmonton, Canada
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McAlister FA, Ye C, Beaupre LA, Rowe BH, Johnson JA, Bellerose D, Hassan I, Majumdar SR. Adherence to osteoporosis therapy after an upper extremity fracture: a pre-specified substudy of the C-STOP randomized controlled trial. Osteoporos Int 2019; 30:127-134. [PMID: 30232538 DOI: 10.1007/s00198-018-4702-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/27/2018] [Accepted: 09/11/2018] [Indexed: 11/28/2022]
Abstract
UNLABELLED Despite their proven efficacy for secondary fracture prevention, long-term adherence with oral bisphosphonates is poor. INTRODUCTION To compare the effectiveness of two interventions on long-term oral bisphosphonate adherence after an upper extremity fragility fracture. METHODS Community-dwelling participants 50 years or older with upper extremity fragility fractures not previously treated with bisphosphonates were randomized to either a multi-faceted patient and physician educational intervention (the active control arm) vs. a nurse-led case manager (the study arm). Primary outcome was adherence (taking > 80% of prescribed doses) with prescribed oral bisphosphonates at 12 months postfracture between groups; secondary outcomes included rates of primary non-adherence and 24-month adherence. We also compared quality of life between adherent and non-adherent patients. RESULTS By 12 months, adherence with the initially prescribed bisphosphonate was similar (p = 0.96) in both groups: 38/48 (79.2%) in the educational intervention group vs. 66/83 (79.5%) in the case manager arm. By 24 months, adherence rates were 67% (32/48) in the educational intervention group vs. 53% (43/81) in case managed patients (p = 0.13). Primary non-adherence was 6% (11 patients) in the educational intervention group and 12% (21 patients) in the case managed group (p = 0.07). Prior family history of osteoporosis (aOR 2.1, 95% CI 1.0 to 4.4) and being satisfied with current medical care (aOR 2.3, 95% CI 1.1 to 4.8) were associated with better adherence while lower income (aOR 0.2, 95% CI 0.1 to 0.6, for patients with income < $30,000 per annum) was associated with poorer rates of adherence. There were no differences in health-related quality of life scores at baseline or during follow-up between patients who were adherent and those who were not. CONCLUSION While both interventions achieved higher oral bisphosphonate adherence compared to previously reported adherence rates in the general population, primary non-adherence and long-term adherence to bisphosphonates were similar in both arms. Adherence was influenced by family history of osteoporosis, satisfaction with current medical care, and income. TRIAL REGISTRATION ClinicalTrials.gov : NCT01401556.
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Affiliation(s)
- F A McAlister
- Department of Medicine, University of Alberta, Edmonton, Canada.
- Clinical Sciences Building, University of Alberta, 11350 83 Avenue, Edmonton, Alberta, T6G 2G3, Canada.
| | - C Ye
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - L A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Canada
| | - B H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, Canada
| | - J A Johnson
- School of Public Health, University of Alberta, Edmonton, Canada
| | - D Bellerose
- Department of Medicine, University of Alberta, Edmonton, Canada
| | - I Hassan
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, Canada
| | - S R Majumdar
- Department of Medicine, University of Alberta, Edmonton, Canada
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Majumdar SR, McAlister FA, Johnson JA, Rowe BH, Bellerose D, Hassan I, Lier DA, Li S, Maksymowych WP, Menon M, Russell AS, Wirzba B, Beaupre LA. Comparing Strategies Targeting Osteoporosis to Prevent Fractures After an Upper Extremity Fracture (C-STOP Trial): A Randomized Controlled Trial. J Bone Miner Res 2018; 33:2114-2121. [PMID: 30040140 DOI: 10.1002/jbmr.3557] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2018] [Revised: 06/11/2018] [Accepted: 06/27/2018] [Indexed: 11/12/2022]
Abstract
We compared osteoporosis care after upper extremity fragility fracture using a low-intensity Fracture Liaison Service (FLS) versus a high-intensity FLS in a pragmatic patient-level parallel-arm comparative effectiveness trial undertaken at a Canadian academic hospital. A low-intensity FLS (active-control) that identified patients and notified primary care providers was compared to a high-intensity FLS (case manager) where a specially-trained nurse identified patients, investigated bone health, and initiated appropriate treatment. A total of 361 community-dwelling participants 50 years or older with upper extremity fractures who were not on bisphosphonate treatment were included; 350 (97%) participants completed 6-month follow-up undertaken by assessors blinded to group allocation. The primary outcome was difference in bisphosphonate treatment between groups 6 months postfracture; secondary outcomes included differences in bone mineral density (BMD) testing and a predefined composite measure termed "appropriate care" (taking or making an informed decision to decline medication for those with low BMD; not taking bisphosphonate treatment for those with normal BMD). Absolute differences (%), relative risks (RR with 95% confidence intervals [CIs]), number-needed-to-treat (NNT), and direct costs were compared. A total of 181 participants were randomized to active-control and 180 to case-manager using computer-generated randomization; the groups were similar on study entry. At 6 months, 51 (28%) active-control versus 86 (48%) case-manager participants started bisphosphonate treatment (20% absolute difference; RR 1.70; 95% CI, 1.28 to 2.24; p < 0.0001; NNT = 5). Of active-controls, 108 (62%) underwent BMD testing compared to 128 (73%) case-managed patients (11% absolute difference; RR 1.17; 95% CI, 1.01 to 1.36; p = 0.03). Appropriate care was received by 76 (44%) active-controls and 133 (76%) case-managed participants (32% absolute difference; RR 1.73; 95% CI, 1.43 to 2.09; p < 0.0001). The direct cost per participant was $18 Canadian (CDN) for the active-control intervention compared to $66 CDN for the case-manager intervention. In summary, case-management led to substantially greater improvements in bisphosphonate treatment and appropriate care within 6 months of fracture than the active control. © 2018 American Society for Bone and Mineral Research.
