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keyboard_arrow_downTitleAbstractIntroductionGuideline Review Process and ValidationMethods (Continued)Prevalence 2009 SummaryPathoanatomical Features 2009 SummaryAnd 2017 SummaryRisk Factors 2009 RecommendationNatural History 2009 SummaryImaging Studies 2009 and 2017 SummaryPhysical Impairment Measures 2009 RecommendationBest-Practice Point Essential Data ElementsSummaryAnti-Inflammatory Agents 2009 and 2017 SummaryAlternative/Complementary Medication 2009 SummaryPatient Education 2009 RecommendationManual Therapy 2009 RecommendationWeight Loss 2009 RecommendationRecommendationdownload

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Download Free PDFPT 505 Hip OA CPGYip Chanhttps://doi.org/10.2519/JOSPT.2017.0301visibility

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Abstract

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This clinical practice guideline outlines the criteria for clinicians to classify adults over 50 years with hip osteoarthritis using the ICD and ICF frameworks. It emphasizes the importance of revising diagnoses and care plans based on patient history and activity limitations. The guideline aims to standardize evidence-based practice in orthopedic physical therapy concerning hip osteoarthritis, providing definitions, classifications, and interventions based on the best available evidence.

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Performance comparison of four triage-based patient flow interventions in the emergency departmentGul Kremer

Numerous efforts have been put forth into eliminating the adverse effects that come along with Emergency Department overcrowding, such as long waiting times, patients leaving without being seen and deterioration of quality of care. From the published patient flow improvement interventions, we focus on strategies that are widely discussed in the relevant literature: FIFO with priority, fast track, physician triage and team triage. The effectiveness of these interventions is shown through mostly observational and a limited number of controlled studies, where only a specific intervention is studied. However, these 'success stories' help little when alternatives are not compared properly. To overcome this problem, we propose a simulation approach to examine these interventions in a controlled environment and to enable the sensitivity analyses of critical ED parameters such as resources or patients' inputs. A patient risk-adjusted ED performance measurement is also proposed to guide future implementations.

downloadDownload free PDFView PDFchevron_rightEvaluating the effect of emergency department crowding on triage destinationLisa Calder, Mathieu Gatien

International Journal of Emergency Medicine, 2014

Emergency Department (ED) crowding has been studied for the last 20 years, yet many questions remain about its impact on patient care. In this study, we aimed to determine if ED crowding influenced patient triage destination and intensity of investigation, as well as rates of unscheduled returns to the ED. We focused on patients presenting with chest pain or shortness of breath, triaged as high acuity, and who were subsequently discharged home. This pilot study was a health records review of 500 patients presenting to two urban tertiary care EDs with chest pain or shortness of breath, triaged as high acuity and subsequently discharged home. Data extracted included triage time, date, treatment area, time to physician initial assessment, investigations ordered, disposition, and return ED visits within 14 days. We defined ED crowding as ED occupancy greater than 1.5. Data were analyzed using descriptive statistics and the χ(2) and Fisher exact tests. Over half of the patients, 260/500 (52.0%) presented during conditions of ED crowding. More patients were triaged to the non-monitored area of the ED during ED crowding (65/260 (25.0%) vs. 39/240 (16.3%) when not crowded, P = 0.02). During ED crowding, mean time to physician initial assessment was 132.0 minutes in the non-monitored area vs. 99.1 minutes in the monitored area, P <0.0001. When the ED was not crowded, mean time to physician initial assessment was 122.3 minutes in the non-monitored area vs. 67 minutes in the monitored area, P = 0.0003. Patients did not return to the ED more often when triaged during ED crowding: 24/260 (9.3%) vs. 29/240 (12.1%) when ED was not crowded (P = 0.31). Overall, when triaged to the non-monitored area of the ED, 44/396 (11.1%) patients returned, whereas in the monitored area 9/104 (8.7%) patients returned, P = 0.46. ED crowding conditions appeared to influence triage destination in our ED leading to longer wait times for high acuity patients. This did not appear to lead to higher rates of return ED visits amongst discharged patients in this cohort. Further research is needed to determine whether these delays lead to adverse patient outcomes.

