Attitude toward second opinions in Germany – a survey of the general population

Background Second medical opinions (SOs) can assist patients in making informed treatment decisions and improve the understanding of their diagnosis. In Germany, there are different approaches to obtain a structured SO procedure: SO programs by health insurers and SOs according to the SO Directive. Through a direct survey of the population, we aimed to assess how structured SOs should be provided to fulfil patients’ needs. Methods A stratified sample of 9990 adults (≥18 years) living in the federal states of Berlin and Brandenburg (Germany) were initially contacted by post in April and sent a reminder in May 2020. The survey results were analyzed descriptively. Results Among 1349 participants (response rate 14%), 56% were female and the median age was 58 years (interquartile range (IQR) 44–69). Participants wanted to be informed directly and personally about the possibility of obtaining an SO (89%; 1201/1349). They preferred to be informed by their physician (93%; 1249/1349). A majority of participants would consider it important to obtain an SO for oncological indications (78%; 1049/1349). Only a subset of the participants would seek an SO via their health insurer or via an online portal (43%; 577/1349 and 16%; 221/1349). A personally delivered SO was the preferred route of SO delivery, as 97% (1305/1349) would (tend to) consider this way of obtaining an SO. Participants were asked to imagine having moderate knee pain for years, resulting in a treatment recommendation for knee joint replacement. They were requested to rate potential qualification criteria for a physician providing the SO. The criteria rated to be most important were experience with the recommended diagnosis/treatment (criterion (very) important for 93%; 1257/1349) and knowledge of the current state of research (criterion (very) important for 86%; 1158/1349). Participants were willing to travel 60 min (median; IQR 60–120) and wait 4 weeks (median; IQR 2–4) for their SO in the hypothetical case of knee pain. Conclusion In general, SOs were viewed positively. We found that participants have clear preferences regarding SOs. We propose that these preferences should be taken into account in the future design and development of SO programs.

Efficacy and safety of radiofrequency treatment for improving knee pain and function in knee osteoarthritis: a meta-analysis of randomized controlled trials

Background The clinical utility of radiofrequency (RF) in patients with knee osteoarthritis (OA) remains unclear. We conducted a meta-analysis to systematically evaluate the efficacy and safety of RF treatment in patients with knee OA. Methods Searches of the PubMed, Web of Science, EMBASE, Cochrane Library, China National Knowledge Infrastructure, and Wanfang Data databases were performed through August 30, 2021. The major outcomes from published randomized controlled trials (RCTs) involving patients with knee OA were compared between RF and control groups, including Visual Analogue Scale (VAS) or Numerical Rating Scale (NRS) scores, the Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), Oxford Knee Score (OKS), Global Perceived Effect (GPE) scale, and adverse effects at available follow-up times. Results Fifteen RCTs involving 1009 patients were included in this meta-analysis, and the results demonstrated that RF treatment correlated with improvements in pain relief (VAS/NRS score, all P < 0.001) and knee function (WOMAC, all P < 0.001) at 1–2, 4, 12, and 24 weeks after treatment as well as patients’ degree of satisfaction with treatment effectiveness (GPE scale, 12 weeks, P < 0.001). OKSs did not differ significantly between the two groups. Moreover, treatment with RF did not significantly increase adverse effects. Subgroup analysis of knee pain indicated that the efficacy of RF treatment targeting the genicular nerve was significantly better than intra-articular RF at 12 weeks after treatment (P = 0.03). Conclusions This meta-analysis showed that RF is an efficacious and safe treatment for relieving knee pain and improving knee function in patients with knee OA.

Free-Living User Perspectives on Musculoskeletal Pain and Patient-Reported Mobility With Passive and Powered Prosthetic Ankle-Foot Components: A Pragmatic, Exploratory Cross-Sectional Study

