Early functional mobilization for non-operative treatment of simple elbow dislocations: a systematic review

2020 ◽  
pp. 175857322095763
Author(s):  
Michael Catapano ◽  
Nikola Pupic ◽  
Iqbal Multani ◽  
David Wasserstein ◽  
Patrick Henry
Keyword(s):  
Systematic Review ◽  
Return To Work ◽  
Range Of Motion ◽  
Early Mobilization ◽  
Complication Rates ◽  
Plaster Of Paris ◽  
Motion Function ◽  
Early Return ◽  
Rehabilitation Protocols ◽  
Rehabilitation Period

Purpose This systematic review aims to elucidate a non-operative rehabilitation program that optimizes recovery based on published approaches and outcomes. Methods Searches of four databases from inception to 1 January 2020 were performed to identify clinical studies addressing the non-operative management of simple elbow dislocations. Results Of 2435 studies that were eligible for title screen, 15 studies satisfied inclusion criteria. Three randomized control studies demonstrated that early mobilization expedited the return of range of motion, function and return to work or activities, however, resulted in increased pain within the six-week rehabilitation period compared to Plaster of Paris casting for 21 days. Patients returned to work sooner after early mobilization (10 vs. 18 days; p = 0.02) compared to Plaster of Paris casting. In all studies, early mobilization resulted in similar re-dislocation rates of 1.3% (3/237) versus 2.2% (12/549) in those with Plaster of Paris casting as well as lower incidence of heterotopic ossification (36% vs. 54%). No significant differences between rehabilitation protocols were determined; however, the large majority of recent papers utilized rehabilitation protocols. Conclusion Early mobilization of simple elbow dislocations results in early return of Range-of-Motion, function and return to work with no increase in complication rates; however, increased pain during the rehabilitation period.

Rehabilitation Protocols After Isolated Meniscal Repair: A Systematic Review

2016 ◽  
Vol 45 (7) ◽  
pp. 1687-1697 ◽  
Author(s):  
Kevin O’Donnell ◽  
Kevin B. Freedman ◽  
Fotios P. Tjoumakaris
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Significant Variation ◽  
Clinical Success ◽  
Meniscal Repair ◽  
Postoperative Rehabilitation ◽  
Treatment Groups ◽  
Rehabilitation Protocols ◽  
Outcome Scores ◽  
The Ideal

Background: Current postoperative rehabilitation protocols after isolated meniscal repair vary widely. No consensus exists with regard to the optimal amount of weightbearing, range of motion, or speed at which the patient progresses through the rehabilitation phases. Confounding factors including concomitant ligamentous or cartilaginous injuries have made studying isolated meniscal tears problematic. Purpose: To systematically review and evaluate the influence of range of motion and weightbearing status during the postoperative rehabilitation period after isolated meniscal repair on clinical efficacy and outcome scores. Study Design: Systematic review. Methods: A search of PubMed, Scopus, and Cochrane Central Register of Controlled Trials was conducted. The selection criteria for inclusion were English-language in vivo clinical studies reporting on isolated meniscal repairs utilizing an arthroscopically assisted technique that outlined the postoperative rehabilitation protocol and included at least a 2-year follow-up. Titles, abstracts, and articles were reviewed, and data concerning patient demographics, tear type, repair technique, postoperative protocol details, clinical failures, and outcome scores were extracted from the eligible studies. Rehabilitation protocols were divided into “accelerated,” “motion restricted,” “weight restricted,” and “dual restricted” according to the limitations placed on the treatment groups. Results: Fifteen studies, containing 17 different treatment groups, met the inclusion criteria. The 2 accelerated groups, 2 motion-restricted groups, 4 weight-restricted groups, and 9 dual-restricted groups showed similar efficacy in terms of clinical success and postoperative outcome scores. Early range of motion and weightbearing status showed no influence over clinical outcomes. Of the 17 groups, 13 reported a greater than 70% clinical success rate with significant variation in the tear type, fixation technique, and postoperative restrictions. Conclusion: Early range of motion and immediate postoperative weightbearing appear to have no detrimental effect on the chances for clinical success after isolated meniscal repair. Significant variation exists between postoperative protocols, with no current consensus on the ideal parameters for weightbearing and range of motion. Studies reporting outcomes regarding isolated meniscal repair are limited. Future research should include determining the ideal combination of weightbearing and range of motion for specific tear types.