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Affiliation(s)
- Sumit R Majumdar
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Jeffrey A Johnson
- School of Public Health, University of Alberta, Edmonton, AB, Canada
| | - Brian H Rowe
- Department of Emergency Medicine, University of Alberta, Edmonton, AB, Canada
| | - Debbie Bellerose
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Imran Hassan
- EPICORE Centre, Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Douglas A Lier
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Stephanie Li
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | | | - Matthew Menon
- Department of Surgery, University of Alberta, Edmonton, AB, Canada
| | | | - Brian Wirzba
- Department of Medicine, University of Alberta, Edmonton, AB, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
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Beaupre LA, Wai EK, Hoover DR, Noveck H, Roffey DM, Cook DR, Magaziner JS, Carson JL. A comparison of outcomes between Canada and the United States in patients recovering from hip fracture repair: secondary analysis of the FOCUS trial. Int J Qual Health Care 2018; 30:97-103. [PMID: 29385446 DOI: 10.1093/intqhc/mzx199] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2017] [Accepted: 01/03/2018] [Indexed: 12/28/2022] Open
Abstract
Objective To determine if adjusted mortality, walking ability or return home differed after hip fracture surgery between Canada and the USA. Design Secondary analysis of the Functional Outcomes in Cardiovascular Patients Undergoing Surgical Hip Fracture Repair (FOCUS) trial data. Setting Data were collected from 47 American and Canadian hospitals. Participants Overall, 2016 subjects with a hip fracture (USA = 1222 (60.6%); Canada = 794 (39.4%)) were randomized to a liberal or restrictive transfusion strategy. Subjects were 50 years and older, with cardiovascular disease and/or risk factors and hemoglobin <100 g/L within 3 days post-surgery. The average age was 82 years and 1527(76%) subjects were females. Intervention Demographics, health status and health services data were collected up to 60 days post-surgery and mortality to a median of 3 years post-surgery. Main outcomes Mortality, inability to walk and return home. Results US subjects had higher adjusted mortality than Canadians at 30 days (odds ratio = 1.78; 95% confidence interval: 1.09-2.90), 60 days (1.53; 1.02-2.29) and up to 3 years (hazard ratio = 1.25; 1.07-1.45). There were no differences in adjusted outcomes for walking ability or return home at 30 or 60 days post-surgery. Median hospital length of stay was longer (P < 0.0001) in Canada (9 days; interquartile range: 5-18 days) than the US (3 days; 2-5 days). US subjects (52.9%) were more likely than Canadians (16.8%) to be discharged to nursing homes for rehabilitation (P < 0.001). Conclusions Adjusted survival favored Canadians post hip fracture while walking ability and return home were not different between countries. The reason(s) for mortality differences warrant further investigation.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | - Eugene K Wai
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada.,Faculty of Medicine, University of Ottawa, 451 Smyth Road, Ottawa, Ontario K1H 8M5, Canada.,Division of Orthopaedic Surgery, Department of Surgery, The Ottawa Hospital, 1053 Carling Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Donald R Hoover
- Department of Statistics and Biostatistics, Rutgers University, The State University of New Jersey, 473 Hill Center, Busch Campus Rutgers University 110 Frelinghuysen Road Piscataway, NJ 08854-8019, USA
| | - Helaine Noveck
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, 125 Paterson St, New Brunswick, NJ 08901, USA
| | - Darren M Roffey
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, 725 Parkdale Avenue, Ottawa, Ontario K1Y 4E9, Canada
| | - Donald R Cook
- Division of General Internal Medicine, Cumming School of Medicine, University of Calgary, FMC North Tower, 1403 29th Street NW, Calgary, Alberta T2N 2T9, Canada
| | - Jay S Magaziner
- Department of Epidemiology and Public Health, University of Maryland School of Medicine, Suite 200, Howard Hall, 660 West Redwood Street, Baltimore, MD 21201, USA
| | - Jeffrey L Carson
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, Rutgers Biomedical and Health Sciences, Rutgers, The State University of New Jersey, 125 Paterson St, New Brunswick, NJ 08901, USA
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Beaupre LA, Stampe K, Masson E, O'Connor G, Clark M, Joffe AM, Boychuk LR, Lavoie G. Health-related quality of life with long-term retention of the PROSthesis of Antibiotic Loaded Acrylic Cement system following infection resolution in low demand patients. J Orthop Surg (Hong Kong) 2018; 25:2309499017716257. [PMID: 28656873 DOI: 10.1177/2309499017716257] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
BACKGROUND The study purpose was to (1) evaluate health-related quality of life (HRQL) with the PROSthesis of Antibiotic Loaded Acrylic Cement (PROSTALAC) in situ for infected total hip arthroplasty (THA), (2) determine infection resolution, and (3) compare subjects who underwent second stage surgery with those who retained the PROSTALAC on a longer term basis. METHODS Demographics, physical demand level, and comorbidities were recorded prospectively in 29 subjects followed to at least 24 months after initial PROSTALAC insertion. HRQL was evaluated using the Western Ontario McMaster Osteoarthritis Index (WOMAC) and RAND 36-Item Health Survey. Infection resolution was determined using a pre-specified clinical definition. RESULTS Twenty-five of 29 (86%) subjects' infections resolved. Three subjects died, of whom two had resolved infections. For survivors, 22/26 (85%) completed HRQL evaluations. After PROSTALAC insertion, pain and function improved within 3-6 months and was retained at 24 months. Of those followed to 24 months, 7/22 (32%) subjects underwent second stage surgery. They were higher physical demand subjects ( p = 0.03) than those not undergoing second stage surgery. We found no difference in WOMAC scores at 24 months between those who underwent second stage surgery and those who retained the PROSTALAC ( p > 0.32). DISCUSSION The PROSTALAC system for THA appears to allow acceptable HRQL while in situ for at least 2 years in low physical demand patients. Subjects with higher physical demand levels are more likely to undergo second stage surgery. CONCLUSION Further evaluation is required to determine whether longer term PROSTALAC retention may be appropriate for specific patient groups.
