Case study: An evidence based approach to the use of dry needling for a concussion within the cervicogenic pathway

Concussion management and treatment continues to be a popular topic of current literature. As discussion of concussion pathways continues to be highlighted, specific intervention strategies are gaining popularity as best treatment options. For patients that fall into the cervicogenic pathway of concussion, DN is an intervention modality that is becoming more prevalent in its use. This presentation will describe the common presentation of patients that fall within this concussion pathway and highlight how DN reduces pain and disability within this subset of patients. We will discuss the current evidence and efficacy of DN as an intervention tool in our clinical practice, specifically for the cervicogenic pathway of concussion. We will outline and demonstrate proper application procedures for DN within the cervical, occipital and temporal regions with discussion of safety considerations. We will then correlate this intervention tool with the use of outcome measures within clinical practice and tie it back to patient reported concussive symptoms. Finally, we will discuss the impact on time to resolution of symptoms DN can have in our patients. Learning Objectives: (1) Discuss the theory of Concussion Clinical Pathways. (2) Understand a specific clinical presentation of a patient within the Cervicogenic Pathway. (3) Define Dry Needling (DN). (4) Understand the utilization and pathophysiology behind DN in clinical practice. (5) Understand the proper application of DN in the cervical, occipital and temporal regions. (6) Recognize the benefit DN has on this specific pathway. (7) Recognize patients that can benefit from this intervention through the use of a case presentation.

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A narrative review of current evidence supporting the implementation of electronic patient-reported outcome measures in the management of chronic diseases

Therapeutic Advances in Chronic Disease ◽

10.1177/20406223211015958 ◽

2021 ◽

Vol 12 ◽

pp. 204062232110159

Author(s):

Olalekan Lee Aiyegbusi ◽

Devika Nair ◽

John Devin Peipert ◽

Kara Schick-Makaroff ◽

Istvan Mucsi

Keyword(s):

Clinical Practice ◽

Chronic Diseases ◽

Patient Reported Outcomes ◽

Healthcare Providers ◽

Patient Reported Outcome ◽

Routine Clinical Practice ◽

Narrative Review ◽

Current Evidence ◽

Patient Reported ◽

The Impact

An application of telemedicine of growing interest and relevance is the use of personal computers and mobile devices to collect patient-reported outcomes (PROs). PROs are self-reports of patients’ health status without interpretation by anyone else. The tools developed to assess PROs are known as patient-reported outcomes measures (PROMs). The technological innovations that have led to an increased ownership of electronic devices have also facilitated the development of electronic PROMs (ePROMs). ePROMs are a conduit for telemedicine in the care of patients with chronic diseases. Various studies have demonstrated that the use of ePROMs in routine clinical practice is both acceptable and feasible with patients increasingly expressing a preference for an electronic mode of administration. There is increasing evidence that the use of electronic patient-reported outcome (ePROMs) could have significant impacts on outcomes valued by patients, healthcare providers and researchers. Whilst the development and implementation of these systems may be initially costly and resource-intensive, patient preferences and existing evidence to support their implementation suggests the need for continued research prioritisation in this area. This narrative review summarises and discusses evidence of the impact of ePROMs on clinical parameters and outcomes relevant to chronic diseases. We also explore recently published literature regarding issues that may influence the robust implementation of ePROMs for routine clinical practice.

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Quality of life assessments in clinical practice using either the EORTC-QLQ-C30 or the SEIOQL-DW: a randomized study

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-021-00315-z ◽

2021 ◽

Vol 5 (1) ◽

Author(s):

Åsa Kettis ◽

Hanna Fagerlind ◽

Jan-Erik Frödin ◽

Bengt Glimelius ◽

Lena Ring

Keyword(s):

