Abstract. Objective. There is no specific framework for the clinical management of sports related brachial plexus injuries. Necessarily, rehabilitation is based on injury presentation and clinical diagnostics but it is unclear what the underlying evidence base to inform rehabilitative management. Methods. A systematic review of the literature was undertaken in line with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. We applied the PEO criteria to inform our search strategy to find articles that reported the rehabilitative management of brachial plexus injuries sustained while playing contact sports. An electronic search of Medline, CINAHL, SPORTDiscus and Web of Science from inception to 3rd November 2022 was conducted. MESH terms and Boolean operators were employed. We applied an English language restriction but no other filters. Manual searches of Google Scholar and citation searching of included manuscripts were also completed. All study types were considered for inclusion provided they were published as peer-reviewed primary research articles and contained relevant information. Two investigators independently carried out the searches, screened by title, abstract and full text. Two researchers independently extracted the data from included articles. Data was cross-checked by a third researcher to ensure consistency. To assess internal validity and risk of bias, the Joanna Briggs Institute (JBI) critical appraisal tools were utilised. Results. The search generated 88 articles. Following removal of duplicates, 43 papers were evaluated against the eligibility criteria. Nine were eligible for full text review, with the majority of exclusions being expert opinion articles. Eight case reports were included. One article reported three individuals, resulting in data for ten athletes. The mean age was 19.8 years (±4.09). Injuries occurred in five American football players, two wrestlers, two rugby players, and a basketball player. No two studies applied the same diagnostic terminology and the severity of injury varied widely. Burning pain and altered sensation was the most commonly reported symptom, alongside motor weakness in the upper limb. Clinical presentation and management differed by injury pattern. Traction injuries caused biceps motor weakness and atrophy of the deltoid region, whereas compression injuries led to rotator cuff weakness. In all cases treatment was separated into acute and rehabilitative management phases, however the time frames related to these differed. Acute interventions varied but essentially entailed soft tissue inflammation management. Rehabilitation approaches variously included strengthening of shoulder complex and cervical musculature. Return-to-play criteria was opaque. The methodological quality of the case reports was acceptable. Four met all nine of the JBI evaluation criteria, and a further three met at least 75% of items. Conclusion(s). There is a distinct lack of evidence supporting rehabilitation management of sports related brachial plexus injury. Through systematic review we found only eight reports, representing ten individual case studies. No trials, cohort studies, or even retrospective registry-based studies are available to inform clinical management, which, necessarily, is driven by expert opinion and application of basic rehabilitation principles. Declaration of Interest. (b) declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported:I declare that there is no conflict of interest that could be perceived as prejudicing the impartiality of the research project

Aims. Psychoeducative prehabilitation to optimize surgical outcomes is relatively novel in spinal fusion surgery and, like most rehabilitation treatments, they are rarely well specified. Spinal fusion patients experience anxieties perioperatively about pain and immobility, which might prolong hospital length of stay (LOS). The aim of this prospective cohort study was to determine if a Preoperative Spinal Education (POSE) programme, specified using the Rehabilitation Treatment Specification System (RTSS) and designed to normalize expectations and reduce anxieties, was safe and reduced LOS. Methods. POSE was offered to 150 prospective patients over ten months (December 2018 to November 2019) Some chose to attend (Attend-POSE) and some did not attend (DNA-POSE). A third independent retrospective group of 150 patients (mean age 57.9 years (SD 14.8), 50.6% female) received surgery prior to POSE (pre-POSE). POSE consisted of an in-person 60-minute education with accompanying literature, specified using the RTSS as psychoeducative treatment components designed to optimize cognitive/affective representations of thoughts/feelings, and normalize anxieties about surgery and its aftermath. Across-group age, sex, median LOS, perioperative complications, and readmission rates were assessed using appropriate statistical tests. Results. In all, 65 (43%) patients (mean age 57.4 years (SD 18.2), 58.8% female) comprised the Attend-POSE, and 85 (57%) DNA-POSE (mean age 54.9 years (SD 15.8), 65.8% female). There were no significant between-group differences in age, sex, surgery type, complications, or readmission rates. Median LOS was statistically different across Pre-POSE (5 days ((interquartile range (IQR) 3 to 7)), Attend-POSE (3 (2 to 5)), and DNA-POSE (4 (3 to 7)), (p = 0.014). Pairwise comparisons showed statistically significant differences between Pre-POSE and Attend-POSE LOS (p = 0.011), but not between any other group comparison. In the Attend-POSE group, there was significant change toward greater surgical preparation, procedural familiarity, and less anxiety. Conclusion. POSE was associated with a significant reduction in LOS for patients undergoing spinal fusion surgery. Patients reported being better prepared for, more familiar, and less anxious about their surgery. POSE did not affect complication or readmission rates, meaning its inclusion was safe. However, uptake (43%) was disappointing and future work should explore potential barriers and challenges to attending POSE. Cite this article: Bone Jt Open 2022;3(2):135–144