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Affiliation(s)
- Lauren A Beaupre
- 1 Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada.,2 Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Kyle Stampe
- 2 Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Edward Masson
- 2 Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Gregory O'Connor
- 2 Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Marcia Clark
- 3 Division of Orthopaedics, University of Calgary, Calgary, AB, Canada
| | - A Mark Joffe
- 4 Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada
| | - Lesia R Boychuk
- 4 Division of Infectious Diseases, University of Alberta, Edmonton, AB, Canada
| | - Guy Lavoie
- 2 Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
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Majumdar SR, Lier DA, Hanley DA, Juby AG, Beaupre LA. Economic evaluation of a population-based osteoporosis intervention for outpatients with non-traumatic non-hip fractures: the "Catch a Break" 1i [type C] FLS. Osteoporos Int 2017; 28:1965-1977. [PMID: 28275838 PMCID: PMC5486946 DOI: 10.1007/s00198-017-3986-3] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/22/2016] [Accepted: 02/23/2017] [Indexed: 01/13/2023]
Abstract
UNLABELLED Fracture liaison services (FLS) are advocated to improve osteoporosis treatment after fragility fracture, but there are few economic analyses of different models. A population-based 1i [=type C] FLS for non-hip fractures was implemented and it costs $44 per patient and it was very cost-effective ($9200 per QALY gained). Small operational changes would convert it from cost-effective to cost-saving. INTRODUCTION After fragility fracture, <20% of patients receive osteoporosis treatment. FLS are recommended to address this deficit but there are very few economic analyses of different FLS models. Therefore, we conducted an economic analysis of a 1i (=type C) FLS called "Catch a Break (CaB)." METHODS CaB is a population-based FLS in Alberta, Canada, that case-finds older outpatients with non-traumatic upper extremity, spine, pelvis, or "other" non-hip fractures and provides telephonic outreach and printed educational materials to patients and their physicians. Cost-effectiveness was assessed using Markov decision-analytic models. Costs were expressed in 2014 Canadian dollars and effectiveness based on model simulations of recurrent fractures and quality-adjusted life years (QALYs). Perspective was healthcare payer; horizon was lifetime; and costs and benefits were discounted 3%. RESULTS Over 1 year, CaB enrolled 7323 outpatients (mean age 67 years, 75% female, 69% upper extremity) at average cost of $44 per patient. Compared with usual care, CaB increased rates of bisphosphonate treatment by 4.3 to 17.5% (p < 0.001). Over their lifetime, for every 10,000 patients enrolled in CaB, 4 hip fractures (14 fractures total) would be avoided and 12 QALYs gained. Compared with usual care, incremental cost-effectiveness of CaB was estimated at $9200 per QALY. CaB was cost-effective in 85% of 10,000 probabilistic simulations. Sensitivity analyses showed if "other" fractures were excluded and intervention costs reduced 25% that CaB would become cost-saving. CONCLUSIONS A relatively inexpensive population-based 1i (=type C) FLS was implemented in Alberta and it was very cost-effective. If CaB excluded "other" fractures and decreased intervention costs by 25%, it would be cost-saving, as would any FLS that was more effective and less expensive.
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Affiliation(s)
- S R Majumdar
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada.
| | - D A Lier
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada
| | - D A Hanley
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Canada
| | - A G Juby
- The Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, 5-134 Clinical Sciences Building, 11350 - 83rd Avenue, Edmonton, Alberta, T6G 2G3, Canada
| | - L A Beaupre
- The Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Canada
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Beaupre LA, Sharifi B, Johnston DWC. A Randomized Clinical Trial Comparing Posterior Cruciate-Stabilizing vs Posterior Cruciate-Retaining Prostheses in Primary Total Knee Arthroplasty: 10-Year Follow-Up. J Arthroplasty 2017; 32:818-823. [PMID: 27693054 DOI: 10.1016/j.arth.2016.08.030] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/03/2016] [Accepted: 08/22/2016] [Indexed: 02/01/2023] Open
Abstract
BACKGROUND This 10-year follow-up compares health-related quality of life (HRQL) and reoperations in 100 subjects who were randomized to receive posterior cruciate ligament substituting (PS) or posterior cruciate ligament retaining (CR) total knee arthroplasty. We previously reported 2-year results. METHODS Subjects were enrolled preoperatively and randomized at surgery. Subjects completed HRQL questionnaires at all evaluation points. Subjects were re-evaluated at 2 and 10 years with reoperations determined through regional medical record review and patient report. RESULTS Over 10 years, 25 (25%) subjects died, 2 subjects were revised and withdrew, and 11 (11%) subjects were lost to follow-up. Of survivors, 62 of 75 (83%) were evaluated at 10 years. Twenty-eight (37%) subjects provided HRQL, radiographic, and reoperation status, 28 (37%) subjects completed HRQL evaluations and reoperation status only, and 6 (8%) subjects provided radiographic and reoperation follow-up. Both groups retained good HRQL between 2 and 10 years with no group differences noted (P > .35). One revision (CR subject), secondary to deep joint infection, occurred within 2 years with 1 further revision (PS subject) occurring at 3 years postoperatively. One subject (PS subject) required manipulation under anesthesia within 3 months of surgery. Four subjects required late patellar resurfacing (1 CR subject, 3 PS subjects) but were retained in the 10-year evaluation. Overall, reoperations were not significantly different between groups (P = .26). CONCLUSION Over 10 years postoperatively, both the PS and CR total knee arthroplasty performed well with subjects reporting acceptable levels of HRQL up to 10 years postoperatively; low levels of revision or reoperation were reported in both groups.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada; Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - B Sharifi
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - D W C Johnston
- Department of Surgery, University of Alberta, Edmonton, Alberta, Canada
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Wozniak LA, Johnson JA, McAlister FA, Beaupre LA, Bellerose D, Rowe BH, Majumdar SR. Understanding fragility fracture patients' decision-making process regarding bisphosphonate treatment. Osteoporos Int 2017; 28:219-229. [PMID: 27423660 PMCID: PMC5206259 DOI: 10.1007/s00198-016-3693-5] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/29/2016] [Accepted: 06/28/2016] [Indexed: 02/05/2023]
Abstract
UNLABELLED We aimed to understand how patients 50 years and older decided to persist with or stop osteoporosis (OP) treatment. Processes related to persisting with or stopping OP treatments are complex and dynamic. The severity and risks and harms related to untreated clinical OP and the favorable benefit-to-risk profile for OP treatments should be reinforced. INTRODUCTION Older adults with fragility fracture and clinical OP are at high risk of recurrent fracture, and treatment reduces this risk by 50 %. However, only 20 % of fracture patients are treated for OP and half stop treatment within 1 year. We aimed to understand how older patients with new fractures decided to persist with or stop OP treatment over 1 year. METHODS We conducted a grounded theory study of patients 50 years and older with upper extremity fracture who started bisphosphonates and then reported persisting with or stopping treatment at 1 year. We used theoretical sampling to identify patients who could inform emerging concepts until data saturation was achieved and analyzed these data using constant comparison. RESULTS We conducted 21 interviews with 12 patients. Three major themes emerged. First, patients perceived OP was not a serious health condition and considered its impact negligible. Second, persisters and stoppers differed in weighting the risks vs benefits of treatments, where persisters perceived less risk and more benefit. Persisters considered treatment "required" while stoppers often deemed treatment "optional." Third, patients could change treatment status even 1-year post-fracture because they re-evaluated severity and impact of OP vs risks and benefits of treatments over time. CONCLUSIONS The processes and reasoning related to persisting with or stopping OP treatments post-fracture are complex and dynamic. Our findings suggest two areas of leverage for healthcare providers to reinforce to improve persistence: (1) the severity and risks and harms related to untreated clinical OP and (2) the favorable benefit-to-risk profile for OP treatments.