downloadDownload free PDFView PDFchevron_rightThe Effect of Triage Diagnostic Standing Orders on Emergency Department Treatment TimeMelissa McCarthy

Annals of Emergency Medicine, 2011

Study objective: Triage standing orders are used in emergency departments (EDs) to initiate evaluation when there is no bed available. This study evaluates the effect of diagnostic triage standing orders on ED treatment time of adult patients who presented with a chief complaint for which triage standing orders had been developed. Methods: We conducted a retrospective nested cohort study of patients treated in one academic ED between January 2007 and August 2009. In this ED, triage nurses can initiate full or partial triage standing orders for patients with chest pain, shortness of breath, abdominal pain, or genitourinary complaints. We matched patients who received triage standing orders to those who received room orders with respect to clinical and temporal factors, using a propensity score. We compared the median treatment time of patients with triage standing orders (partial or full) to those with room orders, using multivariate linear regression. Results: Of the 15,188 eligible patients, 25% received full triage standing orders, 56% partial triage standing orders, and 19% room orders. The unadjusted median ED treatment time for patients who did not receive triage standing orders was 282 minutes versus 230 minutes for those who received a partial triage standing order or full triage standing orders (18% decrease). Controlling for other factors, triage standing orders were associated with a 16% reduction (95% confidence interval Ϫ18% to Ϫ13%) in the median treatment time, regardless of chief complaint. Conclusion: Diagnostic testing at triage was associated with a substantial reduction in ED treatment time for 4 common chief complaints. This intervention warrants further evaluation in other EDs and with different clinical conditions and tests. [

downloadDownload free PDFView PDFchevron_rightTriage of patients out of the emergency department: Three-year experienceJoseph Silva

The American Journal of Emergency Medicine, 1992

Because of severe emergency department (ED) overcrowding, the authors initiated a program of referring certain patients who were assessed as not needing emergency care away from the ED. A selected group of patients who presented to a busy university ED were refused treatment and triaged away following a medical screening examination performed by a nurse. In this &year study 136,794 patients presented to the triage area in the ED, of which 21,069 (16%) were refused care and referred elsewhere. letters and calls to all referral clinics, eight local EDs, and the coroner's office identified no patients who had been grossly mistriaged, and only insignificant adverse outcomes could be identified. Additional follow-up on 3,740 individuals triaged away was performed by telephone. Responses from this survey indicated that 42% of persons received care elsewhere the same day, 37% within 2 days, and 22% decided not to seek medical care. A gmup of 1.6% sought care at other hospital EDs for minor complaints. The authors concluded that a gmup of patients can be selectively triaged out of the ED without significant adverse outcomes, which may offer one approach to the problem of ED overcrowding. (Am J Emerg Med lgg2;1O:lgS-199. Copyright 0 1992 by W.B. Saunders Company) The number of patients presenting to emergency departments (EDs) for care has increased significantly over the past several years. '3' The increase in demand for services by these patients has overwhelmed facilities throughout the country and has led to prolonged patient waits, delays in treating seriously ill patients, quality assurance issues, and overall crowding and inefftciency3 (Time 1990;135:58-65). The reasons for ED overcrowding are complex and multifactorial, and include: (1) prolonged stays in the ED for admitted patients because hospital wards and intensive care unit beds are filled; (2) increases in numbers of critically ill patients brought to EDs because of advances in emergency medical service systems; (3) shortages in physician and nurse staffmg; (4) decreased numbers of EDs; and (5) use of the ED by persons not needing emergency care.4-6 It has been estimated that 10% to 20% of patients present to EDs with minor complaints.7-9 As a result, resources must be diverted from the care of the critically ill and injured to those not actually needing emergency care. Use of EDs by these patients may result from the convenience of receiving care on demand. One partial solution has been the introduc-From the Division of Emergency Medicine,

downloadDownload free PDFView PDFchevron_rightRepublished paper: Emergency department triage revisitedGeorge Jelinek