scholarly journals Assessing the effectiveness of workplace accommodations in facilitating return to work after traumatic brain injury: a systematic review protocol

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e041581
Author(s):  
Reema Shafi ◽  
Angela Colantonio
Keyword(s):  
Systematic Review ◽  
Traumatic Brain Injury ◽  
Brain Injury ◽  
Return To Work ◽  
Systematic Reviews ◽  
Methodological Approach ◽  
Scientific Journal ◽  
Early Return ◽  
Workplace Accommodations

IntroductionReturning to work and sustaining employment can be a significant challenge for traumatic brain injury (TBI) survivors. Within the literature, there is recurring support for the role of workplace accommodations in effective and early return-to-work (RTW). To date, however, there has been a lack of systematic reviews exploring the specific role of workplace accommodations within the context of RTW after TBI. The primary objective of this protocol is to outline the methodological approach that will be undertaken to systematically review the literature and to assess the effectiveness of workplace accommodations in facilitating RTW.Methods and analysisA total of nine databases will be searched systematically using the concepts ‘Brain injury,’ ‘RTW’ and ‘Job Accommodations.’ Study selection will be performed independently by three reviewers, based on predetermined eligibility criteria through two rounds of screening using, first, the title and abstract, followed by a full-text search. Extracted information will include the study’s purpose, design, and setting; the data source and type; the severity of TBI and the diagnostic criterion used; a comprehensive description of the intervention provided; the RTW outcome variables and the statistical methods used, etc. The data will be tabulated and narratively synthesised. Systematic review registration: This protocol has been registered with International Prospective Register of Systematic Reviews.Ethics and disseminationAs this review intends to use pre-existing published studies hence research ethics board approvals will not be required. Nevertheless, this review will follow the ethical and governance standards in the data management and presentation of results. The findings from this review will potentially be published in a peer-reviewed scientific journal (electronically and in print). The results of this review will be presented at both national/international conferences and shared with stakeholders influencing RTW practices.PROSPERO registration numberCRD42016043517.

scholarly journals Full-Endoscopic Procedures Versus Traditional Discectomy Surgery for Discectomy: A Systematic Review and Meta-analysis of Current Global Clinical Trials

2016 ◽  
Vol 3;19 (3;3) ◽  
pp. 103-118
Author(s):  
Chun-Ming Huang
Keyword(s):  
Systematic Review ◽  
Postoperative Pain ◽  
Blood Loss ◽  
Return To Work ◽  
Meta Analysis ◽  
Cochrane Library ◽  
Complication Rates ◽  
Pooled Data ◽  
Vas Score ◽  
Matching Criteria