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Affiliation(s)
- L A Wozniak
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, T6G 2E1, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - J A Johnson
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, T6G 2E1, Edmonton, Alberta, Canada
| | - F A McAlister
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, T6G 2E1, Edmonton, Alberta, Canada
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - L A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - D Bellerose
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - B H Rowe
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, T6G 2E1, Edmonton, Alberta, Canada
- Department of Emergency Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada
| | - S R Majumdar
- School of Public Health, University of Alberta, 2-040 Li Ka Shing Centre for Health Research Innovation, T6G 2E1, Edmonton, Alberta, Canada.
- Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, Alberta, Canada.
- University of Alberta, 5-134B Clinical Sciences Building, 11350-83rd Avenue, Edmonton, T6G 2G3, Canada.
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Jones CA, Martin RS, Westby MD, Beaupre LA. Total joint arthroplasty: practice variation of physiotherapy across the continuum of care in Alberta. BMC Health Serv Res 2016; 16:627. [PMID: 27809849 PMCID: PMC5095989 DOI: 10.1186/s12913-016-1873-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2016] [Accepted: 10/21/2016] [Indexed: 12/27/2022] Open
Abstract
Background Comprehensive and timely rehabilitation for total joint arthroplasty (TJA) is needed to maximize recovery from this elective surgical procedure for hip and knee arthritis. Administrative data do not capture the variation of treatment for rehabilitation across the continuum of care for TJA, so we conducted a survey for physiotherapists to report practice for TJA across the continuum of care. The primary objective was to describe the reported practice of physiotherapy for TJA across the continuum of care within the context of a provincial TJA clinical pathway and highlight possible gaps in care. Method A cross-sectional on-line survey was accessible to licensed physiotherapists in Alberta, Canada for 11 weeks. Physiotherapists who treated at least five patients with TJA annually were asked to complete the survey. The survey consisted of 58 questions grouped into pre-operative, acute care and post-acute rehabilitation. Variation of practice was described in terms of number, duration and type of visits along with goals of care and program delivery methods. Results Of the 80 respondents, 26 (33 %) stated they worked in small centres or rural settings in Alberta with the remaining respondents working in two large urban sites. The primary treatment goal differed for each phase across the continuum of care in that pre-operative phase was directed at improving muscle strength, functional activities were commonly reported for acute care, and post-acute phase was directed at improving joint range-of-motion. Proportionally, more physiotherapists from rural areas treated patients in out-patient hospital departments (59 %), whereas a higher proportion in urban physiotherapists saw patients in private clinics (48 %). Across the continuum of care, treatment was primarily delivered on an individual basis rather than in a group format. Conclusions Variation of practice reported with pre-and post-operative care in the community will stimulate dialogue within the profession as to what is the minimal standard of care to provide patients undergoing TJA. Electronic supplementary material The online version of this article (doi:10.1186/s12913-016-1873-9) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- C Allyson Jones
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada.
| | - Ruben San Martin
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada
| | - Marie D Westby
- School of Public Health, University of Alberta, Edmonton, Alberta, T6G 1C9, Canada
| | - Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, T6G 2G4, Canada
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Dyer SM, Crotty M, Fairhall N, Magaziner J, Beaupre LA, Cameron ID, Sherrington C. A critical review of the long-term disability outcomes following hip fracture. BMC Geriatr 2016; 16:158. [PMID: 27590604 PMCID: PMC5010762 DOI: 10.1186/s12877-016-0332-0] [Citation(s) in RCA: 481] [Impact Index Per Article: 60.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2016] [Accepted: 08/20/2016] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Hip fractures are an increasingly common consequence of falls in older people that are associated with a high risk of death and reduced function. This review aims to quantify the impact of hip fracture on older people's abilities and quality of life over the long term. METHODS Studies were identified through PubMed and Scopus searches and contact with experts. Cohort studies of hip fracture patients reporting outcomes 3 months post-fracture or longer were included for review. Outcomes of mobility, participation in domestic and community activities, health, accommodation or quality of life were categorised according to the World Health Organization's International Classification of Functioning and synthesised narratively. Risk of bias was assessed according to four items from the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) statement. RESULTS Thirty-eight studies from 42 publications were included for review. Most followed a clearly defined sample from the time of fracture. Hip fracture survivors experienced significantly worse mobility, independence in function, health, quality of life and higher rates of institutionalisation than age matched controls. The bulk of recovery of walking ability and activities for daily living occurred within 6 months after fracture. Between 40 and 60 % of study participants recovered their pre-fracture level of mobility and ability to perform instrumental activities of daily living, while 40-70 % regained their level of independence for basic activities of daily living. For people independent in self-care pre-fracture, 20-60 % required assistance for various tasks 1 and 2 years after fracture. Fewer people living in residential care recovered their level of function than those living in the community. In Western nations, 10-20 % of hip fracture patients are institutionalised following fracture. Few studies reported impact on participation in domestic, community, social and civic life. CONCLUSIONS Hip fracture has a substantial impact on older peoples' medium- to longer-term abilities, function, quality of life and accommodation. These studies indicate the range of current outcomes rather than potential improvements with different interventional approaches. Future studies should measure impact on life participation and determine the proportion of people that regain their pre-fracture level of functioning to investigate strategies for improving these important outcomes.
