RCOT announces revised guidelines for occupational therapy and total hip replacement

The Royal College of Occupational Therapists (RCOT) is delighted to announce the publication of the second edition of the practice guidelines for working with people undergoing total hip replacement. Endorsed by the British Hip Society, the new guidelines recognise in particular the changes in length of recommended stay for patients as well as the fact that this surgery is increasingly being performed on younger patients.
https://www.rcot.co.uk/practice-resources/rcot-practice-guidelines/hip

Distal Biceps and Triceps Injuries

The Open Orthopaedics Journal, 2017, 11, (Suppl-8, M4) 1364-1372

Whilst non-operative treatment may be appropriate for patients with low functional demands, surgical management is the preferred option for the majority of patients. We have described a cortical button technique and osseous tunnel technique utilised at our institution for distal biceps and triceps tendon fixation respectively. For biceps or triceps tendon injuries, those receiving an early diagnosis and undergoing surgical intervention, an excellent functional outcome can be expected.

James C. Beazley, Thomas M. Lawrence, Steven J. Drew and Chetan S. Modi

Transforming musculoskeletal and orthopaedic elective care services

This handbook from NHS England has been created to to support the improvement of local health and care systems for musculoskeletal and orthopaedic elective care services.

NHS RightCare pathway: falls and fragility fractures

The latest NHS RightCare pathway on falls and fragility fractures pathway has been developed in collaboration with the national clinical director for musculoskeletal services, Public Health England (PHE), National Osteoporosis Society and a range of other stakeholders from across the health and care system. The pathway defines the key interlocking components for an optimal system for prevention and management, and the priority higher value interventions that systems should focus on to address variation, improve outcomes, reduce cost and contribute toward a sustainable NHS.

Physios help reduce London’s neuromuscular emergency admissions

Physiotherapists have helped cut the number of emergency admissions and readmissions for people with neuromuscular conditions in London and the South East over the last five years.

An audit led by consultant neurologist Michael Hanna has revealed that emergency admissions for neuromuscular patients fell from 63 per cent to 32.8 per cent between 2012 and 2017, while readmissions halved from 25.1 per cent to 12.4 per cent.

The mortality rate over the same period dropped from 4.5 per cent to 0.3 per cent, with only one death in the 2017 sample compared to 24 in 2012.

One major factor in these improvements has been better coordination between specialist neuromuscular teams, including physios, and hospital staff. 

Physiotherapy app wins top rehabilitation award

A physiotherapy company specialising in the assessment and treatment of musculoskeletal conditions has won the Rehabilitation First training award for its ‘one-stop shop’ healthcare app.

The device includes a secure self-help and education website as well as tailored video exercise regimes, instant messaging, blogs and webinars.

It also offers a visual triage service which enables clinicians to see their patient and make a detailed on-the-spot assessment of their condition. They can then send patients tailored video exercises and check on screen they are being followed correctly.

First contact physio scheme to be rolled out across England

NHS England’s national primary care director Dr Arvind Madan told last week’s Royal College of General Practitioners’ conference that, following successful pilots, his ambition was to begin rolling out the physio first scheme across the country in 2018.

It would mean that ‘patients with musculoskeletal issues can have direct access to musculoskeletal professionals and they don't always, necessarily, go by the GP consulting room,’ he said.

Around one fifth of all patients visiting a GP present with musculoskeletal problems but at present many do not get to see a physio until their symptoms have significantly worsened.

See also this case study on Improving Access with Physio First.

Report shows prevalence of key conditions across England

Figures released by NHS Digital provide information on the prevalence of 21 conditions, including asthma, hypertension, dementia, diabetes, and depression.

The annual report, Quality and Outcomes Framework (QOF) - Prevalence, Achievements and Exceptions Report, England 2016-17 also identifies how the prevalence of these conditions has changed since the previous year.

Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by high spinal cord injuries (IPG594)

New NICE Interventional Procedure guidance on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure in people with high spinal cord injuries. This involves implanting electrodes into the diaphragm to make it contract. This gradually strengthens the diaphragm and may eventually help the person to breathe without a ventilator.

