Healthcare Professionals' Decision-Making Regarding Lumbar Fusion Surgery or Conservative Care for Adults With Severe, Persistent Low Back Pain: An Australian Cross-Sectional Survey Using Case Vignettes.

Study DesignCross-sectional Survey.ObjectivesThe objective of this study was to describe clinicians' decision-making regarding suitability of patient cases for lumbar fusion surgery or conservative care and the level of equipoise to randomise participants into a randomised controlled trial (RCT).MethodsAn online survey distributed via Australian professional networks to clinicians involved in low back pain care, collected data on clinical discipline, clinical experience, practice setting and preferred care of five patient case vignettes (ranging in age, pain duration, BMI, imaging findings, neurological signs/symptoms).

Comfortable knowing little about lymphoedema? A qualitative study of medical interns in Australia.

Objectives: Knowledgeable doctors are needed for timely assessment, diagnosis and management of lymphoedema. This qualitative study explored the thoughts and feelings of Australian interns (medical graduates in their first postgraduate year) towards (i) their understanding of the lymphatic system and lymphoedema, (ii) curricula pertaining to lymphoedema within their Australian medical degree and (iii) how they perceive that their understanding and medical training in lymphoedema influence their clinical practice.

Study Design And Methods: Qualitative semistructured interviews were conducted with interns employed within their first postgraduate year in Australia.

Exploring Congruence Between Patient and Clinician Expectations of Benefit in the Non-Surgical Management of Common Musculoskeletal Conditions in Tertiary Care.

Background: Patient and clinician expectations of benefit from recommended management approaches may potentially impact the success of managing musculoskeletal conditions.

Methods: This was a multisite study in an advanced practice musculoskeletal service across Queensland, Australia. Relationships between patient and clinician (advanced physiotherapy practitioner) expectations of benefit, patient characteristics, and clinical outcome recorded 6 months later were explored with regression analysis in 619 patients undergoing non-surgical multidisciplinary care for either knee osteoarthritis (n = 286), low back pain (n = 249) or shoulder impingement syndrome (n = 84).

Lumbar spine fusion surgery versus best conservative care for patients with severe, persistent low back pain.

Aims: People with severe, persistent low back pain (LBP) may be offered lumbar spine fusion surgery if they have had insufficient benefit from recommended non-surgical treatments. However, National Institute for Health and Care Excellence (NICE) 2016 guidelines recommended not offering spinal fusion surgery for adults with LBP, except as part of a randomized clinical trial. This survey aims to describe UK clinicians' views about the suitability of patients for such a future trial, along with their views regarding equipoise for randomizing patients in a future clinical trial comparing lumbar spine fusion surgery to best conservative care (BCC; the FORENSIC-UK trial).

Exploring equity of care for Aboriginal and Torres Strait Islander peoples within the state-wide Musculoskeletal Physiotherapy Screening Clinic and Multi-disciplinary Service in Queensland Health.

Objective This study aimed to explore equity of care for Aboriginal and Torres Strait Islander peoples compared to non-Indigenous Australians within a Queensland-wide musculoskeletal service. Method The service database was analysed between July 2018 and April 2022 across 18 Queensland Health facilities. Representation of Aboriginal and Torres Strait Islander peoples within the service's patient population was first explored.

Pain Education and Virtual Reality Improves Pain, Pain-related Fear of Movement, and Trunk Kinematics in Individuals With Persistent Low Back Pain.

Objectives: To evaluate the effect of combining pain education and virtual reality (VR) exposure therapy using a cognitive-behavioral therapy-informed approach (virtual reality-based cognitive behavioral therapy [VR-CBT]) on pain intensity, fear of movement, and trunk movement in individuals with persistent low back pain.

Materials And Methods: Thirty-seven participants were recruited in a single cohort repeated measures study, attending 3 sessions 1 week apart. The VR-CBT intervention included standardized pain education (session 1) and virtual reality-based exposure therapy (VRET; session 2) incorporating gameplay with mixed reality video capture and reflective feedback of performance.

Prospective validity of a clinical prediction rule for response to non-surgical multidisciplinary management of knee osteoarthritis in tertiary care: a multisite prospective longitudinal study.

Objectives: We tested a previously developed clinical prediction tool-a nomogram consisting of four patient measures (lower patient-expected benefit, lower patient-reported knee function, greater knee varus angle and severe medial knee radiological degeneration) that were related to poor response to non-surgical management of knee osteoarthritis. This study sought to prospectively evaluate the predictive validity of this nomogram to identify patients most likely to respond poorly to non-surgical management of knee osteoarthritis.

Design: Multisite prospective longitudinal study.

Improving multidisciplinary management of patients living with obesity: The evaluation of seated bioimpedance measures and relationship to functional performance following targeted intervention.