Introduction: The aim of this study is to investigate the relationship between patient psychological characteristics, adherence to rehabilitation physiotherapy and outcome at one year following anterior cruciate ligament reconstruction. Methods: A group of 57 patients undergoing ACL reconstruction received a pre-operative psychological assessment comprising of five questionnaires; Athletic Identity Measurement Scale (AIMS), Recovery Locus of Control Scale (RLCS), Self-Motivation Inventory (SMI), Hospital Anxiety and Depression Scale (HADS), and Short Form Social Support Questionnaire (SSQ6). Four functional questionnaires were completed pre-operatively by the patient; Subjective Knee Evaluation Form (IKDC 2000), Tegner Activity Scale (TAS), Lysholm Score (LS), and Lower Extremity Functional Score (LEFS). Final outcome was assessed by repeating the functional questionnaires at 1-year post-operatively following rehabilitation. Anterior displacement of the tibia was recorded using a KT1000 arthrometer pre-operatively and at 1 year postoperatively. Adherence to rehabilitation was recorded using the Sport Injury Rehabilitation Adherence Scale (SIRAS) and attendance to physiotherapy appointments. Results: The data were analysed using regression analysis. Self motivation, a higher athletic identity, good social support and an internal locus of control are all positive predictors of final outcome. Poor self motivation and an external locus of control are associated with less successful final outcome. Rehabilitation adherence is also a positive predictor of final outcome, although psychological factors were not found to be predictive of adherence to rehabilitation. Discussion and Conclusion: Self motivation and an internal locus of control are positive predictors of adherence to physiotherapy and final outcome. These aspects can be reinforced during rehabilitation. Patients with an external locus of control and poor self-motivation can be identified and their pre- and post-operative management adapted to achieve optimal outcome

Early prediction of outcome following hip fracture surgery would save valuable time towards arranging post-op rehabilitation benefiting the patient and health economics. The study aim was to develop a prognostic scoring system for elderly hip fracture patients, which on admission is able to predict rehabilitation needs at discharge based on pre-injury factors. A simple and fast prognostic scoring system was developed based on age, pre-injury level of “independence in activities of daily living” (Katz), medical co-morbidities, cognitive functioning (MMSE) and presence of a caregiver, to predict rehabilitation needs at discharge (0–8 points). Rehabilitation options were direct return to pre-injury living situation (group 1), transfer to an orthopaedic rehabilitation unit for a period shorter than 3 months (group 2), or transfer to a psychogeriatric or orthopaedic rehabilitation unit for a period longer than 3 months (group 3). Rehabilitation needs as predicted and the clinical decision by independent, blinded observers were compared. The score was validated in a prospective study on a consecutive cohort of 77 hip fractured patients. Overall positive predictive value (PPV) of the prognostic score was 0.87 (CI 0.77–0.93), a marked improvement compared to previously published scoring systems with a PPV of 0.68 (CI 0.55–0.79). PPV per group (0.80, 0.92, 0.87) was highest for the most critical groups 2 and 3. In-hospital mortality was 1.3 percent. The average length of hospital stay (LOS) was 11.4 days. Using the score fast and reliable prediction of rehabilitation needs could be made already on admission gaining maximum time for the preparation of adequate discharge destinations improving care and reducing costly LOS