Postgraduate Medical Journal, 2010

Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the diversity of factors determining the urgency of any individual patient. It is timely to accept this diversity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.

downloadDownload free PDFView PDFchevron_rightAccuracy of Triage in Service in The Emergency Department (Literature Review)eka nur soemah

Journal of Scientific Research, Education, and Technology (JSRET)

Service accuracy is the minimum standard of service that must be achieved by nurses in the emergency room, so that proper triage implementation is needed. Triage is the classification of patients based on the level of emergency by prioritising actions on airway (A), breathing (B), and circulation (C) disorders by considering facilities, human resources and the probability of patient life. The literature search in this literature review uses six databases with high and medium quality criteria, namely scient driect, IEEG, cedekia, Sci-hub, ProQuest, Pubmed. For previous studies using correlational analytics with a cross-sectional study approach, descriptive: combination (mixed methods) with sequential explanatory design. cross sectional. Check Prisma to guide this review. Titles, abstracts, full text and methodology were assessed for study eligibility. Data were tabulated and analysed narratively. Results: Nine journal literature met the inclusion criteria, with the major theme of tri...

downloadDownload free PDFView PDFchevron_rightImproving emergency department patient flowPaul Jarvis

Clinical and Experimental Emergency Medicine, 2016

Emergency departments (ED) face significant challenges in delivering high quality and timely patient care on an ever-present background of increasing patient numbers and limited hospital resources. A mismatch between patient demand and the ED's capacity to deliver care often leads to poor patient flow and departmental crowding. These are associated with reduction in the quality of the care delivered and poor patient outcomes. A literature review was performed to identify evidence-based strategies to reduce the amount of time patients spend in the ED in order to improve patient flow and reduce crowding in the ED. The use of doctor triage, rapid assessment, streaming and the co-location of a primary care clinician in the ED have all been shown to improve patient flow. In addition, when used effectively point of care testing has been shown to reduce patient time in the ED. Patient flow and departmental crowding can be improved by implementing new patterns of working and introducing new technologies such as point of care testing in the ED.

downloadDownload free PDFView PDFchevron_rightDeterminates of Throughput Times in the Emergency DepartmentLa Downey

Journal of Health Management, 2007

This article studies factors that affect throughput times in a level 1 inner city emergency department (ED) in Chicago, USA. Previous research has shown increased throughput times are related to non-urgent patient use of the ED and lack of coordination of auxiliary hospital departments. Knowledge of these factors will allow for an improvement in patient flow and a reduction in wait times. This is a retrospective study of all factors that contribute to throughput times. Data was collected on a monthly basis for a four-year period that included presenting illness, triage level, wait times, time taken for laboratory results, radiology, bed availability, admitted or sent home, Fast Track availability, age, gender and race. The results show that factors affecting throughput are influenced by numerous determinants often beyond the ED itself. The two most influential are: the numbers of presenting illnesses that require in-patient beds, and the ability of the hospital's auxiliary depar...

downloadDownload free PDFView PDFchevron_rightImpact of revised triage to improve throughput in an ED with limited traditional fast track populationTamala Bradham

American Journal of Emergency Medicine, 2018

Emergency Department (ED) crowding is associated with patient safety concerns, increased patients left without being seen (LWBS), low patient satisfaction, and lost ED revenue. The objective was to measure the impact of a revised triage process on ED throughput. This study took place at an urban, university-affiliated, adult ED with an annual census of 70,000 and admission rate of 34%. The revised triage approach included: identifying eligible patients at triage based on complaint, comorbidities, and illness acuity; and reallocating a nurse practitioner (NP) into our triage area. We trialed the intervention from 1100-2300 on weekdays from January 13-26, 2016. Adult patients who were not likely to require intensive evaluations were eligible. Primary outcomes were throughput measures including: time to provider, ED length of stay (LOS), and LWBS. Pre-and post-intervention metrics were compared using the Mann-Whitney U test, given the nonnormal distribution of the metrics. The NP evaluated 120 patients of which 101(84%) were discharged, 3 (2.5%) admitted, and 16 (13%) required more intense evaluation. Time to provider decreased from a median (IQR) of 42 (16, 114) to 27 (12.4, 81.5) minutes (p < 0.01) and ED LOS from 290 (194.8, 405.6) to 257 (171.2, 363.4) minutes (p < 0.01) for all patients not admitted and not requiring a consult. LWBS decreased from a pre-trial 4.6% to 2.2% (p < 0.01).