Quality Of Life ◽

Clinical Practice ◽

Significant Difference ◽

Patient Reported ◽

Health Related Qol ◽

Health Related ◽

Secondary Outcomes ◽

The Impact ◽

Over Time

Abstract Background Effective patient-physician communication can improve patient understanding, agreement on treatment and adherence. This may, in turn, impact on clinical outcomes and patient quality of life (QoL). One way to improve communication is by using patient-reported outcome measures (PROMs). Heretofore, studies of the impact of using PROMs in clinical practice have mostly evaluated the use of standardized PROMs. However, there is reason to believe that individualized instruments may be more appropriate for this purpose. The aim of this study is to compare the effectiveness of the standardized QoL-instrument, the European Organization for Research and Treatment of Cancer Quality of Life C-30 (EORTC-QOL-C30) and the individualized QoL instrument, the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW), in clinical practice. Methods In a prospective, open-label, controlled intervention study at two hospital out-patient clinics, 390 patients with gastrointestinal cancer were randomly assigned either to complete the EORTC-QOL-C30 or the SEIQoL-DW immediately before the consultation, with their responses being shared with their physician. This was repeated in 3–5 consultations over a period of 4–6 months. The primary outcome measure was patients’ health-related QoL, as measured by FACIT-G. Patients’ satisfaction with the consultation and survival were secondary outcomes. Results There was no significant difference between the groups with regard to study outcomes. Neither intervention instrument resulted in any significant changes in health-related QoL, or in any of the secondary outcomes, over time. This may reflect either a genuine lack of effect or sub-optimization of the intervention. Since there was no comparison to standard care an effect in terms of lack of deterioration over time cannot be excluded. Conclusions Future studies should focus on the implementation process, including the training of physicians to use the instruments and their motivation for doing so. The effects of situational use of standardized or individualized instruments should also be explored. The effectiveness of the different approaches may depend on contextual factors including physician and patient preferences.

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Sleep disordered breathing at the extremes of age: the elderly

Breathe ◽

10.1183/20734735.003216 ◽

2016 ◽

Vol 12 (1) ◽

pp. 50-60 ◽

Cited By ~ 20

Author(s):

Alison McMillan ◽

Mary J. Morrell

Keyword(s):

Risk Factors ◽

Older People ◽

Sleep Disordered Breathing ◽

Treatment Options ◽

Current Evidence ◽

List Type ◽

Pressure Therapy ◽

Age Related ◽

The Impact ◽

Disordered Breathing

Key pointsSleep disordered breathing (SDB) is common and its prevalence increases with age. Despite this high prevalence, SDB is frequently unrecognised and undiagnosed in older people.There is accumulating evidence that SDB in older people is associated with worsening cardio- cerebrovascular, cognitive and functional outcomes.There is now good evidence to support the use of continuous positive airway pressure therapy in older patients with symptomatic SDB.Educational aimsTo highlight the prevalence and presentation of sleep disordered breathing (SDB) in older people.To inform readers about the risk factors for SDB in older people.To explore the impact of SDB in older people.To introduce current evidence based treatment options for SDB in older people.Sleep disordered breathing (SBD) increases in prevalence as we age, most likely due to physiological and physical changes that occur with ageing. Additionally, SDB is associated with comorbidity and its subsequent polypharmacy, which may increase with increasing age. Finally, the increased prevalence of SDB is intrinsically linked to the obesity epidemic. SDB is associated with serious outcomes in younger people and, likewise, older people. Thus, identification, diagnosis and treatment of SDB is important irrelevant of age. This article reviews the age-related changes contributing to SDB, the epidemiology and the risk factors for SDB in older people, the association of SDB with adverse outcomes, and diagnostic and treatment options for this population.

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Against the stream: early diagnosis of dementia, is it so desirable?

BJPsych Bulletin ◽

10.1192/bjb.2018.107 ◽

2019 ◽

Vol 43 (3) ◽

pp. 123-125 ◽

Cited By ~ 1

Author(s):

Carol Brayne ◽

Sarah Kelly

Keyword(s):

Clinical Practice ◽

Early Diagnosis ◽

Empirical Evidence ◽

Treatment Options ◽

Evidence Base ◽

Current Evidence ◽

Dementia Diagnosis ◽

Case Identification ◽

Current Evidence Base ◽

Diagnosis Of Dementia

SummaryThe Prime Minister's challenge on dementia called for improved dementia diagnosis rates, based on assumptions of benefit to individuals and those who care for them. Subsequent policies have led to increased target drives for clinical practice to achieve early diagnosis of dementia through intense case identification. However, the current evidence base and treatment options do not support screening for dementia, and there is little empirical evidence that such intensive case identification and early diagnosis for dementia is justified without a better understanding of the benefits, costs and potential harms to individuals and services.Declaration of interestNone.