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Affiliation(s)
- Suzanne M. Dyer
- Department of Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, Adelaide, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
| | - Maria Crotty
- Department of Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, Adelaide, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
| | - Nicola Fairhall
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, USA
| | - Lauren A. Beaupre
- Departments of Physical Therapy and Surgery (Division of Orthopaedic Surgery), University of Alberta, Edmonton, Canada
| | - Ian D. Cameron
- Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, St Leonards, Australia
| | - Catherine Sherrington
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
| | - for the Fragility Fracture Network (FFN) Rehabilitation Research Special Interest Group
- Department of Rehabilitation, Aged and Extended Care, School of Health Sciences, Flinders University, Adelaide, Australia
- Cognitive Decline Partnership Centre, The University of Sydney, Sydney, Australia
- The George Institute for Global Health, Sydney Medical School, The University of Sydney, Sydney, Australia
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, USA
- Departments of Physical Therapy and Surgery (Division of Orthopaedic Surgery), University of Alberta, Edmonton, Canada
- John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, St Leonards, Australia
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Bornes TD, Jaremko JL, Beaupre LA, Bouliane MJ. Radiographic sclerotic contour loss in the identification of glenoid bone loss. Knee Surg Sports Traumatol Arthrosc 2016; 24:2167-73. [PMID: 25246175 DOI: 10.1007/s00167-014-3328-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 09/12/2014] [Indexed: 12/01/2022]
Abstract
PURPOSE Quantification of glenoid bone loss guides surgical management in the setting of anterior shoulder instability. Glenoid defects resulting in ≥20 % articular area loss require bony reconstruction. The objective of this study was to evaluate the utility of sclerotic glenoid contour loss on true anteroposterior radiography in the detection of varying quantities of simulated glenoid bone loss using a cadaveric model. METHODS Eight cadaveric scapulae with full radiographic sclerotic contour were osteotomized to produce glenoid surface area reductions of 10-50 %. Radiography was performed initially and following each osteotomy, and assessed by an orthopedic surgeon and radiologist twice. Quantity of glenoid loss was compared using Fisher's exact test. Sensitivity, specificity, and reliability analyses were performed. RESULTS On the first radiographic review, sclerotic contour loss was detected in 6 out of 8 scapulae with 50 % area loss, but only 1 out of 8 scapulae with 20 % area loss. There was a significantly higher proportion of radiographs containing sclerotic contour loss for defects with 50 % area loss compared to those with 0-25 % loss (p ≤ 0.02). In the detection of ≥20 % area loss, sclerotic contour loss had a sensitivity of 33-43 % and specificity of 88-100 %. Moderate inter-observer reliability (Cohen's kappa value of 0.42-0.53) and intra-observer reliability (kappa value of 0.46-0.58) were found. CONCLUSION Radiographic sclerotic contour loss is commonly observed in radiographs of scapulae with 40-50 % glenoid area loss and less often with smaller lesions. However, this finding lacks utility in discerning specific quantifications of glenoid bone loss. In a clinical setting, sclerotic contour loss suggests the presence of a large glenoid defect that may require bony reconstruction. However, an intact sclerotic contour does not rule out significant bone loss.
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Affiliation(s)
- Troy D Bornes
- Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada
| | - Jacob L Jaremko
- Department of Radiology and Diagnostic Imaging, University of Alberta, 2A2.41 Walter Mackenzie Centre, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada
| | - Lauren A Beaupre
- Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada.,Department of Physical Therapy, University of Alberta, 3-48 Corbett Hall, 8205-114 Street NW, Edmonton, AB, T6G-2G4, Canada
| | - Martin J Bouliane
- Division of Orthopaedic Surgery, University of Alberta, 6-110B Clinical Sciences Building, 8440-112 Street NW, Edmonton, AB, T6G-2B7, Canada.
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Jasper LL, Jones CA, Mollins J, Pohar SL, Beaupre LA. Risk factors for revision of total knee arthroplasty: a scoping review. BMC Musculoskelet Disord 2016; 17:182. [PMID: 27113334 PMCID: PMC4845333 DOI: 10.1186/s12891-016-1025-8] [Citation(s) in RCA: 65] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2016] [Accepted: 04/09/2016] [Indexed: 01/10/2023] Open
Abstract
Background In spite of the increasing incidence of total knee arthroplasties (TKA), evidence is limited regarding risk factors for revision. The objective of this scoping review was to identify and assess demographic, surgical and health services factors that may increase the risk for revision surgery following TKA. Methods A scoping review was undertaken following an electronic search in MEDLINE (1990 to December 2013), CINAHL (to December 2013), EMBASE (1990 to December 2013) and Web of Science (1990 to December 2013). Results Of the 4460 articles screened, 42 were included of which 26 articles were based on registry data. Increased risk of revision was associated with demographic factors (younger age, African American), surgical factors related to the primary TKA (uncemented components, implant malalignment, increased surgery duration), and health services (low volume hospitals). Conclusions Identifying emerging trends in characteristics of those requiring revision following TKA can help identify those at risk and allocate appropriate resources. Further primary clinical articles on risk factors for revision of TKA are necessary to ensure maximal function and lifespan following TKAs. Electronic supplementary material The online version of this article (doi:10.1186/s12891-016-1025-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- L L Jasper
- Department of Physical Therapy, University of Alberta, Rm 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
| | - C A Jones
- Department of Physical Therapy, University of Alberta, Rm 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada.