Background. Proximal femoral fracture is a common, major health problem resulting in loss of functional independence and a high cost burden on society. Rehabilitation can potentially maximise functional recovery, but evidence of effectiveness is lacking. An enhanced rehabilitation intervention designed to improve self-efficacy and increase the amount and quality of practice of physical exercise and activities of daily living has been developed consisting of patient held workbooks and extra therapy sessions in the community. This study aims to define characteristics of the cohort of individuals this intervention is targeted to, assess acceptability of the intervention and feasibility of recruiting participants for a larger scale trial. Methods. An anonymous cohort study of all proximal femoral fracture patients admitted to three acute hospitals will provide details on residence pre-admission, type of fracture, type of surgery, adverse events and subsequent readmissions. A separate randomised feasibility study recruiting participants from this cohort will assess acceptability and feasibility of the study in terms of eligibility, recruitment, reasons for decline, retention and outcome measure completion. The success rate of identifying patients for the feasibility study and whether the recruited participants are representative of the cohort population will be evaluated by comparison of the feasibility participant screening and background data with that of the cohort. Results. 541 patients were screened for the feasibility study between June 2014 and February 2015 (ongoing). 298 were ineligible, 243 were eligible and 53 (22%) have been recruited to date. Lack of capacity is the leading cause of ineligibility and burden of taking part is perceived as a significant block to participation. Completion rate of outcome measures is high at baseline and follow up. Conclusions. Recruitment from the acute setting is challenging. However, study processes, outcome measurement and intervention is well tolerated by participants. Level of Evidence. I - Well conducted Randomised Trial (Pilot)

Introduction. Early rehabilitation of hip and knee replacement patients has been advocated with the recent minimally invasive approaches to lower limb replacement allowing earlier mobilization and earlier discharge. Rehabilitation has been progressively shortened from the time of Charnley in such a way that patients are now expected to stay in hospital for only a couple of days before going home. New rehabilitation protocols recommend mobilization on day 0, the day of surgery, with earlier discharge possible. Methods. All primary hip and knee replacement patients were enrolled in a rapid rehabilitation protocol. All patients had standard incisions performed: a posterior approach for THR and a standard Insall para-patellar approach for TKR. The protocol included pre-emptive analgesia, post-op oral analgesia with high dose NSAIDs, pregabolin, neuro-axial anaesthesia, avoidance of opiates and colloid fluid replacement prior to mobilization. Morning patients were mobilized the day of surgery and afternoon patient the following morning. Duration of hospitalisation was compared to patients treated the previous year where the only difference in protocol was femoral blocks for TKR, no colloid replacement prior to mobilization, and routine day 1 mobilization. Results. 125 patients were enrolled (78 TKR and 47 THR). All patients could be mobilized according to this protocol, irrespective of age. The day of discharge was on average 4,2 days post-op. (Range 3 – 6 days). This was compared to the previous year of joint replacements where the average discharge day was 6,3 days (range 4 – 8 days). Conclusion. This protocol has seen an average 2,1 day earlier discharge from hospital with the same end point at discharge. This has shown us that safe day 0 mobilization of patients is possible, with dramatically improved patient morale, which resulted in much earlier discharge from hospital. These results can thus be achieved not only by minimal invasive surgery but also with standard arthroplasty approaches. NO DISCLOSURES

Introduction:. Rehabilitation after total knee arthroplasty (TKA) is an essential component of treatment. Various protocols and methodologies have evolved to enhance the effect of rehabilitation in the postoperative period. We prospectively evaluated the effect of using an antigravity treadmill as an alternative to routine postoperative physical therapy. Methods:. Twenty-nine patients undergoing unilateral primary TKA were randomized to either gait training (standard outpatient physical therapy) or to the use of an AlterG® antigravity device for gait training for 2 days/week for 4 weeks for a total of 8 therapy sessions. Average age was 68 and 55% were female. The Knee Injury and Osteoarthritis Outcome Score (KOOS) and Timed Up and Go (TUG) test were collected at baseline (first therapy session), at final therapy session and at 3 months postoperatively. The numerical rating scale (NRS) for pain was measured at baseline and at end of therapy. Adverse events and complications were recorded. Results:. All patients completed standard therapy and antigravity treadmill protocol without adverse events. KOOS, TUG and NRS scores improved in both groups but no statistically significant difference was apparent between groups. Overall, the greatest improvement was seen in the Sports/Recreation and Quality of Life subscales of the KOOS; scores improved from 23 and 32 to 67 and 69 at 3 months, respectively. TUG scores improved from 14 seconds to 7 seconds at 3 months. Pain, as measured on the NRS, improved from 2.8 to 1.1. Subjectively, therapists reported 100% satisfaction with the antigravity treadmill for use in postoperative TKA rehabilitation. Conclusion:. This initial study demonstrated that an antigravity treadmill device was safe and effective for outpatient postoperative TKA rehabilitation. Further studies are warranted to better define the role of this device as an alternative or adjunct to currently established TKA rehabilitation protocols

The results of an accelerated rehabilitation programme were collected retrospectively from 293 case notes between January 1995 and December 1998. Different grafts were used: bone patellar-tendon bone (BPTB) grafts, hamstrings grafts and allografts. The criteria used to evaluate the knees of these patients were based on patient satisfaction, clinical examination and Cybex evaluation. All 293 patients were followed up for six months or longer. Four to six months after the reconstruction procedure, 94.2% returned to sport activities.