downloadDownload free PDFView PDFchevron_rightImproving Patient Flow with Data-Driven Patient Prioritization Method in the Emergency DepartmentSean Lam

2015

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Waiting for Triage: Unmeasured Time in Patient FlowLeon Sanchez

Western Journal of Emergency Medicine, 2015

downloadDownload free PDFView PDFchevron_rightModern triage in the emergency departmentBingisser R, Elke Platz

2010

Because the volume of patient admissions to an emergency department (ED) cannot be precisely planned, the available resources may become overwhelmed at times (&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;crowding&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;), with resulting risks for patient safety. The aim of this study is to identify modern triage instruments and assess their validity and reliability. Review of selected literature retrieved by a search on the terms &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;emergency department&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; and &amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot;triage.&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;quot; Emergency departments around the world use different triage systems to assess the severity of incoming patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; conditions and assign treatment priorities. Our study identified four such instruments: the Australasian Triage Scale (ATS), the Canadian Triage and Acuity Scale (CTAS), the Manchester Triage System (MTS), and the Emergency Severity Index (ESI). Triage instruments with 5 levels are superior to those with 3 levels in both validity and reliability (p&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;lt;0.01). Good to very good reliability has been shown for the best-studied instruments, CTAS and ESI (κ-statistics: 0.7 to 0.95), while ATS and MTS have been found to be only moderately reliable (κ-statistics: 0.3 to 0.6). MTS and ESI are both available in German; of these two, only the ESI has been validated in German-speaking countries. Five-level triage systems are valid and reliable methods for assessment of the severity of incoming patients&amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;amp;#39; conditions by nursing staff in the emergency department. They should be used in German emergency departments to assign treatment priorities in a structured and dependable fashion.

downloadDownload free PDFView PDFchevron_rightTriage Process and the Effect on Patients Leaving Against Medical Advice and Wait TimesAngie Lopez

2019

• ED crowding has been described as both a patient safety issue and a worldwide public health problem and has become a major barrier in patients receiving timely emergency department care 2, 4, 8 • Utilizing the bypass rapid assessment triage (BRAT), arrival-to-triage time improved by 36%, arrival-to-room time improved by 32%, and arrival-tophysician time improved by 26% 1, 4, 5, 7. • Using BRAT process, patient satisfaction was increased and those leaving against medical advice was reduced. 1,7 • The Emergency Department Length of Stay (EDLOS) is reduced by assessment and initiation of interventions in the waiting room 1, 2, 5, 6 • Generally, most studies acknowledge a reduction in ED wait times with a change in triage process or with early intervention in the ED waiting room. However, one study by Innes states that there is no statistical significance in reduction in wait times with early intervention.

downloadDownload free PDFView PDFchevron_rightEmergency department triage revisitedGeorge Jelinek

Emergency Medicine Journal, 2010

Triage is a process that is critical to the effective management of modern emergency departments. Triage systems aim, not only to ensure clinical justice for the patient, but also to provide an effective tool for departmental organisation, monitoring and evaluation. Over the last 20 years, triage systems have been standardised in a number of countries and efforts made to ensure consistency of application. However, the ongoing crowding of emergency departments resulting from access block and increased demand has led to calls for a review of systems of triage. In addition, international variance in triage systems limits the capacity for benchmarking. The aim of this paper is to provide a critical review of the literature pertaining to emergency department triage in order to inform the direction for future research. While education, guidelines and algorithms have been shown to reduce triage variation, there remains significant inconsistency in triage assessment arising from the diversity of factors determining the urgency of any individual patient. It is timely to accept this diversity, what is agreed, and what may be agreeable. It is time to develop and test an International Triage Scale (ITS) which is supported by an international collaborative approach towards a triage research agenda. This agenda would seek to further develop application and moderating tools and to utilise the scales for international benchmarking and research programmes.

