Timely Access and Strong Patient-Provider Relationships: An Observational Retrospective Study of Clinically Meaningful Outcomes, Satisfaction and Program Participation in Digital Physical Therapy (Preprint)

2021 ◽  
Author(s):  
Lauren Beresford ◽  
Todd Norwood
Keyword(s):  
Retrospective Study ◽  
Physical Therapy ◽  
Clinical Outcomes ◽  
Program Participation ◽  
Survey Question ◽  
Timely Access ◽  
Virtual Visits ◽  
Clinically Meaningful Outcomes ◽  
And Function

BACKGROUND Digital physical therapy (DPT) programs deliver physical therapy (PT) via a mobile app to privately-insured employees as an employer-sponsored healthcare benefit. Although evidence shows that some DPT clinical outcomes are comparable to in-person care, no research examines how DPT delivers these outcomes. We evaluated a DPT program that delivered care through an app including initial video PT evaluations, follow-up video visits and in-app chat. Participants also accessed prescribed workouts, education and therapeutic activities assigned by their physical therapists (PTs) in the app. OBJECTIVE This study examined the correlates of “good” outcomes in DPT, defined as minimal clinically important differences (MCIDs) in pain and function as well as patient satisfaction. It then examined the effects of the strength of the patient-provider relationship and timely access to care on participation in DPT. METHODS We conducted an observational retrospective study of 814 pre and post surveyed DPT participants, 18 years and older, enrolled in DPT from February 2019 through December 2020 using generalized linear models. Binary variables defined participants with MCIDs in pain and function as the clinical outcomes. “Satisfied” participants had Net Promoter Scores of 9-10 on a final survey question capturing participants’ likelihood to recommend the program. Program participation included workouts per week and number of weeks in the program. RESULTS Clinically meaningful outcomes in DPT are directly affected by program participation. The odds participants had MCIDs in pain increased by 13% (p<0.01) for each additional weekly workout completed and the odds they had MCIDs in function increased by a factor of 1.04 (p<0.05) with each additional week in the program. Participant’s satisfaction was greater for those with significant changes in pain and function and more virtual visits. Participants with MCIDs in function and large changes in pain were approximately 1.85 (p<0.01) and 2.84 (p<0.0001) times more satisfied, respectively. Those with virtual visits beyond their initial evaluation were approximately 2-3 times (p<0.01) more satisfied. Direct access to and virtual visits with PTs were associated with great participation. Each additional PT-initiated message per week increased weekly workouts by 11% (p<0.0001). Virtual follow-up visits increased weekly workouts and weeks in the program by factors between 1 and 2. Access to a PT within 24 hours was associated with a 14% increase in workouts per week. CONCLUSIONS Program participation (program length and frequency of exercise) are associated with clinical outcomes in a DPT program. Satisfaction is affected by both virtual face-to-face visits and clinically meaningful changes in pain and function. Participation in DPT, which drives outcomes, is secured by strong relationships between PTs and patients as well as timely access to a PT.

Management of Complete Talocrural Luxations by Selective Talocrural Arthrodesis using Hybrid Transarticular External Skeletal Fixation in Dogs

2018 ◽  
Vol 31 (04) ◽  
pp. 291-297
Author(s):  
Taylan Önyay ◽  
Kamil İnal ◽  
Deniz Özbakır ◽  
Ahmet Özak ◽  
Cenk Yardımcı
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Injured Limb ◽  
Clinical Utilization ◽  
Removal Time ◽  
Hybrid External Fixator ◽  
Early Use ◽  
Clinical Benefits ◽  
Age And Sex