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A relevant study was missed in our systematic review on the impact of patient-reported outcomes in clinical practice

Quality of Life Research ◽

10.1007/s11136-008-9367-9 ◽

2008 ◽

Vol 17 (6) ◽

pp. 965-966

Author(s):

J. M. Valderas ◽

A. Kotzeva ◽

M. Espallargues ◽

G. Guyatt ◽

C. E. Ferrans ◽

...

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Patient Reported Outcomes ◽

Relevant Study ◽

Patient Reported ◽

The Impact

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The impact of patient-reported outcome measures in clinical practice for pain: a systematic review

Quality of Life Research ◽

10.1007/s11136-016-1449-5 ◽

2016 ◽

Vol 26 (2) ◽

pp. 245-257 ◽

Cited By ~ 31

Author(s):

Michelle M. Holmes ◽

George Lewith ◽

David Newell ◽

Jonathan Field ◽

Felicity L. Bishop

Keyword(s):

Systematic Review ◽

Clinical Practice ◽

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Patient Reported ◽

The Impact

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Non-radiographic versus radiographic axSpA: what’s in a name?

Rheumatology ◽

10.1093/rheumatology/keaa422 ◽

2020 ◽

Vol 59 (Supplement_4) ◽

pp. iv18-iv24

Author(s):

Xabier Michelena ◽

Clementina López-Medina ◽

Helena Marzo-Ortega

Keyword(s):

Clinical Practice ◽

Axial Spondyloarthritis ◽

Treatment Options ◽

Classification Criteria ◽

Current Evidence ◽

Inflammatory Condition ◽

New Bone Formation ◽

Severe Phenotype ◽

Clinical Presentations

Abstract Axial spondyloarthritis is a heterogeneous inflammatory condition with variable clinical presentations and outcomes. The complexity of its diagnosis and absence of biomarkers hamper the development of diagnostic criteria with the risk of misuse of the available classification criteria in clinical practice and its consequences. Axial spondyloarthritis should be regarded as a continuum in which some patients, but not all, will have a more severe phenotype characterized by progression into new bone formation and joint fusion. Growing understanding of the factors that might drive disease progression and treatment response will allow for better characterization of treatment options and outcome for each affected individual. The aim of this review is to update the current evidence of what is axial spondyloarthritis and to highlight the need to focus on the concept rather than its classification.

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A Role for Heat Therapy in Low Back Pain in Modern Clinical Practice

10.20944/preprints202106.0663.v1 ◽

2021 ◽

Author(s):

Jürgen Freiwald ◽

Alberto Magni ◽

Pablo Fanlo-Mazas ◽

Ema Paulino ◽

Luís Sequeira de Medeiros ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Clinical Practice ◽

Pain Relief ◽

Treatment Options ◽

Work Productivity ◽

Low Back ◽

Published Evidence ◽

Heat Therapy ◽

The Impact

Low back pain (LBP) is a leading cause of disability. It significantly impacts the patient’s quality of life, limits their daily living activities, and reduces work productivity. To reduce the burden of LBP, several pharmacological and non-pharmacological treatment options are available. This review summarizes the role of heat therapy in the management of LBP. First, we outline the common causes of LBP, then discuss the general mechanisms of heat therapy on (LB)P, and finally review the published evidence regarding the impact of heat therapy in patients with acute or chronic non-specific LBP. This review demonstrates that continuous, low-level heat therapy provides pain relief, improves muscular strength, and increases flexibility. Therefore, this effective, safe, easy-to-use, and cost-effective non-pharmacological pain relief option is still relevant in modern clinical practice.

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