Current evidence on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by high spinal cord injuries shows that there are serious but well-recognised safety concerns. Evidence on efficacy is limited in quantity and quality. Therefore, this procedure should only be used in the context of research.

Intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by motor neurone disease [IPG 593]

New Interventional Procedures guidance from NICE on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure in people with motor neurone disease. This involves implanting electrodes into the diaphragm to make it contract. This gradually strengthens the diaphragm and may eventually help the person to breathe without a ventilator.

Current evidence on intramuscular diaphragm stimulation for ventilator-dependent chronic respiratory failure caused by motor neurone disease suggests that there are serious long-term safety concerns. Evidence on efficacy is limited and therefore, this procedure should not be used to treat this condition.

Physical examination tests and imaging studies based on arthroscopic assessment of the long head of biceps tendon are invalid

Knee Surgery, Sports Traumatology, Arthroscopy October 2017, Volume 25, Issue 10, pp 3229–3236

The aim of this study was to evaluate whether glenohumeral arthroscopy is an appropriate gold standard for the diagnosis of long head of biceps (LHB) tendon pathology. The objectives were to evaluate whether the length of tendon that can be seen at arthroscopy allows visualisation of areas of predilection of pathology and also to determine the rates of missed diagnoses at arthroscopy when compared to an open approach.

UHCW Research: Robert W. Jordan

Adult native knee extensor mechanism ruptures

Injury. 2016 Oct;47(10):2065-2070. doi: 10.1016/j.injury.2016.06.032. Epub 2016 Jun 27.

Extensor mechanism rupture is a serious event requiring prompt diagnosis and treatment. Patella fractures are reportedly six times more frequent than soft tissue injuries such as quadriceps or patella tendon ruptures. Classically quadriceps and patella tendon ruptures are seen more in males, with those over 40 predominantly suffering from quadriceps tendon ruptures, often associated with an underlying condition, whereas patella tendon ruptures are mostly associated with sport injuries and are commonly seen in the under 40s. Almost all types of extensor mechanism ruptures benefit from early management which typically involves surgery. Diagnosis can be deemed easy to make by demonstrating inability to actively extend the knee, this however can be easily overlooked and missed in a busy emergency department leading to a late diagnosis and necessitating more complex surgery. Earlier surgical intervention and rehabilitation tend to produce improved outcomes.

UHCW Research: Pengas I. P. and Spalding, T.

Multiple Sclerosis Management Service for Children

This service specification from NHS England also covers children with suspected Multiple Sclerosis (MS) or equally rare ‘MS-like’, recurrent acquired demyelinating syndromes (ADS) or who have had a first demyelination episode and have a high risk of relapse which require similar treatments, including:

• Neuromyelitis Optica Spectrum Disorder (NMO, NMOSD) and other AQP4 antibody associated demyelination;
• Myelin Oligodendrocyte Glycoprotein (MOG) antibody associated relapsing demyelination and
• Other forms of recurrent relapsing demyelination.

Collagenase clostridium histolyticum for treating Dupuytren's contracture - guidance (TA459)

New Technology Appraisal Guidance from NICE on using collagenase clostridium histolyticum (Xiapex) for treating Dupuytren’s contracture in adults.

People who meet the inclusion criteria for the ongoing clinical trial (HTA-15/102/04), comparing collagenase clostridium histolyticum (CCH) with limited fasciectomy, are encouraged to participate in the study.

For people not taking part in the ongoing clinical trial, CCH is recommended as an option for treating Dupuytren's contracture with a palpable cord in adults only if all of the following apply:

• There is evidence of moderate disease (functional problems and metacarpophalangeal joint contracture of 30° to 60° and proximal interphalangeal joint contracture of less than 30° or first web contracture) plus up to 2 affected joints.
• Percutaneous needle fasciotomy (PNF) is not considered appropriate, but limited fasciectomy is considered appropriate by the treating hand surgeon.
• The choice of treatment (CCH or limited fasciectomy) is made on an individual basis after discussion between the responsible hand surgeon and the patient about the risks and benefits of the treatments available.
• One injection is given per treatment session by a hand surgeon in an outpatient setting.