downloadDownload free PDFView PDFchevron_rightFactors Impacting Emergency Department Triage DurationDiane Dubinski

2011

Patient Gender Male 4.62 (2.63) p = 0.47 Female 4.39 (2.57) • Our results may be biased because this was an adult, single center, study (university medical center, urban) conducted in a southern state. • A retrospective study of existing data may not identify all factors impacting triage. • We did not include patient chief complaint in our analysis. • We did not look at triage accuracy. Our pr imary object ive was to determine the pat ient and system factors that impact ED tr iage durat ion. OBJECTIVE 97,885 triage events from 368 teams

downloadDownload free PDFView PDFchevron_rightM E D I C I N E Modern Triage in the Emergency Departmentliz aliaga

SUMMARY Background: Because the volume of patient admissions to an emergency department (ED) cannot be precisely planned, the available resources may become overwhelmed at times (" crowding "), with resulting risks for patient safety. The aim of this study is to identify modern triage instruments and assess their validity and reliability.

downloadDownload free PDFView PDFchevron_rightMind the gap: triage guidelines and their utilisation at the emergency departmentPetrie Roodbol

Nederlands Tijdschrift voor Evidence Based Practice, 2014

List of publications Dankwoord / Acknowledgements Curriculum Vitae Triage More and more patients visit hospital emergency departments (EDs), with urgent and non-urgent problems. 1 In the Netherlands, several explanations have been brought up with regard to overcrowding EDs, such as people bypassing the general practitioner (GP) and going straight to the ED and the proportional rise in the ageing population. 1,9 Overcrowded waiting rooms result in people needing care urgently without being treated in time. 10 Prioritising patients according to urgency of need for medical assessment is one possibility to overcome this problem. This is referred to as triage. 9,11-13 The term triage comes from the French verb 'trier' meaning to separate, sort, shift or select, and was applied to the sorting of military casualties. 14-15 Triage is a process of decision-making to prioritise treatment and needs of patients in ED based on clinical urgency. Triage is defined as the classification of patient acuity that characterises the degree to which the patient's condition is life-threatening and whether immediate treatment is needed to alleviate symptoms. 16 Triage nurses classify patients on the basis of their need for medical attention: patients with the highest medical needs will be treated first. Based on the classification, doctors need to see patients within the given urgency codes (Table 1). 9,17-19 Triage systems Worldwide, different triage systems are used. Systems most commonly used are the Australasian Triage Scale (ATS,

downloadDownload free PDFView PDFchevron_rightDecreasing Length of Stay in the Emergency Department With a Split Emergency Severity Index 3 Patient Flow ModelRajiv Arya