Background: Traditional discectomy surgery (TDS) provides good or excellent results in clinical surgical discectomy but may induce neural adhesion, spinal structural damage, instability, and other complications. The potential advantages of full-endoscopic (FE) procedures over standard TDS include less blood loss, less postoperative pain, shorter hospitalization, and an earlier return to work. However, more evidence is needed to support this new technology in clinical applications. Objective: The aim of this systematic review and meta-analysis was to compare the safety and efficacy of FE and TDS. Study Design: Comprehensive systematic review and meta-analysis of the literature. Methods: Electronic databases, including PubMed, EMBASE, SinoMed, and Cochrane Library, were searched to identify clinical therapeutic trials comparing FE to TDS for discectomy. Results: Six trials comprising 730 patients were included, and the overall quality of the literature was moderate, including 4 Grade I levels of evidence (4 randomized controlled trials, [RCTs]) and 2 Grade II levels (2 non-RCTs). The pooled data revealed no difference in reoperation rates between FE and TDS (P = 0.94), but the complication rate was significantly lower in the FE group (3.86%) than in the TDS group (11.4%). Perioperative parameters (operation time, blood loss, hospitalization time, and return to work days) were significantly lower in the FE group (P < 0.05 for all groups using either score). Postoperative pain and neurology score assessments were conducted at 4 different time points at 3 months, 6 months, 12 months, and 24 months. Significant differences were detected in the following: lumbar North American Spine Society (NASS) pain at 6 months (P = 0.008); cervical NASS neurology at 6 months (P = 0.03); visual analog scale (VAS) score in leg at 3 months (P < 0.001); VAS score in arm at 24 months (P = 0.002); VAS score in neck at 3 months, 6 months, and 12 months after therapy (P = 0.003, P = 0.004, P = 0.01); and VAS score in neck at 3 months and 6 months (P = 0.01, P = 0.004). Moreover, the pooled data revealed no statistically significant differences in improvements in the Oswestry disability index (ODI), instability (X-ray), and Hilibrand criteria (P > 0.05 for all groups). Limitations: Only 6 studies were included, 4 of which had the same authors. Between-study heterogeneity due to differences in socioeconomic factors, nutrition, and matching criteria is difficult to avoid. Conclusions: Based on this meta-analysis of 24 months of clinical results, we conclude that the FE procedure is as effective as TDS but has the additional benefits of lower complication rates and superior perioperative parameters. In addition, patients may experience less pain with FE techniques due to a smaller incision and less operative injury. However, large-volume, well-designed RCTs with extensive follow-up are needed to confirm and update the findings of this analysis. Key words: Full-endoscopic, minimally invasive, discectomy, meta-analysis

Quadriceps tendon autograft is an effective alternative graft for posterior cruciate ligament reconstruction in isolated or multiligament injuries: a systematic review

2021 ◽  
pp. jisakos-2020-000487
Author(s):  
Austin McCadden ◽  
Matthew Akelman ◽  
Sophia A Traven ◽  
Shane K Woolf ◽  
John W Xerogeanes ◽  
...  
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Posterior Cruciate Ligament ◽  
Functional Outcomes ◽  
Cruciate Ligament ◽  
Quadriceps Tendon ◽  
Clinical Results ◽  
Complication Rates ◽  
Pcl Reconstruction ◽  
Patient Reported

ImportanceHigh-grade posterior cruciate ligament (PCL) tears can be a significant cause of patient morbidity and knee instability. The graft of choice for operative repair remains controversial, although recently there has been increased interest in quadriceps tendon (QT) as an autologous graft option.ObjectiveThe purpose of this study was to perform a systematic review to assess reported clinical outcomes of PCL reconstructions using QT autografts.Evidence reviewA comprehensive review of clinical studies was performed evaluating PCL reconstruction with QT autograft including a systematic search of PubMed, Scopus, Cochrane and Google Scholar databases, and reference lists of relevant papers. Clinical results, stability results, functional outcomes, range-of-motion outcomes, complications and morbidity, and the conclusions of each study were evaluated.FindingsSeven studies were included in the review of clinical results, including 145 subjects undergoing PCL reconstructions with QT autograft. All studies evaluated quadriceps tendon bone (QT-B) grafts. Among these seven studies, two included isolated PCL reconstruction while five included multiligamentous knee injury reconstruction. These studies suggest that QT-B autograft offers a viable graft option for primary PCL reconstruction with generally favourable patient-reported outcomes, knee stability and range of motion reported along with relatively low complication rates.Conclusions and relevanceUse of the QT-B autograft may be a reasonable graft option for PCL reconstruction. However, high-quality prospective studies are required to evaluate the long-term safety, efficacy and functional outcomes.Level of evidenceLevel IV (Systematic review of Level IV studies).