Anterior knee pain seemed not to be a problem when using autogenous BPTB grafts. The rehabilitation programme should decrease the postoperative morbidity.

ACL injured patients show variability in the ability to perform functional activities (Button et al., 2006). It is unknown whether this is due to differences in physical capability or whether fear of re-injury plays a role. Fear of re-injury is not commonly addressed in rehabilitation. This study aimed to investigate whether fear of re-injury impacts rehabilitation of ACL injured patients. An initial group of five ACL reconstructed participants (ACLR, age: 30±11 years, weight: 815±115 N, height: 1.74±0.07 m, all male), five ACL deficient participants (ACLD, age: 31±12 years, weight: 833±227 N, height: 1.80±0.11 m, four male and one female), and five healthy controls (age: 30±3 years, weight: 704±126 N, height: 1.70±0.09 m, three male and two female) were compared. Fear of re-injury was assessed using the Tampa Scale for Kinesiophobia (Kvist, 2004). Quadriceps strength was measured on a Biodex dynamometer. Functional activity was assessed by a single legged maximum distance hop (on the injured leg for ACL patients). Motion analysis was performed with a VICON system, and a Kistler force plate. Hop distance was calculated using the ankle position. The peak knee extension moment during landing, and the knee angle at this peak moment were calculated in VICON Nexus. The ACLD group scored worse on the Tampa scale for Kinesiophobia than the ACLR group (32±4 and 26±4). The ACLD patients did not hop as far as the ACLR and control groups (1.0±0.3, 1.3±0.1 and 1.4±0.3 m). The peak knee extension moments during landing were lowest in the ACLD group (263±159 Nm), slightly higher in the control group (354±122 Nm) and highest in the ACLR group (490±222 Nm), while knee flexion angles at these moments were similar (ACLD: 28±11, ACLR: 33±7 and control: 36±13 degrees). The ACLD group had weaker quadriceps than the control group, while the ACLR group was stronger (143±44 Nm, 152±42, and 167±50 Nm respectively). Fear of re-injury and decreased quadriceps strength potentially both impact on the functional performance of ACL injured patients. Rehabilitation of ACL injured patients could therefore be improved by addressing strength and fear of re-injury. Future research with more participants will further clarify this

Rehabilitation systems based on inertial measurement units (IMU) and bio-feedbacks are increasingly used in many different settings for patients with neurological disorders such as Parkinson disease or balance impairment, and more recently for functional recover after orthopedic surgical interventions or injuries especially concerning the lower limb. These systems claim to provide a more controlled and correct execution of the motion exercises to be performed within the rehabilitation programs, hopefully resulting in a better outcomes with respect to the traditional direct support of a physical therapists. In particular recruitment of specific muscles during the exercise is expression of its correct and finalized execution. The objective of this study was to compare muscular activation patterns of relevant lower limb muscles during different exercises performed with traditional rehabilitation and with a new validated system based on IMU and biofeedback (Riablo, Corehab, Trento, Italy). Twelve healthy subjects (mean age 28.1 ± 3.9, BMI 21.8± 2.1) were evaluated in a rehabilitation center. Muscular activation pattern of gluteus maximum, gluteus medium, rectus femoris and biceps femoris was recorded through surface EMG (Cometa; Milan) during six different motion tasks: hip abduction in standing position, lunge, hip flexion with extended knee in standing position, lateral lunge, hip abduction with extended knee in lateral decubitus, squat. Subjects performed 10 repetitions of each task for a total of 100 repetitions per motion task, with and without Riablo System as well as during standard rehabilitation. An additional IMU was positioned on the shank in order to detect beginning and end of each repetition. A single threshold algorithm was used to identify muscle activation timing. During hip abduction in standing position, gluteus maximum and rectus femoris showed a better and longer activation pattern while using Riablo compared to traditional rehabilitation. Gluteus medium showed a similar activation pattern whereas biceps femoris showed no activation from 30% to 80% using Riablo. During squat, rectus femoris and biceps femoris had a similar activation pattern with and without Riablo whereas gluteus maximum and gluteus medium showed a better activation pattern while using Riablo. The recent development of innovative rehabilitation systems meets the need of manageable, reliable and efficient instruments able to reduce rehabilitation costs but with the same good clinical outcomes. Muscular activation patterns of relevant lower limb muscles during selected motion tasks reveal their correct execution. The use of this new rehabilitation system based on IMU and biofeedback seems to allow a more selective and effective muscular recruitment, likely due to the more correct and controlled execution of the exercise, particularly for the identification and interdiction of possible compensation mechanisms

