Image‐Guided Sacroiliac Joint Injections: an Evidence‐based Review of Best Practices and Clinical Outcomes

PM&R ◽  
2019 ◽  
Vol 11 (S1) ◽  
Author(s):  
Patricia Zheng ◽  
Byron J. Schneider ◽  
Aaron Yang ◽  
Zachary L. McCormick
Keyword(s):  
Best Practices ◽  
Clinical Outcomes ◽  
Sacroiliac Joint ◽  
Evidence Based ◽  
Image Guided ◽  
Joint Injections

Sacroiliac Pain

2018 ◽  
Author(s):  
Rene Przkora ◽  
Richard Cleveland Sims ◽  
Andrea Trescot
Keyword(s):  
Differential Diagnosis ◽  
Sacroiliac Joint ◽  
Physical Exam ◽  
Evidence Based ◽  
Steroid Injections ◽  
Image Guided ◽  
Radiofrequency Denervation ◽  
Si Joint ◽  
Cause Of Pain

The sacroiliac joint (SIJ) is often overlooked as a cause of pain, partially because it is not well visualized on standard imaging and partially because other structures may refer pain to it. This chapter reviews the anatomy of the SIJ as well as the diagnosis and differential diagnosis of SI joint dysfunction and pain, including a multitude of physical exam maneuvers such as the FABER, Gaenslen, extension, Gillet’s, sacroiliac shear, thigh thrust, compression, and distraction tests. In addition, it discusses the evidence-based approach to treat sacroiliac pain, with a focus on both conservative and nonconservative approaches such as image-guided steroid injections and radiofrequency denervation procedures and outcomes.

Imaging techniques for sacroiliac joint injections

2021 ◽  
pp. 115-120
Author(s):  
Jacqueline Weisbein
Keyword(s):  
Computed Tomography ◽  
Stem Cells ◽  
Sacroiliac Joint ◽  
Image Guidance ◽  
Platelet Rich Plasma ◽  
Imaging Techniques ◽  
Image Guided ◽  
Computed Tomography Fluoroscopy ◽  
Regenerative Therapies ◽  
Joint Injections

Injections into the sacroiliac joint for both diagnostic and therapeutic purposes have become commonplace. There have been advances in the use of regenerative therapies other than prolotherapy, such as platelet-rich plasma and stem cells. Prior to the introduction of image-guided techniques, blind injections were performed. However, data have consistently shown that without image guidance, injections failed to be accurately placed within the joint. Therefore, the use of image guidance, whether by computed tomography, fluoroscopy, or ultrasound, is imperative to ensure accurate placement of the injectate. This chapter discusses these three types of imaging techniques for sacroiliac joint injections.

Debates in Dysphagia Management: How Do You Use Evidence-Based Practice in Your Dysphagia Patient Care?

2011 ◽  
Vol 20 (4) ◽  
pp. 121-123
Author(s):  
Jeri A. Logemann
Keyword(s):  
Decision Making ◽  
Patient Care ◽  
Clinical Outcomes ◽  
Clinical Judgment ◽  
Clinical Decision Making ◽  
Evidence Based Practice ◽  
Clinical Decision ◽  
Evidence Based ◽  
Clinical Method ◽  
Do So

Evidence-based practice requires astute clinicians to blend our best clinical judgment with the best available external evidence and the patient's own values and expectations. Sometimes, we value one more than another during clinical decision-making, though it is never wise to do so, and sometimes other factors that we are unaware of produce unanticipated clinical outcomes. Sometimes, we feel very strongly about one clinical method or another, and hopefully that belief is founded in evidence. Some beliefs, however, are not founded in evidence. The sound use of evidence is the best way to navigate the debates within our field of practice.

Best Practices for Data Visualization: Creating and Evaluating a Report for an Evidence-Based Fall Prevention Program (Preprint)

2018 ◽  
Author(s):  
Srijesa Khasnabish ◽  
Zoe Burns ◽  
Madeline Couch ◽  
Mary Mullin ◽  
Randall Newmark ◽  
...  
Keyword(s):  
Literature Review ◽  
Best Practices ◽  
Implementation Science ◽  
Data Visualization ◽  
Systematic Literature Review ◽  
Fall Prevention ◽  
Prevention Program ◽  
Evidence Based ◽  
Data Display ◽  
Fall Prevention Program