Early Return to Work Following Open Carpal Tunnel Decompression in Lamb Freezing Workers

2008 ◽  
Vol 33 (4) ◽  
pp. 440-444 ◽  
Author(s):  
M. C. WYATT ◽  
G. A. VEALE
Keyword(s):  
Return To Work ◽  
Carpal Tunnel ◽  
Good Evidence ◽  
Processing Plant ◽  
Complication Rates ◽  
Visual Analogue Pain ◽  
Pain Scores ◽  
Prospective Group ◽  
Early Return ◽  
Tunnel Syndrome

Carpal tunnel syndrome is common at the largest lamb processing plant in the world, especially in new lamb boners. The purpose of this study was to establish the incidence and whether expeditious return to work following open carpal tunnel decompression was possible. Two hundred patients with a neurophysiologically confirmed diagnosis underwent surgery between 2002 and 2006. One hundred and eighty-seven patients were assessed retrospectively and 13 prospectively. The incidence in new lamb boners was 10% in their first season. On average, workers commenced rehabilitation at 11 days post-operatively and full duties at 29 days post-operatively with minimal further time off taken. Ninety percent returned to their previous role. By 8 weeks in the prospective group visual analogue pain scores had improved from 8.75 to 2.0 ( P<0.01) and Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) scores had improved from 140 points to 68 ( P<0.01). Grip/pinch testing, static two-point discrimination scores and complication rates were comparable with previous studies. This study provides good evidence that coordinated, early rehabilitation and return to work is effective in a high-demand population.

scholarly journals Rehabilitation following meniscal repair: a systematic review

2018 ◽  
Vol 4 (1) ◽  
pp. e000212 ◽  
Author(s):  
Robert C Spang III ◽  
Michael C Nasr ◽  
Amin Mohamadi ◽  
Joseph P DeAngelis ◽  
Ara Nazarian ◽  
...  
Keyword(s):  
Systematic Review ◽  
Range Of Motion ◽  
Clinical Studies ◽  
Weight Bearing ◽  
Meniscal Repair ◽  
Rehabilitation Protocol ◽  
Early Motion ◽  
Accelerated Rehabilitation ◽  
Rehabilitation Protocols ◽  
Meta Analyses

ObjectiveTo review existing biomechanical and clinical evidence regarding postoperative weight-bearing and range of motion restrictions for patients following meniscal repair surgery.Methods and data sourcesFollowing the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guideline, we searched MEDLINE using following search strategy: ((((“Weight-Bearing/physiology”[Mesh]) OR “Range of Motion, Articular”[Mesh]) OR “Rehabilitation”[Mesh])) AND (“Menisci, Tibial”[Mesh]). Additional articles were derived from previous reviews. Eligible studies were published in English and reported a rehabilitation protocol following meniscal repair on human. We summarised rehabilitation protocols and patients’ outcome among original studies.ResultsSeventeen clinical studies were included in this systematic review. There was wide variation in rehabilitation protocols among clinical studies. Biomechanical evidence from small cadaveric studies suggests that higher degrees of knee flexion and weight-bearing may be safe following meniscal repair and may not compromise the repair. An accelerated protocol with immediate weight-bearing at tolerance and early motion to non-weight-bearing with immobilising up to 6 weeks postoperatively is reported. Accelerated rehabilitation protocols are not associated with higher failure rates following meniscal repair.ConclusionsThere is a lack of consensus regarding the optimal postoperative protocol following meniscal repair. Small clinical studies support rehabilitation protocols that allow early motion. Additional studies are needed to better clarify the interplay between tear type, repair method and optimal rehabilitation protocol.

Early return to work and improved range of motion with modified relative motion splinting: a retrospective comparison with immobilization splinting for zones V and VI extensor tendon repairs

Hand Therapy ◽  
2011 ◽  
Vol 16 (4) ◽  
pp. 86-94 ◽  
Author(s):  
Melissa J Hirth ◽  
Kate Bennett ◽  
Eldon Mah ◽  
Hamish C Farrow ◽  
Andrew V Cavallo ◽  
...  
Keyword(s):  
At Risk ◽  
Return To Work ◽  
Range Of Motion ◽  
Relative Motion ◽  
Extensor Tendon ◽  
Postoperative Management ◽  
Active Motion ◽  
Average Return ◽  
Early Return ◽  
Total Active Motion