Management of obesity requires a multidisciplinary approach including physical activity interventions, which have significant impacts on overall health outcomes. Greater levels of lean muscle mass are significantly associated with improved health and reduced risk of comorbidities and should be preserved where possible when undertaking rapid weight loss. This article reports on the physical and functional outcomes achieved during a 12-week intensive multidisciplinary intervention targeting obesity and evaluates correlations between body composition and functional outcomes.

Performance of key physical tests for temporomandibular disorder via telehealth: Establishing validity and reliability.

Background: During the COVID-19 pandemic, many individuals sought healthcare virtually. Physiotherapy is integral in managing temporomandibular disorders (TMDs); therefore, establishing how key physical tests can be appropriately adapted to telehealth is paramount.

Objectives: To establish the validity and reliability of telehealth (specifically videoconferencing) assessments against in-person assessments on a battery of TMD physical tests.

Distress in the care of people with chronic low back pain: insights from an ethnographic study.

Introduction: Distress is part of the experiences and care for people with chronic low back pain. However, distress is often pathologised and individualised; it is seen as a problem within the individual in pain and something to be downplayed, avoided, or fixed. To that end, we situate distress as a normal everyday relational experience circulating, affecting, moving in, through, and across bodies.

Does the method of telehealth delivery affect the physiotherapy management of adults with bleeding disorders? A comparison of audioconferencing and videoconferencing.

Aim: To determine whether the method of telehealth delivery (audioconferencing or videoconferencing) affects the physiotherapy management of adults with inherited bleeding disorders.

Methods: A cross-sectional observational study was utilised involving 40 physiotherapy consultations (23 initial consultations and 17 follow-up consultations) of adults (>18) with a diagnosed bleeding disorder. Each consultation involved an initial audioconferencing component followed immediately by a separate videoconferencing component.

The impact of Three-Dimensional Gait Analysis in adults with pathological gait on management recommendations.

Background: Three-Dimensional Gait Analysis (3DGA) is a gold standard tool that can help identify pathological components of walking patterns. It has been well established that this tool influences the treatment decision making of clinicians treating paediatric patients with Cerebral Palsy, but it has not been established whether this tool changes decision making of clinicians treating adults with complex pathological gait.

Research Question: To investigate the impact of pre-treatment 3DGA on treatment plans and management of adults with complex pathological gait.

Adherence to recommended guidelines for low back pain presentations to an Australian emergency department: Barriers and enablers.

Objective: This study sought to evaluate the adherence to guidelines for the management of mechanical Low Back Pain within a single tertiary metropolitan Emergency Department setting. Our objectives were: METHODS: A two-stage multi-methods study design was undertaken. Stage 1 involved a retrospective chart audit of patients presenting with a diagnosis of mechanical Low Back Pain to establish documented adherence to clinical guidelines.

People at a persistent pain service can walk it, but some struggle to talk about it: Reliability, detectable difference and clinically important difference of the six-minute walk test.

Objectives: The six-minute walk test (6MWT) is a commonly used measure of functional capacity. This study is the first to investigate the test-retest reliability, minimal detectable difference (MDD) and the minimal clinically important difference (MCID) for people attending a persistent pain service. Relationships between change in 6MWT performance and change in self-reported physical, functional and psychological outcome measures were also explored.

The impact of exercise intended for fitness or sport on the prevalence of non-specific neck pain in adults: A systematic review.

Objective: This study systematically reviewed the literature investigating the relationship between participation in exercise intended to improve fitness or sport and the prevalence of non-specific neck pain in adults. A secondary objective evaluated if exercise characteristics (frequency, and total duration of weekly exercise) impacted any observed relationship between this form of exercise and neck pain prevalence.

Design: Narrative systematic review.

Disparities in Service and Clinical Outcomes in State-Wide Advanced Practice Physiotherapist-Led Services.

This study explored variations in the primary service and clinical outcomes of a state-wide advanced practice physiotherapist-led service embedded in public medical specialist orthopaedic and neurosurgical outpatient services across Queensland, Australia. An audit of the service database over a six-year period was taken from 18 service facilities. The primary service and clinical outcomes were described.

A multisite longitudinal evaluation of patient characteristics associated with a poor response to non-surgical multidisciplinary management of low back pain in an advanced practice physiotherapist-led tertiary service.

Background: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service.

Methods: Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study.

Mobility levels of acute medical patients: Is behavioural mapping comparable to accelerometry?

Objective: To (1) determine agreement between behavioural mapping and accelerometry for measuring mobility levels in an acute medical inpatient setting and to (2) explore and compare the required resources and costs for both methods.

Design: Observational cross-sectional study.

Setting: Tertiary referral teaching hospital in Brisbane, Australia.

Patient characteristics associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis: a multisite prospective longitudinal study in an advanced practice physiotherapist-led tertiary service.

Objectives: To explore patient characteristics recorded at the initial consultation associated with a poor response to non-surgical multidisciplinary management of knee osteoarthritis (KOA) in tertiary care.

Design: Prospective multisite longitudinal study.

Setting: Advanced practice physiotherapist-led multidisciplinary orthopaedic service within eight tertiary hospitals.