IntroductionStudies with a powered prosthetic ankle-foot (PwrAF) found a reduction in sound knee loading compared to passive feet. Therefore, the aim of the present study was to determine whether anecdotal reports on reduced musculoskeletal pain and improved patient-reported mobility were isolated occurrences or reflect a common experience in PwrAF users.MethodsTwo hundred and fifty individuals with transtibial amputation (TTA) who had been fitted a PwrAF in the past were invited to an online survey on average sound knee, amputated side knee, and low-back pain assessed with numerical pain rating scales (NPRS), the PROMIS Pain Interference scale, and the PLUS-M for patient-reported mobility in the free-living environment. Subjects rated their current foot and recalled the ratings for their previous foot. Recalled scores were adjusted for recall bias by clinically meaningful amounts following published recommendations. Statistical comparisons were performed using Wilcoxon's signed rank test.ResultsForty-six subjects, all male, with unilateral TTA provided data suitable for analysis. Eighteen individuals (39%) were current PwrAF users, whereas 28 subjects (61%) had reverted to a passive foot. After adjustment for recall bias, current PwrAF users reported significantly less sound knee pain than they recalled for use of a passive foot (−0.5 NPRS, p = 0.036). Current PwrAF users who recalled sound knee pain ≥4 NPRS with a passive foot reported significant and clinically meaningful improvements in sound knee pain (−2.5 NPRS, p = 0.038) and amputated side knee pain (−3 NPRS, p = 0.042). Current PwrAF users also reported significant and clinically meaningful improvements in patient-reported mobility (+4.6 points PLUS-M, p = 0.016). Individuals who had abandoned the PwrAF did not recall any differences between the feet.DiscussionCurrent PwrAF users reported significant and clinically meaningful improvements in patient-reported prosthetic mobility as well as sound knee and amputated side knee pain compared to recalled mobility and pain with passive feet used previously. However, a substantial proportion of individuals who had been fitted such a foot in the past did not recall improvements and had reverted to passive feet. The identification of individuals with unilateral TTA who are likely to benefit from a PwrAF remains a clinical challenge and requires further research.

Acceptability of a nurse-led non-pharmacological complex intervention for knee pain: Nurse and patient views and experiences

Objectives The overall purpose of this research programme is to develop and test the feasibility of a complex intervention for knee pain delivered by a nurse, and comprising both non-pharmacological and pharmacological interventions. In this first phase, we examined the acceptability of the non-pharmacological component of the intervention; issues faced in delivery, and resolved possible challenges to delivery. Methods Eighteen adults with chronic knee pain were recruited from the community. The intervention comprised holistic assessment, education, exercise, weight-loss advice (where appropriate) and advice on adjunctive treatments such as hot/cold treatments, footwear modification and walking aids. After nurse training, the intervention was delivered in four sessions spread over five weeks. Participants had one to one semi-structured interview at the end of the intervention. The nurse was interviewed after the last visit of the last participant. These were audio recorded and transcribed verbatim. Themes were identified by one author through framework analysis of the transcripts, and cross-checked by another. Results Most participants found the advice from the nurse easy to follow and were satisfied with the package, though some felt that too much information was provided too soon. The intervention changed their perception of managing knee pain, learning that it can be improved with self-management. However, participants thought that the most challenging part of the intervention was fitting the exercise regime into their daily routine. The nurse found discussion of goal setting to be challenging. Conclusion The nurse-led package of care is acceptable within a research setting. The results are promising and will be applied in a feasibility randomised-controlled trial.

Association between Kinesiophobia and Knee Pain Intensity, Joint Position Sense, and Functional Performance in Individuals with Bilateral Knee Osteoarthritis

In current clinical practice, fear of movement has been considered a significant factor affecting patient disability and needs to be evaluated and addressed to accomplish successful rehabilitation strategies. Therefore, the study aims (1) to establish the association between kinesiophobia and knee pain intensity, joint position sense (JPS), and functional performance, and (2) to determine whether kinesiophobia predicts pain intensity, JPS, and functional performance among individuals with bilateral knee osteoarthritis (KOA). This cross-sectional study included 50 participants (mean age: 67.10 ± 4.36 years) with KOA. Outcome measures: The level of kinesiophobia was assessed using the Tampa Scale of Kinesiophobia, pain intensity using a visual analog scale (VAS), knee JPS using a digital inclinometer, and functional performance using five times sit-to-stand test. Knee JPS was assessed in target angles of 15°, 30°, and 60°. Pearson’s correlation coefficients and simple linear regressions were used to analyze the data. Significant moderate positive correlations were observed between kinesiophobia and pain intensity (r = 0.55, p < 0.001), JPS (r ranged between 0.38 to 0.5, p < 0.05), and functional performance (r = 0.49, p < 0.001). Simple linear regression analysis showed kinesiophobia significantly predicted pain intensity (B = 1.05, p < 0.001), knee JPS (B ranged between 0.96 (0° of knee flexion, right side) to 1.30 (15° of knee flexion, right side)), and functional performance (B = 0.57, p < 0.001). We can conclude that kinesiophobia is significantly correlated and predicted pain intensity, JPS, and functional performance in individuals with KOA. Kinesiophobia is a significant aspect of the recovery process and may be taken into account when planning and implementing rehabilitation programs for KOA individuals.