| | - J Mollins
- Alberta Health Services, Edmonton, Canada
| | - S L Pohar
- Canadian Agency for Drugs and Technologies in Health, Ottawa, Canada
| | - L A Beaupre
- Department of Physical Therapy, University of Alberta, Rm 2-50 Corbett Hall, Edmonton, AB, T6G 2G4, Canada
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Beaupre LA, Rezansoff A, Clark M, Jen H, Lambert RG, Majumdar S. Bone Mineral Density Changes in the Hip and Spine of Men and Women 1-Year After Primary Cemented Total Knee Arthroplasty: Prospective Cohort Study. J Arthroplasty 2015; 30:2185-9. [PMID: 26169453 DOI: 10.1016/j.arth.2015.06.026] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2015] [Revised: 06/17/2015] [Accepted: 06/17/2015] [Indexed: 02/01/2023] Open
Abstract
This study evaluated age- and sex-adjusted changes in total hip and spine bone mineral density (BMD) within 1 year of total knee arthroplasty (TKA) using a prospective, longitudinal cohort with a one-year follow-up. Preoperatively, subjects underwent routine bone mineral densitometry of their hip and spine, which was repeated 12 months postoperatively. Of 108 subjects, 97 (90%) completed BMD testing. Total hip BMD decreased significantly over time (1.80% change, P<0.001) with females losing more than males (P<0.001). The pattern was similar, but attenuated in the spine. Subjects undergoing primary cemented TKA had significant bone loss in the hip within 12 months, beyond that expected with age.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, University of Alberta; 2-50 Corbett Hall, Edmonton, AB, Canada
| | - Alexander Rezansoff
- Department of Surgery, Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Marcia Clark
- Department of Surgery, Division of Orthopaedic Surgery, University of Alberta, Edmonton, AB, Canada
| | - Ho Jen
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Robert G Lambert
- Department of Radiology and Diagnostic Imaging, University of Alberta, Edmonton, AB, Canada
| | - Sumit Majumdar
- Department of Medicine, Division of Internal Medicine, University of Alberta, Edmonton, AB, Canada
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Sheps DM, Bouliane M, Styles-Tripp F, Beaupre LA, Saraswat MK, Luciak-Corea C, Silveira A, Glasgow R, Balyk R. Early mobilisation following mini-open rotator cuff repair: a randomised control trial. Bone Joint J 2015; 97-B:1257-63. [PMID: 26330594 DOI: 10.1302/0301-620x.97b9.35250] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
This study compared the clinical outcomes following mini-open rotator cuff repair (MORCR) between early mobilisation and usual care, involving initial immobilisation. In total, 189 patients with radiologically-confirmed full-thickness rotator cuff tears underwent MORCR and were randomised to either early mobilisation (n = 97) or standard rehabilitation (n = 92) groups. Patients were assessed at six weeks and three, six, 12 and 24 months post-operatively. Six-week range of movement comparisons demonstrated significantly increased abduction (p = 0.002) and scapular plane elevation (p = 0.006) in the early mobilisation group, an effect which was not detectable at three months (p > 0.51) or afterwards. At 24 months post-operatively, patients who performed pain-free, early active mobilisation for activities of daily living showed no difference in clinical outcomes from patients immobilised for six weeks following MORCR. We suggest that the choice of rehabilitation regime following MORCR may be left to the discretion of the patient and the treating surgeon.
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Affiliation(s)
- D M Sheps
- University of Alberta, Edmonton, Alberta, Canada
| | - M Bouliane
- University of Alberta, Edmonton, Alberta, Canada
| | | | - L A Beaupre
- University of Alberta, Edmonton, Alberta, Canada
| | - M K Saraswat
- Alberta Health Services, Edmonton, Alberta, Canada
| | | | - A Silveira
- Alberta Health Services, Edmonton, Alberta, Canada
| | - R Glasgow
- University of Alberta, Edmonton, Alberta, Canada
| | - R Balyk
- University of Alberta, Edmonton, Alberta, Canada
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Saraswat MK, Styles-Tripp F, Beaupre LA, Luciak-Corea C, Otto D, Lalani A, Balyk RA. Functional Outcomes and Health-Related Quality of Life After Surgical Repair of Full-Thickness Rotator Cuff Tears Using a Mini-Open Technique: A Concise 10-Year Follow-up of a Previous Report. Am J Sports Med 2015; 43:2794-9. [PMID: 26394889 DOI: 10.1177/0363546515602017] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Although good short-term and midterm outcomes are reported for mini-open rotator cuff repair, few prospective studies have investigated long-term results. HYPOTHESIS Function and health-related quality of life (HRQL) outcomes would be maintained 10 years after mini-open rotator cuff repair. STUDY DESIGN Cohort study; Level of evidence, 2. METHODS Patients with a confirmed full-thickness rotator cuff tear who underwent mini-open repair between April 1997 and July 2000 were evaluated preoperatively as well as 1 year and 10 years postoperatively for (1) pain, function, and HRQL using the American Shoulder and Elbow Surgeons (ASES) score and Western Ontario Rotator Cuff Index (WORC) score; (2) active shoulder range of motion (ROM) using goniometry; and (3) satisfaction by an independent evaluator. Changes in function, HRQL, and ROM over time were analyzed using repeated-measures analysis of variance. RESULTS A total of 84 patients were enrolled, of which 61 (73%) were men; the mean (±SD) age was 53.0 ± 9.9 years. At 10 years, 4 (5%) patients were deceased, and 4 (5%) had symptomatic retears. Fifty-nine (74%) patients were evaluated, composed of 43 (73%) men; 26 (44%) were younger than 60 years. Function and HRQL significantly improved over the course of follow-up (P < .001), primarily within the first postoperative year. At 10 years, the mean ASES score was 90.4 ± 19.4, similar to the 1-year score of 91.1 ± 12.0 (P = .83). The mean WORC score at 10 years was 88.7 ± 17.8, with no change from the 1-year score of 88.4 ± 13.6 (P = .93). This relationship did not change after adjusting for age and tear size. Shoulder ROM was also maintained over 10 years. Flexion ROM improved in the first postoperative year, and this improvement was sustained at 10 years after surgery (P ≥ .30). External rotation ROM was slower to improve postoperatively, and significant improvements were seen between 1 and 10 years (P < .01). Fifty-three patients (90%) were satisfied or very satisfied with their results. Tear size, workers' compensation board claimant status, sex, and smoking status did not influence HRQL or shoulder ROM (P > .06). CONCLUSION Postoperative improvements in function and HRQL after mini-open rotator cuff repair were retained at 10 years.