The principal of “function priority, early rehabilitation, and return to sports” is now the goal for sports injury rehabilitation. Neuromuscular electrical stimulation for anterior cruciate ligament (ACL) reconstruction is a rising procedure for early rehabilitation. This paper systematically assessed the effects of neuromuscular electrical stimulation on postoperative ACL reconstruction to provide guidance for physiotherapist and patient when designing a suitable rehabilitation protocol.

To evaluate the interventional outcomes of neuromuscular electrical stimulation following ACL reconstruction, we searched PubMed, EMbase, the Cochrane Library, Web of Science and CNKI to collect all randomized controlled trials (RCTs) comparing the effects with neuromuscular electrical stimulation and without intervention on rehabilitation after ACL reconstruction up to January 30, 2022. Two investigators independently performed literature screening, data extraction, bias assessment of risk, and used RevMan 5.3 software to conduct a meta-analysis.

A total of six RCTs were included, and the results showed that the use of neuromuscular electrical stimulation after anterior cruciate ligament reconstruction significantly improved the International Knee Documentation Committee (IKDC) scores (MD 6.33, 95% CI [-0.43, 12.22]; I2 = 66%; p = 0.040), the Lysholm score (MD 7.94, 95% CI [6.49, 9.39]; I2 = 89%; p < 0.001), and the range of motion (ROM) (MD 9.99, 95% CI [7.97, 12.02]; I2 = 81%; p < 0.001) in the knees when compared to the control group without using neuromuscular electrical stimulation.

Existing evidence show that neuromuscular electrical stimulation is beneficial for early rehabilitation after ACL reconstruction. The use of neuromuscular electrical stimulation is encouraged in the design of rehabilitation protocol. However, due to the limited number of RCT studies and the small sample size, further multi-center RCTs with more participants are needed for a higher-level evidence.

Introduction: The aim of this study is to present the effect of various local anaesthetics, in particular solution concentrations, in peri- and post-operative analgesia in patients with carpal tunnel syndrome (CTS). Material and Method: 105 patients with CTS (81 female, 24 male, ages 27–79) underwent carpal tunnel release under local anaesthesia. The patients were divided into 5 groups (xylocaine 2%, ropivacaine 0.75%, ropivacaine 0.375%, chirocaine 0.5%, chirocaine 0.25%). A tablet of Gabapentin (Neurontin) 400mg was administered to some patients of each group (41 pts of the 105pts) 12 hours prior to surgery. All patients were evaluated immediately after surgery, in 2 weeks and 2 months postoperatively according to VAS pain score, grip strength, finger active motion and two point discrimination. Postoperative complications were also reported. Results: Anesthesia was immediate after the local injection. All patients improved postoperativelly regarding relief from pain and paresthesias. There was no statistically significant difference in grip strength before and after surgery. Only 10 patients used paracetamol immediately after surgery, without any statistically significant correlation to any group of patients. 1 patient developed complex regional pain syndrome 2 months after surgery. Conclusion: The use of local anaesthesia in carpal tunnel release surgery is beneficial in providing immediate intraoperative effect and recovery and mobilization after surgery. Rehabilitation seems to be irrelevant of the type of local anaesthetic that was used during the procedure. Small solution concentrations of local anaesthetics (ropivacaine 0.375%, chirocaine 0.25%) provide adequate analgesia during surgery and provide a normal postoperative course