Academic Emergency Medicine, 2013

Objectives: There has been a steady increase in emergency department (ED) patient volume and wait times. The desire to maintain or decrease costs while improving throughput requires novel approaches to patient flow. The break-out session "Interventions to Improve the Timeliness of Emergency Care" at the June 2011 Academic Emergency Medicine consensus conference "Interventions to Assure Quality in the Crowded Emergency Department" posed the challenge for more research of the split Emergency Severity Index (ESI) 3 patient flow model. A split ESI 3 patient flow model divides high-variability ESI 3 patients from low-variability ESI 3 patients. The study objective was to determine the effect of implementing a split ESI 3 flow model has on patient length of stay (LOS) for discharged patients. Methods: This was a retrospective chart review at an urban academic ED seeing over 70,000 adult patients a year. Cases consisted of adults who presented from 9 a.m. to 11 p.m. from June 1, 2011, to December 31, 2011, and were discharged. Controls were patients who presented on the same times and days, but in 2010. Visit descriptors included age, race, sex, ESI score, and first diagnosis. The first diagnosis was coded based on methods used by the Agency for Healthcare Research and Quality to codify International Classification of Diseases, ninth version, into disease groups. Linear models compared log-transformed LOS for cases and controls. A front-end ED redesign involved creating guidelines to split ESI 3 patients into low and high variability, a hybrid sort/triage registered nurse, an intake area consisting of an internal results waiting room, and a treatment area for patients after initial assessment. The previous low-acuity area (ESI 4s and 5s) began to see low-variability ESI 3 patients as well. This was done without additional beds. The intake area was staffed with an attending emergency physician (EP), a physician assistant (PA), three nurses, two medical technicians, and a scribe. Results: There was a 5.9% decrease, from 2.58 to 2.43 hours, in the geometric mean of LOS for discharged patients from 2010 to 2011 (95% confidence interval CI = 4.5% to 7.2%; 2010, n = 20,215; 2011, n = 20,653). Abdominal pain was the most common diagnostic grouping (2010, n = 2,484; 2011, n = 2,464) with a reduction in LOS of 12.9%, from 4.37 to 3.8 hours (95% CI = 10.3% to 15.3%). Conclusions: A split ESI 3 patient flow model improves door-to-discharge LOS in the ED.

downloadDownload free PDFView PDFchevron_rightImpact of point-of-care testing on patients' length of stay in a large emergency departmentLawrence Lewis

Clinical Chemistry, 1996

We prospectively investigated whether routine use of a point-of-care testing (POCT) device by nonlaboratory operators in the emergency department (ED) for all patients requiring the available tests could shorten patient length of stay (LOS) in the ED. ED patient LOS, defined as the length of time between triage (initial patient interview) and discharge (released to home or admitted to hospital), was examined during a 5-week experimental period in which ED personnel used a hand-held POCT device to perform Na, K, Cl, glucose (Gluc), and blood urea nitrogen (BUN) testing. Preliminary data demonstrated acceptable accuracy of the hand-held device. Patient LOS distribution during the experimental period was compared with the LOS distribution during a 5-week control period before institution of the POCT device and with a 3-week control period after its use. Among nearly 15 000 ED patient visits during the study period, 4985 patients (2067 during the experimental period and 2918 during the ...

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The Management between Comorbidities and Pain Level with Physical Activity in Individuals with Hip Osteoarthritis with Surgical Indication: A Cross-Sectional StudyErick Porto

Medicina

Background and Objectives: The degenerative pathology of the hip joint appears in young age groups, related to fem-oroacetabular impingement, and in advanced age, due to other inflammatory causes, with greater potential for severity in the presence of comorbidities. Objectives: To evaluate the participation of the main causes of osteoarthritis in relation to physical activities, s Body Mass Index (BMI) and television time (TV). Materials and Methods: 54 patients with surgical indication treated at an orthopedic referral university hospital were stratified into groups (Impact: I, Osteonecrosis/rheumatic: II, Infectious/traumatic: III), and the influence of comorbidities on physical activity performance, relative to BMI and TV time. Results: It was observed that the impact group was the most frequent (51.8%), with 79.6% under the age of 60 years. This group followed the general mean (p &lt; 0.05), using the variables of comorbidity and the level of physical activity. Pain intensity, T...

downloadDownload free PDFView PDFchevron_rightEffects of dry needling on pain, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis: Secondary analysis of a randomized controlled trialIsabel Albarova-Corral