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Affiliation(s)
- Manoj K Saraswat
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | | | - Lauren A Beaupre
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada Department of Physical Therapy, University of Alberta, Edmonton, Alberta, Canada
| | | | - David Otto
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Aleem Lalani
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
| | - Robert A Balyk
- Division of Orthopaedic Surgery, University of Alberta, Edmonton, Alberta, Canada
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Jones CA, Jhangri GS, Feeny DH, Beaupre LA. Cognitive Status at Hospital Admission: Postoperative Trajectory of Functional Recovery for Hip Fracture. J Gerontol A Biol Sci Med Sci 2015; 72:61-67. [DOI: 10.1093/gerona/glv138] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2015] [Accepted: 07/20/2015] [Indexed: 11/13/2022] Open
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Beaupre LA, Carson JL, Noveck H, Magaziner J. Recovery of Walking Ability and Return to Community Living within 60 Days of Hip Fracture Does Not Differ Between Male and Female Survivors. J Am Geriatr Soc 2015. [PMID: 26200232 DOI: 10.1111/jgs.13535] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES To compare risk-adjusted differences between men and women 30 and 60 days after hip fracture surgery in not walking, ability to return home in a community-dwelling subset, not walking in a nursing home resident subset, and mortality within 60 days. DESIGN Cohort study. SETTING Data were from a randomized clinical trial that compared two blood transfusion protocols after hip fracture. PARTICIPANTS Individuals with hip fracture (N = 2,016; 489 (24%) male). MEASUREMENTS Walking, dwelling, and mortality were determined in telephone follow-up 30 and 60 days after randomization, which occurred within 3 days of surgery. Sex differences for each outcome were compared using univariate and multivariate regression adjusting for potential confounders. RESULTS Men were younger (P < .001) and more likely to have comorbidity (P = .003) than women at the time of hip fracture and to die within 60 days, even after risk adjustment (odds ratio (OR) = 1.76, 95% confidence interval (CI) = 1.15-2.69). After risk adjustment, male survivors were as likely as female survivors not to walk (OR = 1.03, 95% CI = 0.78-1.34) and no less likely to return home (OR = 0.90, 95% CI = 0.69-1.17) 60 days after hip fracture. No differences were noted between male and female nursing home residents in not walking within 60 days (OR = 0.95, 95% CI = 0.32-2.86). CONCLUSION Although men experience higher mortality, male survivors can expect recovery of walking ability similar to that of female survivors and are as likely to return to community living.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jeffrey L Carson
- Rutgers Biomedical Health Sciences, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey.,Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Helaine Noveck
- Division of General Internal Medicine, Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey
| | - Jay Magaziner
- Department of Epidemiology and Public Health, School of Medicine, University of Maryland, Baltimore, Maryland
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Weber D, Dulai SK, Bergman J, Buckley R, Beaupre LA. Time to initial operative treatment following open fracture does not impact development of deep infection: a prospective cohort study of 736 subjects. J Orthop Trauma 2014; 28:613-9. [PMID: 25050748 DOI: 10.1097/bot.0000000000000197] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To evaluate the association between time to surgery, antibiotic administration, Gustilo grade, fracture location, and development of deep infection in open fractures. DESIGN Prospective cohort between 2001 and 2009. SETTING Three Level 1 Canadian trauma centers. PARTICIPANTS A total of 736 (791 fractures) subjects were enrolled and 686 subjects (93%; 737 fractures) provided adequate follow-up data (1-year interview and/or clinical follow-up >90 days). INTERVENTION Demographics, injury information, time to surgery, and antibiotics were recorded. Subjects were evaluated using standardized data forms until the fracture(s) healed. Phone interviews were undertaken 1 year after the fracture. MAIN OUTCOME MEASURES Infection requiring unplanned surgical debridement and/or sustained antibiotic therapy. RESULTS Tibia/fibula fractures were most common (n = 413, 52%), followed by upper extremity (UE) (n = 285, 36%), and femoral (n = 93, 12%) fractures. Infection developed in 46 fractures (6%). The median time to surgery was 9 hours 4 minutes (interquartile range, 6 hours 39 minutes to 12 hours 33 minutes) and 7 hours 39 minutes (interquartile range, 6 hours 10 minutes to 9 hours 54 minutes) for those without and with infection, respectively (P = 0.04). Gustilo grade 3B/3C fractures accounted for 17 of 46 infections (37%) (P < 0.001). Four UE (1.5%), 7 femoral (8%), and 35 tibia/fibula (9%) fractures developed infections (P = 0.001). Multivariate regression found no association between infection and time to surgery [odds ratio (OR), 0.97; 95% confidence interval (95% CI), 0.90-1.06] or antibiotics (OR, 1.0; 95% CI, 0.90-1.05). Grades 3A (OR, 6.37; 95% CI, 1.37-29.56) and 3B/3C (OR, 12.87; 95% CI, 2.72-60.95) relative to grade 1 injuries and tibia/fibula (OR, 3.91; 95% CI, 1.33-11.53) relative to UE fractures were significantly associated with infection. CONCLUSION Infection after open fracture was associated with increasing Gustilo grade or tibia/fibula fractures but not time to surgery or antibiotics. LEVEL OF EVIDENCE Prognostic level I. See instructions for authors for a complete description of levels of evidence.