Rehabilitation as a concept, and the practice of rehabilitation, have changed remarkably during the preceding years. Modern rehabilitation is multidisciplinary and multi-professional. The development and research of rehabilitation has also grown international. The contents of modern rehabilitation include medical, social and psychological aspects, and in vocational rehabilitation, the working conditions and organisational questions are dealt with as well (Jager 1999). Traditional methods in vocational rehabilitation and guidance include medical and psychological assessment, and work clinics assessment (which includes practical work assessment in the work place). Presently, the methods, have advanced and rehabilitation is not seen merely as a specific method for handicapped people. Various rehabilitation measures are flexibly applied, and rehabilitation includes elements of adult education, training of working skills, and ideas of on-the-job training and career advancement. The concepts, targets and contexts of rehabilitation and prevention can be described as follows:. Primary Prevention: health education and ergonomic advice for general, non-disabled population. Secondary Prevention: early rehabilitation for groups at risk with early signs of disability. Tertiary Prevention: rehabilitation and habilitation of severely disabled to secure social integration. The outcome of rehabilitation has been studied extensively, but the number of randomised controlled trials (RCT) is not large in any of the major target groups of rehabilitation. Among musculoskeletal disorders, the best evidence for the efficacy of multidisciplinary rehabilitation is for sub-acute and chronic low back pain disorders. Systematic reviews have been performed in various other musculoskeletal disorders as well, e.g. in fibromyalgia and multilocational pain syndromes, where no clear evidence has yet been demonstrated. It should be noted though that RCT’s are not the only way to get information about the outcome, efficacy or effectiveness of rehabilitation, and vocational rehabilitation in particular. The outcome of vocational rehabilitation, i.e. the success of occupational integration, depends a great deal on the general employment outlook. This is generally known but often ignored. Various forms of supported employments have become more important than earlier. The European Social Fund’s Employment Horizon initiative has launched many projects in Europe. As a result, new training and employment approaches have been developed for disabled persons, including co-operatives, social enterprises and distance work. In practice, supported employment takes the form of individual training at the workplace and consists of finding suitable supported work, redesigning job requirements in co-operation with both employer and employee to fit the employee’s abilities, and ongoing support as long as it is needed. These programmes reflect the important values of the society. It is a valuable goal to help disabled people to integrate into society, which involves participation into working life. This makes it possible for them to preserve their dignity as well. In fact, how Society deals with its disabled people enables it to discover most clearly its basic values

Background. Although tourniquets are widely used in total knee arthroplasty (TKA), their influence on the postoperative course is still unclear. In addition, tourniquet-related soft tissue damage is a major concern in daily practice. We performed a prospective, randomized controlled trial to clarify the role of tourniquets in TKA. Methods. Seventy-two patients undergoing TKA were randomly allocated to a tourniquet or non-tourniquet group. Changes in C-reactive protein, creatine phosphokinase, and other indicators of soft tissue damage were monitored preoperatively and postoperatively on days 1, 2, and 4. Rehabilitation progress was also recorded for comparison. Results. Patients in the tourniquet group showed smaller increases in C-reactive protein (peak values: 175 ± 55 versus 139 ± 75 mg/dl) and creatine phosphokinase (peak values: 214 ± 89 versus 162 ± 104 U/l) compared those in the non-tourniquet group. There was slightly less postoperative pain in the non-tourniquet group, and no significant differences in swelling, or rehabilitation progress. Conclusions. Using tourniquets in TKA was effective for reducing blood loss and avoiding excessive postoperative inflammation and muscle damage. Tourniquets caused slightly more postoperative pain but did not affect postoperative recovery

Introduction

Over the past 30 years multiple wars and embargos have reduced healthcare resources, infrastructure, and staff in Iraq. Subsequently, there are a lack of physiotherapists to provide rehabilitation after an anterior cruciate ligament reconstruction (ACLR). The implementation of home-based rehabilitation programmes may provide a potential solution to this problem. This study, set in in the Kurdistan region of Iraq, describes the epidemiology and outcomes of anterior cruciate ligament reconstruction (ACLR) followed by home-based rehabilitation alone.

Purpose and Background

Work-related musculoskeletal disorders (WRMSD) can affect 56–80% of physiotherapists. Patient handling is reported as a significant risk factor for developing WRMSD with the back most frequently injured. Physiotherapists perform therapeutic handling to manually assist and facilitate patients’ movement to aid rehabilitation, which can increase physiotherapists risk of experiencing high forces during patient handling.