BACKGROUND Data visualization experts have identified core principles to follow when creating visual displays of data that facilitate comprehension. Such principles can be applied to creating effective reports for clinicians that display compliance with quality improvement protocols. A basic tenet of implementation science is continuous monitoring and feedback. Applying best practices for data visualization to reports for clinicians can catalyze implementation and sustainment of new protocols. OBJECTIVE To apply best practices for data visualization to create reports that clinicians find clear and useful. METHODS First, we conducted a systematic literature review to identify best practices for data visualization. We applied these findings and feedback collected via a questionnaire to improve the Fall TIPS Monthly Report (FTMR), which shows compliance with an evidence-based fall prevention program, Fall TIPS (Tailoring Interventions for Patient Safety). This questionnaire was based on the requirements for effective data display suggested by expert Stephen Few. We then evaluated usability of the FTMR using a 15-item Health Information Technology Usability Evaluation Scale (Health-ITUES). Items were rated on a 5-point Likert scale from strongly disagree (1) to strongly agree (5). RESULTS The results of the systematic literature review emphasized that the ideal data display maximizes the information communicated while minimizing the cognitive efforts involved with data interpretation. Factors to consider include selecting the correct type of display (e.g. line vs bar graph) and creating simplistic reports. The qualitative and quantitative evaluations of the original and final FTMR revealed improved perceptions of the visual display of the reports and their usability. Themes that emerged from the staff interviews emphasized the value of simplified reports, meaningful data, and usefulness to clinicians. The mean (SD) rating on the Health-ITUES scale when evaluating the original FTMR was 3.86 (0.19) and increased to 4.29 (0.11) when evaluating the revised FTMR (Mann Whitney U Test, z=-12.25, P<0.001). CONCLUSIONS Best practices identified through a systematic review can be applied to create effective reports for clinician use. The lessons learned from evaluating FTMR perceptions and measuring usability can be applied to creating effective reports for clinician use in the context of other implementation science projects.

scholarly journals AB0642 SACROILIAC JOINT INJECTIONS PERFORMED WITH ULTRASOUND GUIDANCE IN PATIENTS WITH SACROILIITIS

2020 ◽  
Vol 79 (Suppl 1) ◽  
pp. 1615.2-1616
Author(s):  
A. R. Cunha ◽  
C. Mazeda ◽  
R. Aguiar ◽  
A. Barcelos
Keyword(s):  
Sacroiliac Joint ◽  
Ultrasound Guidance ◽  
Disease Duration ◽  
Corticosteroid Injection ◽  
Controlled Study ◽  
Ultrasound Guided ◽  
Sonographic Guidance ◽  
Number Of Patients ◽  
Joint Injections

Background:Sacroiliitis is the hallmark of axial Spondyloarthritis (axSpA). ASAS-EULAR management recommendations for axSpA, consider glucocorticoid injections directed to the local site of musculoskeletal inflammation as a treatment option for pain relief, besides treatment with oral non-steroidal anti-inflammatory (NSAIDs) before starter biotechnological treatment. However, there are few studies to evaluate efficacy of this technique with a small number of patients and a short follow-up. Ultrasonography has been used as a valuable option to guide this technique.Objectives:To evaluate the efficacy and safety of ultrasound-guided injections of sacroiliac joints (SIJs) in patients with sacroiliitis using clinical and laboratory outcomes at baseline and at 4-6thweeks.Methods:This study involved patients with axSpA with acute sacroiliitis, ≥18 and ≤ 65 years old, with body mass index (BMI) < 30kg/m2attending the Rheumatology Outpatient Clinic, which had been poorly controlled (ASDAS>2.1) by conventional therapy (physiotherapy, NSAIDs at maximum tolerated dosing during ≥ 4 weeks). Sociodemographic, clinical (disease duration, BMI, BASDAI, BASFI, ASDAS) and laboratory (CRP) data was collected from the medical records at baseline and at 4-6thweeks.Statistical analyses were conducted using SPSS version 25. Continuous variables were described with mean/median ± standard deviation (SD).SIJs injection was performed, under ultrasound guidance, using standard procedures with 2mL of lidocaine 1% and 40mg of methylprednisolone, with a 22-gauge needle. The procedure was performed by the same operator. Written informed consents were obtained from all patients.Results:We performed eleven sacroiliac injection in eleven consecutive patients (one procedure per patient). Nine patients (81.8%) were female, mean age (±SD) of 40.6(±9.4) years, median disease duration(±SD) of 0.9(±6.2) years and median BMI(±SD) of 24.2(±3.3). Eight patients (72.7%) had Nr-axSpA. All patients were non-responders to NSAIDs.At 4-6thweeks there was a decreased in median (±SD) BASDAI (5.4±1.9 vs 4.1±1.9), BASFI (4.2±1.4 vs 3.5±2.3) and ASDAS (3.2±0.8 vs 2.2±0.6) indexes.Conclusion:As previous studies demonstrated, this technique seems to be safe and quite effective.Our goal is to increase the number of patients undergoing this technique and have a longer follow up to evaluate its efficacy. The study has several limitations: the mid- and long-term effects should be evaluated in the future based on the results of the short-term effects and the study was not conducted as a double-blinded, controlled study.References:[1]van der Heijde D, Burgos-Vargas R, Ramiro S.,et al. ASAS/EULAR recommendations for the management of ankylosing spondylitis. Ann Rheum Dis 2017; 76:978–991[2]Maugars Y, Mathis C, Vilon P, Prost A. Corticosteroid injection of the sacroiliac joint in patients with seronegative spondylarthropathy. Arthritis Rheum 1992; 35:564–8.[3]Pekkafahli MZ, Kiralp MZ, Basekim CC et al. Sacroiliac joint injections performed with sonographic guidance. J Ultrasound Med 2003;22:553–9[4]Klauser A, De Zordo T, Feuchtner G et al. Feasibility of ultrasound-guided sacroiliac joint injection considering sonoanatomic landmarks at two different levels in cadavers and patients. Arthritis Rheum 2008; 59:1618–1624.Disclosure of Interests:Ana Rita Cunha: None declared, Carolina Mazeda: None declared, Renata Aguiar: None declared, Anabela Barcelos Speakers bureau: Bene, Eli-Lilly, Pfizer, MSD, Novartis