Genicular Nerve Radiofrequency Ablation and Dual Subsartorial Block for Chronic Knee Pain Post Total Knee Replacement: A Case Report

Introduction. Chronic pain defines as pain persisting for three months or longer, chronic post-surgical pain can affect all dimensions of health-related quality of life, and is associated with functional limitations. treatment of chronic pain after total knee replacement is challenging, and evaluation of combined treatments and individually targeted treatments matched to patient characteristic. Genicular nerve block radiofrequency ablation is a safe and effective therapeutic procedure for pain associated with chronic pain due to knee osteoarthritis, and the evolution of newer regional analgesia techniques aids in reducing postoperative pain Dual Subsartorial Block (DSB) as a procedure specific, post total knee replacemet. historically there has been a reliance on using a pain-spesific assessment tools Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) Case Presentation. A 55-year old woman admitted she had pain on bilateral knee, the knee pain had affected her daily living, she was diagnosed with chronic knee pain post TKR because of osteoarthritis genu bilateral, the patient was planning genicular nerve radiofrequency ablation and dual subsartorial block, from the examination we found that numeric rating scale was 6 (moderate pain) with WOMAC score 76, before the procedure the patients are examined through radiology for any deformity in the knee. The genicular nerve radiofrequency ablation under ultrasound guidance on bonylandmark, resulting anesthesia of the anterior compartment of the knee, and dual subsartorial block that cover almost all the innervations of pain generating component of the anterior and posterior knee joint involved in TKR surgery. After the procedure we reevaluated the pain score using NRS was 2 (mild pain), and with WOMAC Score 19. Conclusion. Treatment of chronic pain post total knee replacemet was challenging, targeted treatment may ameliorate the pain and prevent long term disability.

Evaluating Comparing the Effects of Massage Therapy and Aromatherapy on Knee Pain, Morning Stiffness, Daily Life Function, and Quality of Life in Patients with Knee Osteoarthritis

Dear Editor, We are very happy to read this article named “Comparing the Effects of Massage Therapy and Aromatherapy on Knee Pain, Morning Stiffness, Daily Life Function, and Quality of Life in Patients with Knee Osteoarthritis” [1]. The study confirmed that massage can effectively improve the quality of life of patients with knee osteoarthritis. This provides clinicians with good health advice. We greatly appreciate the author’s research. If the research design can be improved, then the research power will be stronger. The authors used simple randomization for patient assignments. Although simple randomization is inexpensive and easy to implement, it is easy to trigger imbalances in terms of important baseline[2]. Furthermore, simple randomization may lead to i=imbalances in the number of participants randomized for each group [3]. In a small samples trial, simple randomization is not a good option for the trial. Blocked randomization may be a better choice for a small sample trial, for example, this study. On the other hand, authors should report the basis for the calculation of sample size according to the CONSORT statement [4]. The authors should consider the balance between medicine and statistics, which will be a bridge of scientific study and ethical requirements. The authors did not disclose how they determined the sample size, so we cannot evaluate whether the study reached a reasonable balance.

Synovial chondromatosis combine with synovial tuberculosis of knee joint: a case report

Backgroud Synovial chondromatosis is a rare synovial-derived metaplasia disease that comes from the formation of cartilage nodules within the synovial connective tissue of the joint. Knee tuberculosis is a disease caused mostly by the pulmonary tuberculosis and a few by tuberculosis of the digestive tract and lymphatic. tube. Case presentation Herein we report a 3-year-old child admitted by intermittent swelling of left knee joint with lameness for half a year, the patient received surgical treatment. The loose bodies filled in the joint cavity was taken out and the degenerative synovium was excised. Biopsy confirmed as synovial chondromatosis combined with synovial tuberculosis of knee joint. After 6 months follow-ups, knee swelling and claudication get totally recovered and the gait of patient recover back to normal. Conclusion Careful investigation of children with knee pain is recommended to avoid misdiagnosis, Synovial chondromatosis combine with tuberculosis should be considered a differential diagnosis in a child with knee pain.