As high incidences of tendinopathies are observed particularly in those who intensively use their tendons, we assume that pathological changes are caused, at least partially, by mechanical overload. This has led to the so-called overload hypothesis, explaining the development of tendinopathies by structural failure resulting from excessive load. At the same time, tendon loading is an important part in tendon rehabilitation. Currently, exercise treatment approaches such as eccentric training or heavy load resistance training are widely applied in tendinopathy rehabilitation, with good clinical results such as an improvement in function and a reduction in pain. Particularly those rehabilitative approaches which impose high strains on the tendon may induce an adaptation of the tendon's mechanical properties such as increased tendon stiffness. An increased tendon stiffness is often interpreted as desirable, as it may protect the tendon from overloading and thus prevent future strain injuries. However, the tendinopathic tendon is not necessarily less stiff than the tendon in the contralateral leg and an improvement in tendon stiffness is not necessarily accompanied by an improvement in tendon pain or function. In addition, metabolic factors, resulting e.g. in low-level systemic inflammation, may contribute to pathological tendon tissue changes and are not necessarily affected by an exercise program, while nutritional interventions or dietary supplements may potentially affect tendon cell metabolism. Indeed, dietary supplements have been introduced as an additional therapeutic approach in the treatment of tendinopathies in recent years, and their positive curative effects have been reported for both the general population and athletes. In the management of tendinopathies, it may thus be advisable if therapeutic approaches aim to address both tendon mechanics and tendon metabolism for better treatment effectiveness and a sustainable improvement in pain and function.

Objective: To assess the effect of the Active Spinal Rehabilitation Programme (ASRP) at four years after completion and its impact upon re-referral rates to General Practitioners and Orthopaedic Consultants. Design: Patients included in the previous twelve-month follow-up study were sent a further explanatory letter and questionnaire including functional goal, exercise, analgesia intake, GP visit, consultant referral, employment status, revised Oswestry Low Back Pain Disability Index and Visual Analogue Scale (VAS). Subjects: The first 140 patients completing the programme between April 1997–1998 were included in this study. An overall response rate of 85% (119 out of 140) was achieved with the aid of a follow-up telephone call (to those who did not respond to the postal questionnaire). Results: The results obtained were comparable to those at one-year follow up. There was an improved VAS in 46% of the patients at four years post ASRP compared with VAS immediately after completion. The Oswestry Score was improved (decrease in patient perceived disability) in 55% of the patients. 56% of the patients achieved their functional goal and 83% felt in control of their pain. 57% of the patients did not visit their GP in the 12 months prior to the four-year follow up and 76% did not require Consultant referral after completing ASRP. Conclusion: This study shows that the multiple benefits of an active spinal rehabilitation programme can be maintained for a four-year period, with a significant reduction in the demands on NHS resources

To determine in skeletally mature patients with a traumatic, first-time, patellar dislocation, the effect of early MPFL reconstruction versus rehabilitation on the rate of recurrent patellar dislocations and functional outcomes.

Three online databases MEDLINE, EMBASE and PubMed were searched from database inception (1946, 1974, 1966 respectively), to August 20th, 2021, for literature addressing the management of patients sustaining acute first-time patellar dislocations. Data on redislocation rates, functional outcomes using the Kujala score, and complication rates were recorded. A meta-analysis was used to pool the mean postoperative kujala score as well as calculate the proportion of patients sustaining redislocation episodes using a random effects model. A risk of bias assessment was performed for all included studies using the MINORS and Detsky scores.

Overall, there were a total of 22 studies and 1705 patients included in this review. The pooled mean redislocation rate in 18 studies comprising 1409 patients in the rehabilitation group was 31% (95% CI 25%-36%, I2 = 65%). Moreover, the pooled mean redislocation rate in five studies comprising 318 patients undergoing early MPFL reconstruction was 7% (95% CI 2%-17%, I2 = 70%). The pooled mean postoperative Kujala anterior knee pain score in three studies comprising 67 patients in the reconstructive group was 91 (95% CI 84-97, I2 = 86%), compared to a score of 81 (95% CI 78-85, I2 = 78%) in 7 studies comprising 332 patients in the rehabilitation group. The reoperation rate was 9.0% in 936 patients in the rehabilitation group and 2.2% in 322 patients in the reconstruction group.

Management of acute first-time patellar dislocations with MPFL reconstruction resulted in a lower rate of redislocation and a higher Kujala score, as well as noninferiority with respect to complication rates compared to nonoperative treatment. The paucity of high-level evidence warrants further investigation in this topic in the form of well-designed and high-powered RCTs to determine the optimal management option in these patients.

Abstract