Musculoskeletal conditions and multimorbidities report

The purpose of this report from Arthritis Research UK is to explore why and how musculoskeletal health should be considered as part of multimorbidity. It examines why the presence of musculoskeletal disease such as osteoarthritis or back pain can have an overall impact on the health, wellbeing and independence of a person living with multimorbidity. The report highlights the extent of the challenge ahead.

Recommended Musculoskeletal Indicator Set launched

A standard set of indicators for musculoskeletal health services, from Arthritis Research UK relevant to people with arthritis and commissioners.

The indicators describe the value, quality and cost of musculoskeletal services, aimed at those who are responsible for shaping services (commissioners and providers) and also relevant and meaningful to clinicians and patients.

Musculoskeletal ultrasound for diagnosis to confirm or rule out a diagnosis of rheumatoid arthritis

In patients with suspected rheumatoid arthritis, does the use ofmusculoskeletal ultrasound increase the ability ofrheumatologists to confirm or rule out a diagnosis ofrheumatoid arthritis at an earlier stage compared to routinediagnostic assessment? 

Evidence note from Healthcare Improvement Scotland:
There is evidence from two overlapping systematic reviews to support the clinical effectiveness of adding musculoskeletal ultrasound to clinical assessment and laboratory testing to diagnose rheumatoid arthritis at an earlier stage of the disease. Results from three primary studies with methodological weaknesses suggest that musculoskeletal ultrasound can increase rheumatologists’ diagnostic certainty, predict progression to inflammatory arthritis and decrease the time to diagnosis or initiation of DMARD therapy in patients with suspected rheumatoid arthritis.

Spondyloarthritis in over 16s: diagnosis and management

This new guideline from NICE covers diagnosing and managing spondyloarthritis that is suspected or confirmed in adults who are 16 years or older. It aims to raise awareness of the features of spondyloarthritis and provide clear advice on what action to take when people with signs and symptoms first present in healthcare settings. It also provides advice on the range of treatments available.

In June 2017, we updated recommendation 1.2.7 to clarify the advice on what imaging should be done.

A combined behavioural and mindfulness programme for people living with Dystonia: results of a feasibility study

Journal of Neural Transmission, December 2016, Volume 123, Issue 12, pp 1505–1527. Abstracts of the Third International Congress on Treatment of Dystonia, 4–7 May 2016, Hannover, Germany

Dystonia (a neurological condition) refers to a range of movement disorders typically characterised by tremor and movements affecting one or more sites of the body and/or abnormal postures from
sustained muscle contractions. Quality of life (QoL) can be diminished leading to higher risks of depression and anxiety. There is a lack of evidence for psychological and behavioural interventions, improving QoL in Dystonia. Mindfulness is shown to improve patient health outcomes for those with chronic conditions. The aim of this study was to test the feasibility of an intervention integrating psychological, behavioural and mindfulness principles for those living with dystonia.

UHCW Research: Belhag, M. and Lindahl, A.

Exploring the role of healthcare in the construction of lay experts’ experience of physical disability: a qualitative interview study of dystonia patients in England

Journal of Neural Transmission, December 2016, Volume 123, Issue 12, pp 1505–1527. Abstracts of the Third International Congress on Treatment of Dystonia, 4–7 May 2016, Hannover, Germany

Health scientists have frequently emphasised the importance of exploring patients’ experiences of healthcare for improving services and quality of life (QoL). Such experiences, including individuals’
perceptions of healthcare provision, have been explored in people with dystonia using mainly quantitative measures. Yet, standardised QoL measures have been criticised for neglecting to capture the nuanced ways in which patients living with dystonia draw on their illness experiences to make sense of complex healthcare decisions. Consequently, the aim of this study is to explore how patients utilise their embodied (physical and socio-emotional) experiences to promote, resist, and challenge healthcare practices.

This study reports on group and individual interview data with 42 adults with multiple types of dystonia. Twenty-seven people attended local dystonia support groups and two were patients. In addition, secondary analysis was conducted on twenty-one interviews with thirteen patients, originally recruited for a feasibility study exploring the self-management of dystonia. The data were thematically analysed for recurring patterns and relationships as well as deviant cases.
UHCW Research: Bernstein C.J., Boardman F. and Griffiths F.