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Orthopaedic Proceedings
Vol. 104-B, Issue SUPP_9 | Pages 14 - 14
1 Oct 2022
Williamson E Boniface G Marian I Dutton S Maredza M Petrou S Garrett A Morris A Hansen Z Ward L Nicolson P Barker K Fairbank J Fitch J Rogers D Comer C French D Mallen C Lamb S
Full Access

Purpose and background

To evaluate the clinical and cost-effectiveness of a physical and psychological group intervention (BOOST programme) compared to physiotherapy assessment and advice (best practice advice [BPA]) for older adults with neurogenic claudication (NC) which is a debilitating spinal condition.

Methods and results

A randomised controlled trial of 438 participants. The primary outcome was the Oswestry Disability Index (ODI) at 12 months. Data was also collected at 6 months. Other outcomes included Swiss Spinal Stenosis Questionnaire (symptoms), ODI walking item, 6-minute walk test (6MWT) and falls. The analysis was intention-to-treat. We collected the EQ5D and health and social care use to estimate cost-effectiveness.

Participants were, on average, 74.9 years old (SD 6.0). There was no significant difference in ODI scores between groups at 12 months (adjusted mean difference (MD): −1.4 [95% Confidence Intervals (CI) −4.03,1.17]), but, at 6 months, ODI scores favoured the BOOST programme (adjusted MD: −3.7 [95% CI −6.27, −1.06]). Symptoms followed a similar pattern. The BOOST programme resulted in greater improvements in walking capacity (6MWT MD 21.7m [95% CI 5.96, 37.38]) and ODI walking item (MD −0.2 [95% CI −0.45, −0.01]) and reduced falls risk (odds ratio 0.6 [95% CI 0.40, 0.98]) compared to BPA at 12 months. Probability that the BOOST programme is cost-effective ranged from 67%–89% across cost-effectiveness thresholds.


Bone & Joint Open
Vol. 1, Issue 12 | Pages 720 - 730
1 Dec 2020
Galloway AM van-Hille T Perry DC Holton C Mason L Richards S Siddle HJ Comer C

Aims

Perthes’ disease is a condition leading to necrosis of the femoral head. It is most common in children aged four to nine years, affecting around one per 1,200 children in the UK. Management typically includes non-surgical treatment options, such as physiotherapy with/without surgical intervention. However, there is significant variation in care with no consensus on the most effective treatment option.

Methods

This systematic review aims to evaluate the effectiveness of non-surgical interventions for the treatment of Perthes’ disease. Comparative studies (experimental or observational) of any non-surgical intervention compared directly with any alternative intervention (surgical, non-surgical or no intervention) were identified from: Cochrane Central Register of Controlled Trials, MEDLINE, EMBASE, the Cumulative Index to Nursing and Allied Health Literature (CINAHL), EMcare, Allied and Complementary Medicine Database (AMED), and the Physiotherapy Evidence Database (PEDro). Data were extracted on interventions compared and methodological quality. For post-intervention primary outcome of radiological scores (Stulberg and/or Mose), event rates for poor scores were calculated with significance values. Secondary outcomes included functional measures, such as range of movement, and patient-reported outcomes such as health-related quality of life.


Bone & Joint Open
Vol. 1, Issue 11 | Pages 691 - 695
1 Nov 2020
Galloway AM Holton C Parnami V Wood M Craven J Green N Siddle HJ Richards S Comer C

Aims

Perthes’ disease is a condition which leads to necrosis of the femoral head. It is most commonly reported in children aged four to nine years, with recent statistics suggesting it affects around five per 100,000 children in the UK. Current treatment for the condition aims to maintain the best possible environment for the disease process to run its natural course. Management typically includes physiotherapy with or without surgical intervention. Physiotherapy intervention often will include strengthening/stretching programmes, exercise/activity advice, and, in some centres, will include intervention, such as hydrotherapy. There is significant variation in care with no consensus on which treatment option is best. The importance of work in this area has been demonstrated by the British Society for Children’s Orthopaedic Surgery through the James Lind Alliance’s prioritization of work to determine/identify surgical versus non-surgical management of Perthes’ disease. It was identified as the fourth-highest priority for paediatric lower limb surgery research in 2018.

Methods

Five UK NHS centres, including those from the NEWS (North, East, West and South Yorkshire) orthopaedic group, contributed to this case review, with each entre providing clinical data from a minimum of five children. Information regarding both orthopaedic and physiotherapeutic management over a two-year post-diagnosis period was reviewed.


The Bone & Joint Journal
Vol. 98-B, Issue 5 | Pages 634 - 640
1 May 2016
Pedowitz DI Kane JM Smith GM Saffel HL Comer C Raikin SM

Aims

Few reports compare the contribution of the talonavicular articulation to overall range of movement in the sagittal plane after total ankle arthroplasty (TAA) and tibiotalar arthrodesis. The purpose of this study was to assess changes in ROM and functional outcomes following tibiotalar arthrodesis and TAA.

Patients and Methods

Patients who underwent isolated tibiotalar arthrodesis or TAA with greater than two-year follow-up were enrolled in the study. Overall arc of movement and talonavicular movement in the sagittal plane were assessed with weight-bearing lateral maximum dorsiflexion and plantarflexion radiographs. All patients completed Short Form-12 version 2.0 questionnaires, visual analogue scale for pain (VAS) scores, and the Foot and Ankle Ability Measure (FAAM).


Orthopaedic Proceedings
Vol. 91-B, Issue SUPP_III | Pages 487 - 487
1 Sep 2009
Mathew R Comer C Hall R Timothy J
Full Access

Introduction & Aims: The X-stop interspinous process decompression system is being used as an alternative to laminectomy in the treatment of neurogenic claudication. To date the clinical outcomes are favourable, but the economic value has not been established within the NHS financial model.

Objective: To compare the average hospital costs of performing an x-stop procedure (under general or local anaesthetic) to a laminectomy in patients with neurogenic claudication.

Design: A retrospective analysis of average length of stay, anaesthetic and operative times, equipment and anaesthetic agent costs. Sources included theatre management systems, the British National Formulary and Leeds Teaching Hospitals Trust in-patient stay data. The study period was from April 2005 to October 2006. The number of patients in the two groups were 318 (laminectomy) and 75 (X-stop).

Results: In comparison to laminectomy, patients under-going an X-stop procedure have a reduced average length of in-patient stay (3 versus 5 days), reduced anaesthetic time (25 versus 29 minutes) and operative duration (40 versus 128 minutes). The average cost for each procedure is £3346 for an X-stop under general anaesthetic (profit £119), £2835 for a laminectomy (profit £1177) and £2237 for an X-stop as a day case (profit £1228).

Conclusions: Tariff reimbursement is an important consideration to ensure insertion of these devices is profitable for the hospital. Our results show that even with the additional cost of the implant device, an X-stop procedure under general anaesthetic remains profitable in comparison to a laminectomy, whilst a day-case X-stop procedure is more profitable. Additional savings are be made by reduced bed and theatre occupancy. Future studies will differentiate costs of 1- and 2-level X-stop procedures, complication rates and revision surgery.