scholarly journals Evidence-Based Policy Making for Public Health Interventions in Cardiovascular Diseases: Formally Assessing the Feasibility of Clinical Trials

2020 ◽  
Vol 13 (11) ◽  
Author(s):  
Kathryn Foti ◽  
Randi E. Foraker ◽  
Pamela Martyn-Nemeth ◽  
Cheryl A.M. Anderson ◽  
Nancy R. Cook ◽  
...  
Keyword(s):  
Public Health ◽  
Clinical Outcomes ◽  
Sodium Intake ◽  
Cardiovascular Outcomes ◽  
Health Interventions ◽  
Evidence Based ◽  
Sodium Reduction ◽  
Public Health Interventions ◽  
Antihypertensive Medications ◽  
Evidence Based Policy

Implementation of prevention policies has often been impeded or delayed due to the lack of randomized controlled trials (RCTs) with hard clinical outcomes (eg, incident disease, mortality). Despite the prominent role of RCTs in health care, it may not always be feasible to conduct RCTs of public health interventions with hard outcomes due to logistical and ethical considerations. RCTs may also lack external validity and have limited generalizability. Currently, there is insufficient guidance for policymakers charged with establishing evidence-based policy to determine whether an RCT with hard outcomes is needed before policy recommendations. In this context, the purpose of this article is to assess, in a case study, the feasibility of conducting an RCT of the oft-cited issue of sodium reduction on cardiovascular outcomes and then propose a framework for decision-making, which includes an assessment of the feasibility of conducting an RCT with hard clinical outcomes when such trials are unavailable. We designed and assessed the feasibility of potential individual- and cluster-randomized trials of sodium reduction on cardiovascular outcomes. Based on our assumptions, a trial using any of the designs considered would require tens of thousands of participants and cost hundreds of millions of dollars, which is prohibitively expensive. Our estimates may be conservative given several key challenges, such as the unknown costs of sustaining a long-term difference in sodium intake, the effect of differential cotreatment with antihypertensive medications, and long lag time to clinical outcomes. Thus, it would be extraordinarily difficult to conduct such a trial, and despite the high costs, would still be at substantial risk for a spuriously null result. A robust framework, such as the one we developed, should be used to guide policymakers when establishing evidence-based public health interventions in the absence of trials with hard clinical outcomes.

Human Factors Considerations for Patients: A Cursory Review of Telehealth Guidelines

2021 ◽  
Vol 65 (1) ◽  
pp. 943-947
Author(s):  
Sarah A. Powers ◽  
Kimberly N. Perry ◽  
Amanda J. Ashdown ◽  
Matthew Pacailler ◽  
Mark W. Scerbo
Keyword(s):  
Best Practices ◽  
Human Factors ◽  
Healthcare Providers ◽  
Evidence Based ◽  
Environmental Requirements ◽  
Laws And Policies

During the COVID-19 pandemic, changes to telehealth laws and policies enabled more patients to meet with their healthcare providers remotely. The rapid implementation of telehealth has resulted in providers and patients interacting remotely with few existing standards or guidelines. Additionally, a cursory search of telehealth guidelines for patients revealed overly broad recommendations related to technology, security, and environmental requirements. Although researchers have recommended some human factors considerations for guidelines, these recommendations were rarely implemented in the guidelines we reviewed. Therefore, human factors professionals can contribute further by implementing best practices for telehealth appointments to create evidence-based standardized guidelines. Some initial areas to focus on include accessibility for patients, overcoming typical telehealth barriers, and addressing a wider diversity of patients.

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