Objective This article presents a novel surgical technique in the management of open complete talocrural luxations and evaluates the results, and clinical benefits with its routine clinical utilization. Study Design Retrospective study. Animals Seventeen medium- or large-breed client-owned dogs of different breed, age and sex with complete talocrural luxations and radiographic follow-up of at least 24 weeks duration. Method Selective talocrural arthrodesis was performed by using a hybrid transarticular external skeletal fixator frame. Clinical and radiographical evaluation was performed regarding the lesion, concomitant injury, duration of the surgery, time to first use of the limb, fixator removal time, complications and clinical outcomes. Results Dogs started to use the injured limb between postoperative days 1 to 11. Pin or wire tract related complications were observed in all dogs. Time to fixator removal ranged from 57 to 90 days with a median of 73 days. All of the operated joints with an exception of one dog resulted in talocrural fusion. Mid-term clinical outcomes score was regarded as excellent in 13/17 dogs, good in 3/17 dogs and poor in 1/17 dogs subject to authors' evaluation. Conclusion A transarticular hybrid external fixator may allow early use of postoperative limb with an excellent patient compliance and is well tolerated as well. The technique showed a promising opportunity of providing favourable limb use.

scholarly journals Comparison of Gastrocnemius Turn Flap and Hamstring Graft for the Treatment of Kuwada Type 3 Chronic Ruptures of the Achilles Tendon: A Retrospective Study

2019 ◽  
Vol 7 (12) ◽  
pp. 232596711988767
Author(s):  
Lu Bai ◽  
Siyao Guan ◽  
Tian You ◽  
Wentao Zhang ◽  
Peng Chen
Keyword(s):  
Retrospective Study ◽  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Hamstring Graft ◽  
Early Recovery ◽  
Level Of Evidence ◽  
Type 3

Background: Chronic Achilles tendon rupture is challenging to repair, and many procedures have been suggested to fill the gap that separates the distal and proximal ends of the ruptured tendon. Purpose: To compare clinical outcomes between the free hamstring graft (HG) and gastrocnemius turn flap (GTF) procedures in the treatment of chronic Achilles tendon rupture. Study Design: Cohort study; Level of evidence, 3. Methods: This retrospective study included 26 patients (25 males, 1 female; mean age, 36.7 years; range, 22-53 years) with Kuwada type 3 chronic rupture of the Achilles tendon. A total of 11 patients underwent GTF surgery, whereas 15 patients underwent HG surgery. Follow-up assessments were conducted at 3, 6, and 12 months postoperatively. Results: The complication rate was significantly higher in the GTF group compared with the HG group (27.2% vs 6.6%, respectively; χ2 = 12.462; P = .001). At the 3-month follow-up, the degree of ankle dorsiflexion was significantly higher in the HG group than in the GTF group ( t = 3.144; P = .004). At 6-month and 1-year follow-up, no significant differences in ankle function were seen between the 2 groups. Conclusion: Hamstring tendon graft is associated with better early recovery of dorsiflexion compared with GTF. The long-term clinical outcomes of these 2 procedures are similar.

scholarly journals Timing of Supervised Physical Therapy after Hindfoot Fractures

2017 ◽  
Vol 2 (3) ◽  
pp. 2473011417S0000
Author(s):  
Stephanie Albin ◽  
Drew Van Boerum ◽  
James Morgan ◽  
Shane Koppenhaver
Keyword(s):  
Physical Therapy ◽  
Clinical Outcomes ◽  
Manual Therapy ◽  
Foot And Ankle ◽  
Therapeutic Exercise ◽  
Therapy Program ◽  
Surgical Fixation ◽  
Physical Therapy Program