Complementary Therapies in Medicine, 2020

To determine the changes produced by dry needling in active myofascial trigger points in hip muscles compared to a sham needling on pain intensity, main pain area, pressure pain threshold and psychological distress in patients with hip osteoarthritis. Design: Secondary analysis of a single-centre, randomized, double-blinded, clinical trial. Intervention: 30 participants with mild to moderate hip osteoarthritis were randomly assigned to DN group (n = 15) or sham DN group (n = 15). DN group received three sessions of penetrating DN, and sham DN group received three sessions of non-penetrating DN in hip muscles. Main outcome measures: Pain intensity (Visual Analogue Scale), main pain area (body chart), pressure pain threshold (algometry), psychological distress (Hospital Anxiety and Depression Scale) and self-reported improvement (Global Rate of Change) were measured before and after treatment. Results: DN group showed statistically significant improvements with large effect sizes for pain intensity (p < 0.001; E.S: 2.7), pressure pain thresholds (p < 0.05; E.S: 1.3-1.8) and psychological distress (p = 0.002; E.S: 1.5) compared to sham DN group. The DN group described a self-reported improvement categorised as quite a bit, great or very great deal better (n = 12, 80%). No statistically significant differences were found between baseline and postintervention in the sham DN group in any variable (p > 0.05). Conclusions: Three sessions of dry needling were more effective than sham dry needling for improving pain intensity, pressure pain threshold and psychological distress in patients with mild to moderate hip osteoarthritis in the short term.

downloadDownload free PDFView PDFchevron_rightHighlighting the Benefits of Rehabilitation Treatments in Hip Osteoarthritisflorin marcu

Medicina-lithuania, 2022

downloadDownload free PDFView PDFchevron_rightRheumatoid arthritis and osteoarthritis clinical practice guidelines provide few complementary and alternative medicine therapy recommendations: a systematic reviewJeremy Ng

Clinical Rheumatology, 2020

Sixty percent of patients with arthritis have used complementary and alternative medicine (CAM) therapies at least once. The two most common types of arthritis include rheumatoid arthritis (RA) and osteoarthritis (OA). The quality and quantity of CAM recommendations for RA and OA is currently unknown. The purpose of this research was to identify the quantity and assess the quality of CAM recommendations in clinical practice guidelines (CPGs) for the treatment and/or management of RA and OA. A systematic review was conducted to identify CPGs; MEDLINE, EMBASE and CINAHL were searched from 2008 to 2018. The Guidelines International Network and the National Center for Complementary and Integrative Health websites were also searched. Three independent reviewers evaluated the quality of reporting for each guideline that provided CAM recommendations, and the specific section providing CAM recommendations, using the AGREE II instrument. From 525 unique search results, seven guidelines (3 OA, 4 RA) mentioned CAM and 5 guidelines made CAM recommendations. Scaled domain percentages from highest to lowest were (overall, CAM) as follows: clarity of presentation (92.2% vs. 94.1%), scope and purpose (90.1% vs. 87.4%), rigour of development (72.6% vs. 64.2%), stakeholder involvement (64.8% vs. 49.6%), editorial independence (61.1% vs. 60.6%), and applicability (51.4% vs. 33.3%). None of the 5 guidelines was recommended by both appraisers for either the overall guideline or CAM section. For the overall guideline, appraisers agreed in their overall recommendation for 3 of 5 guidelines, including 3 Yes with modifications; of the remaining 2 guidelines, 1 was rated by the three appraisers as 1 No and 2 Yes with modifications, while 1 guideline was rated at 2 Yes and 1 Yes with modifications. For the CAM section, appraisers agreed in their overall recommendation for all 5 guidelines including 1 No, and 4 Yes with modifications. Roughly half of arthritis CPGs found included in this review provided CAM recommendations. The quality of CAM recommendations are of lower quality than overall Page 3 of 39 recommendations across the scope and purpose, stakeholder involvement, rigour of development, applicability, and editorial independence domains. Quality varied within and across guidelines.

downloadDownload free PDFView PDFchevron_rightQuantity and Quality of Rheumatoid Arthritis and Osteoarthritis Clinical Practice Guidelines: Systematic Review and Assessment Using AGREE IIJeremy Ng