Introduction There is a lack of evidence on the best method for rehabilitating extensor tendon injuries in zones V and VI. The purpose of this study was to evaluate the outcomes of modified relative motion splinting compared with immobilization following repair of extensor tendons in zones V and VI. Methods A retrospective analysis compared the outcomes of relative motion splinting with immobilization. Sixteen patients (16 fingers) were treated by conventional immobilization splinting for four weeks (immobilization group) followed by mobilization with avoidance of ‘at-risk/heavy’ activities for a further 4–6 weeks. Twenty-three patients (23 fingers) were treated with the modified relative motion splint (mRMS group) during the day and a resting splint worn overnight for the first four weeks. The relative motion splint was continued for ‘at-risk/heavy’ activities for a further 4–6 weeks. Results The mRMS group demonstrated statistically significant improvement in range of motion compared with the immobilization group. This effect was most marked at six weeks ( P = 0.0194, two-way mixed ANOVA) with the mRMS group achieving a 12% higher mean percentage total active motion ( P = 0.0076, Mann-Whitney U test). Results were similar for both groups 12 weeks postoperatively. Differences in return to work times between groups were statistically significant ( P = 0.0062, Mann-Whitney U test). Average return to work was 9.4 weeks for the immobilization group and 3.3 weeks for the mRMS group, equating to a 42 days earlier return to work for the mRMS group. There was no incidence of tendon rupture in either group. Conclusion This study demonstrates that modified relative motion splintage (finger based without wrist component) can be applied in the postoperative management of single zone V or VI extensor tendon repairs. The main advantages of this protocol, compared with immobilization include the small simple splint design, and straightforward patient instructions that enable earlier mobilization, functional hand use and return to both daily living and work.

Both open and endoscopic gluteal tendon repairs lead to functional improvement with similar failure rates: a systematic review

2020 ◽  
pp. jisakos-2020-000474
Author(s):  
Robert Longstaffe ◽  
Patrick Dickerson ◽  
Charles A Thigpen ◽  
Ellen Shanley ◽  
Michael J Kissenberth ◽  
...  
Keyword(s):  
Systematic Review ◽  
Complication Rate ◽  
Open Repair ◽  
Tendon Repair ◽  
Functional Improvement ◽  
Complication Rates ◽  
Endoscopic Repair ◽  
Partial Thickness ◽  
Patient Reported ◽  
Rehabilitation Protocols

ImportanceOperative treatment of gluteal tendon tears is becomingly increasingly more common with varying surgical techniques and rehabilitation protocols.ObjectiveTo perform a systematic review of gluteal tendon repair as it relates to tear characteristics, rehabilitation protocols, patient-reported outcomes, satisfaction, resolution of gait deviation and complication rates.Evidence reviewA comprehensive literature search of PubMed and Embase/MEDLINE was used to identify all literature pertaining to gluteal tendon repair. A total of 389 articles were identified.FindingsA total of 22 studies (611 hips) were included in this review. The majority of tears were noted to be partial thickness (77.9% vs 22.1%). Both arthroscopic and open repair demonstrated improvements in functional outcomes. Within studies documenting gait deviation, 54% were noted to have gait deviation preoperatively, of which approximately 70% had resolution following repair. On average, abduction strength increased almost one whole grade (0.84) following repair. Overall complication rate was found to be 5.2% (20 of 388 hips). Endoscopic repair demonstrated a decreased complication rate compared with open (0.7% vs 7.8%). Retear rate was found to be 3.8%, with open repair having a slightly increased rate compared with endoscopic repair (3.4% vs 4.1%).Conclusions and relevanceThe majority of tears tend to be partial thickness with involvement of gluteus medius in almost all cases and concomitant involvement of gluteus minimus in close to half of cases. Both endoscopic and open gluteal tendon repairs resulted in improvements in outcomes and functional improvement. Retear rates were similar between the two repair techniques, while endoscopic repair demonstrated a lower complication rate.Level of evidenceLevel IV, systematic review.

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