Category: Ankle, Hindfoot Introduction/Purpose: Fractures to the hindfoot, including the talus and calcaneus, have devastating long-term functional outcomes. To date, no randomized trials have been done assessing the best time to initiate physical therapy after surgical fixation of these fractures. The purpose of this study is to assess whether initiating a supervised physical therapy program including therapeutic exercise and manual therapy two weeks post-operatively (EARLY) versus seven weeks post-operatively (LATE) in patients following surgical fixation for these fractures results in differences in clinical outcomes. The secondary purpose of this study is to assess what factors predict outcomes after these hindfoot fractures. Methods: Fifty patients between the ages of 18-70 years having undergone an open reduction internal fixation (ORIF) of the calcaneus or talus were recruited to participate from two foot and ankle fellowship-trained orthopedic surgeons. Subjects were randomly assigned to initiate formal physical therapy starting within 2 weeks post-operatively (EARLY) (n=26) or 8 weeks post-operatively (LATE) (n=24). Treatment for both groups consisted of impairment based manual therapy and therapeutic exercise. The lower extremity functional scale (LEFS), the American Orthopeadic Foot and Ankle Society (AOFAS) hindfoot scale, range of motion (ROM), pain and girth measurements to assess swelling were the outcome measures for this study. Subjects in both groups were seen for a total of 10 visits. All subjects underwent follow-up assessments at 3 months, 6 months, and 12 months post-operatively. Between-group differences were analyzed using ANCOVAs with baseline scores as covariates. Regression was used to assess factors predicting patients’ self-reported outcomes. Results: Results demonstrated no significant differences between the groups at any time point (3, 6 or 12 months) for the LEFS (p=0.637) or the AOFAS (p=0.634). No significant differences existed between the two groups for active ROM (p=0.106) or swelling (p=0.389). Subjects in both groups demonstrated improved AOFAS scores from baseline to one year follow-up by 26 points (p=0.00); however, most of the change occurred within the first 6 months post-operatively with only a 1.722 (95% CI -3.63 to 7.08) change between 6 to 12 month follow-up visits. Baseline anxiety (as measured by the Beck Anxiety Questionnaire) significantly predicted LEFS scores at both the 6 month and 12 month follow-up periods (r= -0.55, p=0.0015 and r= -0.53, p=0.007). Conclusion: This study did not demonstrate that initiating early supervised physical therapy (within 2 weeks after surgical fixation) improves self-reported outcomes for patients after surgical fixation of a hindfoot fracture as assessed by the LEFS, the AOFAS hindfoot scores, or clinical outcomes such as ROM or swelling compared to patients initiating a formal physical therapy program seven weeks after surgery. Although, many these patients typically have less than ideal clinical outcomes, it is possible that addressing other factors such as anxiety may help improve long-term outcomes.

Heterotopic ossification following total elbow arthroplasty

2018 ◽  
Vol 100-B (6) ◽  
pp. 767-771 ◽  
Author(s):  
P. M. Robinson ◽  
S. J. MacInnes ◽  
D. Stanley ◽  
A. A. Ali
Keyword(s):  
Retrospective Study ◽  
Heterotopic Ossification ◽  
Clinical Outcomes ◽  
Total Elbow Arthroplasty ◽  
Range Of Movement ◽  
Exact Test ◽  
Elbow Arthroplasty ◽  
Fisher’S Exact Test ◽  
Trauma Group

Aim The primary aim of this retrospective study was to identify the incidence of heterotopic ossification (HO) following elective and trauma elbow arthroplasty. The secondary aim was to determine clinical outcomes with respect to the formation of heterotopic ossification. Patients and Methods A total of 55 total elbow arthroplasties (TEAs) (52 patients) performed between June 2007 and December 2015 were eligible for inclusion in the study (29 TEAs for primary elective arthroplasty and 26 TEAs for trauma). At review, 15 patients (17 total elbow arthroplasties) had died from unrelated causes. There were 14 men and 38 women with a mean age of 70 years (42 to 90). The median clinical follow-up was 3.6 years (1.2 to 6) and the median radiological follow-up was 3.1 years (0.5 to 7.5). Results The overall incidence of HO was 84% (46/55). This was higher in the trauma group (96%, 25/26) compared with the elective arthroplasty group (72%, 21/29) (p = 0.027, Fisher’s exact test). Patients in the trauma group had HO of higher Brooker class. The presence of HO did not significantly affect elbow range of movement within the trauma or elective groups (elective arthroplasty, Mann–Whitney U test, p = 0.070; trauma arthroplasty, p = 0.370, Mann–Whitney U test). Conclusion HO after total elbow arthroplasty is seen more commonly than previously reported. We have reported a significantly higher rate of HO in TEAs performed for trauma than those performed electively. Cite this article: Bone Joint J 2018;100-B:767–71.