2021

The purpose of this study was to identify the quantity and evaluate the quality of clinical practice guidelines for the treatment and/or management of rheumatoid arthritis (RA) and osteoarthritis (OA). We conducted a systematic review, searching MEDLINE, EMBASE and CINAHL databases from 2008 to 2018. The Guidelines International Network website was also searched. Eligible guidelines were assessed using the AGREE II instrument. From 525 unique search results, 12 RA guidelines and 3 OA CPGs were found to be eligible. Scaled domain percentages from highest to lowest were clarity of presentation (89.8%), scope and purpose (88.0%), stakeholder involvement (67.6%), rigour of development (62.2%), editorial independence (56.4%) and applicability (53.3%). Quality varied within and across guidelines. None of the 15 guidelines were recommended by both appraisers; 11 were recommended as Yes or Yes with modifications. A number of guidelines for the treatment and/or management of RA or OA are ava...

downloadDownload free PDFView PDFchevron_rightThe 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on assessment and treatment of femoroacetabular impingement syndrome (FAIS): an international consensus statementKeelan Enseki

Journal of Hip Preservation Surgery, 2021

The 2019 International Society of Hip Preservation (ISHA) physiotherapy agreement on femoroacetabular impingement syndrome (FAIS) was intended to build an international physiotherapy consensus on the assessment, non-surgical physiotherapy treatment, pre-/post-operative management, and return to sport decisions for those patients with FAIS. The panel consisted of 11 physiotherapists and 8 orthopaedic surgeons. There is limited evidence regarding the use of physiotherapy in the overall management of those with FAIS. Therefore, a group of ISHA member physiotherapists, who treat large numbers of FAIS patients and have extensive experience in this area, constructed a consensus statement to guide physiotherapy-related decisions in the overall management of those with FAIS. The consensus was conducted using a modified Delphi technique. Six major topics were the focus of the consensus statement: (i) hip assessment, (ii) non-surgical physiotherapy management, (iii) pre-habilitation prior to ...

downloadDownload free PDFView PDFchevron_rightIdentifying strategies that support equitable person-centred osteoarthritis care for diverse women: content analysis of guidelinesDeborah Marshall

BMC Musculoskeletal Disorders

Introduction Women are disproportionately impacted by osteoarthritis (OA) but less likely than men to access early diagnosis and management, or experience OA care tailored through person-centred approaches to their needs and preferences, particularly racialized women. One way to support clinicians in optimizing OA care is through clinical guidelines. We aimed to examine the content of OA guidelines for guidance on providing equitable, person-centred care to disadvantaged groups including women. Methods We searched indexed databases and websites for English-language OA-relevant guidelines published in 2000 or later by non-profit organizations. We used manifest content analysis to extract data, and summary statistics and text to describe guideline characteristics, person-centred care (PCC) using a six-domain PCC framework, OA prevalence or barriers by intersectional factors, and strategies to improve equitable access to OA care. Results We included 36 OA guidelines published from 2003...

downloadDownload free PDFView PDFchevron_rightProlotherapy agent P2G is associated with upregulation of fibroblast growth factor-2 genetic expression in vitroChandrakanth Emani

Journal of Experimental Orthopaedics

Purpose Osteoarthritis (OA) is a prevalent, progressively degenerative disease. Researchers have rigorously documented clinical improvement in participants receiving prolotherapy for OA. The mechanism of action is unknown; therefore, basic science studies are required. One hypothesized mechanism is that prolotherapy stimulates tissue proliferation, including that of cartilage. Accordingly, this in vitro study examines whether the prolotherapy agent phenol-glycerin-glucose (P2G) is associated with upregulation of proliferation-enhancing cytokines, primarily fibroblast growth factor-2 (FGF-2). Methods Murine MC3T3-E1 cells were cultured in a nonconfluent state to retain an undifferentiated osteochondroprogenic status. A limitation of MC3T3-E1 cells is that they do not fully reproduce primary human chondrocyte phenotypes; however, they are useful for modeling cartilage regeneration in vitro due to their greater phenotypic stability than primary cells. Two experiments were conducted: on...

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