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Affiliation(s)
- Donald Weber
- *Department of Surgery, University of Alberta, Edmonton, Alberta, Canada; and †Department of Surgery, University of Calgary, Calgary, Alberta, Canada
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Beaupre LA, Masson ECO, Luckhurst BJ, Arafah O, O'Connor GJ. A randomized pilot study of a comprehensive postoperative exercise program compared with usual care following primary total hip arthroplasty in subjects less than 65 years of age: feasibility, selection of outcome measures and timing of assessment. BMC Musculoskelet Disord 2014; 15:192. [PMID: 24889213 PMCID: PMC4060584 DOI: 10.1186/1471-2474-15-192] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/22/2014] [Accepted: 05/14/2014] [Indexed: 11/10/2022] Open
Abstract
Background Total Hip Arthroplasty (THA) is being used more commonly in younger higher demand patients. The purpose of this randomized pilot study was to explore a) feasibility of comprehensive postoperative rehabilitation compared to usual care following primary THA in subjects <65 years, b) appropriate outcome measures including performance-based measures and c) timing of assessments. Methods 21 subjects who underwent primary THA were randomized to receive a three-month out-patient rehabilitation program (Intervention) or usual postoperative care (Control). Subjects were assessed preoperatively, six-weeks postoperatively (Pre-intervention) and four and 12 months postoperatively (Post-intervention). Self-report measures were the Western Ontario McMaster Osteoarthritis Index (WOMAC) and Rand 36-Item Health Survey (RAND-36). Performance-based measures included lower extremity strength, walking speed and endurance, and gait laboratory assessment. Results Ten Control and 11 Intervention subjects with an average age of 53.4 (SD9.3) years were randomized. All Intervention subjects completed the program without adverse effects. Although no statistically significantly results were reported, four months postoperatively, Intervention subjects had clinically important differences (CID) in strength compared with Control subjects. Walking endurance, WOMAC and RAND scores improved significantly with no CID noted between groups. Ten (48%) subjects reported a ceiling effect on the WOMAC (9 (43%) subjects on Pain; 1 (5%) subject on Function). No group CID were noted in gait measures. Conclusions Our recommendations would be that performance-based strength measures should be considered for the primary outcome in this younger cohort. Because of the ceiling effects with WOMAC Pain, a different pain measure is indicated. Other more challenging functional performance-based tests should be considered such as a more prolonged endurance test. There is merit in one-year follow-up as strength improved after four months in both groups.
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Affiliation(s)
- Lauren A Beaupre
- Department of Physical Therapy, 2-50 Corbett Hall, University of Alberta, Edmonton, AB T6G 2G4, Canada.
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Chow R, Beaupre LA, Rudnisky CJ, Otto D, Clark M. Surgeons' perception of fluoroscopic radiation hazards to vision. Am J Orthop (Belle Mead NJ) 2013; 42:505-510. [PMID: 24340320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
Exposure to ionizing radiation, such as that used in fluoroscopy, can lead to cataracts. This is relevant in orthopedic surgery as fluoroscopic procedures are commonly performed. In this study, we determined perceived level of: (1) personal risk, (2) awareness of risk for cataract formation due to ionizing radiation exposure, (3) awareness of occupational dose limits for ophthalmologic radiation exposure, (4) current radioprotective practices amongst orthopedic surgeons. Canadian Orthopaedic Association members were asked to participate and 264 responses (23%) were received. Many respondents believed that they were at least at moderate risk for cataract formation due to occupational radiation exposure (n = 107; 41%). Fifty-nine respondents (22%) indicated that they lacked sufficient knowledge to estimate risk and almost half (n = 120; 45%) reported having minimal awareness that ionizing radiation may contribute to cataractogenesis; almost 75% (n = 197) reported having minimal awareness that dose limits exist. The association between perceived risk and awareness was significant (P<.001). There is an information deficit among orthopedic surgeons regarding awareness of either the potential cataractogenesis risk due to radiation exposure or the dose limits.
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Weeks CA, Begum F, Beaupre LA, Carey JP, Adeeb S, Bouliane MJ. Locking plate fixation of proximal humeral fractures with impaction of the fracture site to restore medial column support: a biomechanical study. J Shoulder Elbow Surg 2013; 22:1552-7. [PMID: 23639833 DOI: 10.1016/j.jse.2013.02.003] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2012] [Revised: 01/16/2013] [Accepted: 02/18/2013] [Indexed: 02/01/2023]
Abstract
BACKGROUND Despite the advent of locking plate techniques, proximal humeral fracture fixation can fail due to varus collapse, especially in osteoporotic bone with medial cortex comminution. This study investigated the effect of restoring the integrity of the medial column by fracture impaction and shaft medialization with locking plate fixation. This construct was compared with a traditional locking plate construct under conditions of varus cyclical loading. MATERIALS AND METHODS Proximal humeral fractures with medial comminution were simulated by performing wedge-shaped osteotomies at the surgical neck in cadaveric specimens and removing 1 cm of medial cortex. For each cadaver (n = 6), 1 humeral fracture was fixed with a traditional locking plate construct. The other was fixed with the locking plate construct plus fracture impaction and shaft medialization, resulting in medial column restoration. The humeral head was immobilized, and a repetitive, varus force was applied to the humeral shaft until construct collapse or until 25,000 cycles were completed. RESULTS None of the constructs with fracture impaction collapsed, whereas 5 of 6 of the nonaugmented constructs collapsed before reaching 25,000 cycles (P = .008). Collapse of the 5 nonimpacted constructs that failed occurred after an average of 11,470 ± 3589 cycles. CONCLUSION Fracture impaction increased the ability of the locking plate to withstand repetitive varus loading. This technique provides a construct biomechanically superior to locking plate fixation alone.
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Affiliation(s)
- Colleen A Weeks
- Department of Orthopedic Surgery, University of Alberta, Edmonton, AB, Canada.
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