Clinical Outcomes of Zone 2 Flexor Tendon Repairs Using the Modified Lim/Tsai Technique

2019 ◽  
Vol 24 (01) ◽  
pp. 83-88
Author(s):  
Min Kai Chang ◽  
Sanchalika Acharyya ◽  
Zeus Yiwei Lim ◽  
Shian Chao Tay
Keyword(s):  
Retrospective Study ◽  
Clinical Outcomes ◽  
Flexor Tendon ◽  
Biomechanical Properties ◽  
Modified Technique ◽  
Active Motion ◽  
Satisfactory Outcome ◽  
Flexor Tendon Injuries ◽  
Total Active Motion

Background: The single looped suture modified Lim/Tsai technique is widely used for flexor tendon repairs. It has been shown to possess better biomechanical properties and require less repair time per tendon as compared to the double looped suture original Lim/Tsai technique. However, there is no clinical data on the modified technique. Methods: The retrospective study included zone 2 flexor tendon repairs made using the modified Lim/Tsai technique from January 2008 to December 2014. Clinical outcome was assessed using the revised Strickland and Glogovac criteria, which categorises repairs based on the total active motion of the repaired digit. Results: Sixty-two patients with 74 digits were included. The overall mean total active motion was 122°. The overall satisfactory outcome of the modified Lim/Tsai technique was 81.1%. The rupture rate of the modified Lim/Tsai technique was 2.7%. Using multivariate linear regression model, we found that outcomes were negatively influenced by subzone 2C and crush/saw injuries, but not by concomitant neurovascular injuries or post-operative follow-up duration. Conclusions: Based on this retrospective study of patients with zone 2 flexor tendon injuries, the clinical outcomes of modified and original Lim/Tsai techniques are comparable. As such, there is no clinical evidence favouring one over the other.

scholarly journals Surgical versus Nonsurgical Multimodality Treatment in an Idiopathic Frozen Shoulder: A Retrospective Study of Clinical and Functional Outcomes

2021 ◽  
Vol 10 (21) ◽  
pp. 5185
Author(s):  
Wojciech Satora ◽  
Roman Brzóska ◽  
Robert Prill ◽  
Paweł Reichert ◽  
Łukasz Oleksy ◽  
...  
Keyword(s):  
Retrospective Study ◽  
Functional Outcomes ◽  
Corticosteroid Injection ◽  
Frozen Shoulder ◽  
Post Treatment ◽  
Capsular Release ◽  
Arthroscopic Capsular Release ◽  
Group I ◽  
And Function

This retrospective study compared the clinical and functional outcomes of patients diagnosed with an idiopathic frozen shoulder with symptom onset of a maximum of six months, treated by arthroscopic capsular release followed by corticosteroid injection and physiotherapy to patients who received only corticosteroid injection followed by physiotherapy. The patients who underwent arthroscopic capsular release, intraoperative corticosteroid injection, and physiotherapy (Group I, n = 30) or received only corticosteroids injection and physiotherapy (Group II, n = 29) were examined in terms of shoulder range of motion (ROM), pain intensity, and function before a given treatment and three, six, and twelve months later. The groups were comparable pre-treatment in terms of ROM, pain, and functional outcome. Group I had statistically and clinically significantly better ROM and function at three and six months post-treatment than Group II. Despite being statistically significant, the between-group differences at twelve-month follow-up in ROM and function were too small to be considered clinically notable. The between-group comparison of pain revealed no significant differences at any post-treatment point of time. The early arthroscopic capsular release preceding corticosteroid injection and physiotherapy seemed more effective at three- and six-month follow-up; however, it brought a comparable result to corticosteroid injection and subsequent physiotherapy at twelve months follow-up.

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