Outcome of manipulation under anaesthesia in adhesive capsulitis patients.

Frozen shoulder although considered self remitting disease causes significant level of pain and stiffness. This study was planned to determine the immediate outcome of manipulation under anaesthesia (MUA) in patients with adhesive capsulitis in terms of gain of range of movement (ROM) and pain relief. Diagnosed cases of adhesive capsulitis (30 in number), who had symptoms of pain and stiffness lasting more than 2 months eventually underwent MUA. They were interviewed immediately before and after MUA to check the difference in pain intensity and ROM. All the subjects had significant improvement (p < 0.001) in range of motion in flexion followed by abduction and medial rotation. Least improvement (mean 2.06 / n=30) was observed in range of movement in external rotation. Significant decrease (p < 0.001) in pain intensity from mean intensity of 3.66 to 2.1 was seen. Hence, MUA is treatment indicated for those who are not responding to conservative methods of treatments.

Making evidence-based medicine (EBM) doable in developing countries: a locally-tailored workshop for EBM in a Pakistani institution.

OBJECTIVE: To demonstrate that evidence-based medicine (EBM) training can be imparted in developing countries using minimal resources. DESIGN: Development of a minimal cost workshop with validation of gain in EBM skills using the Berlin questionnaire. SETTING: Teaching hospital in Pakistan. PARTICIPANTS: Multidisciplinary faculty from The Shifa College of Medicine and Nursing, Pakistan. INTERVENTION: A 14-hour locally-tailored McMaster-style workshop, using a problem-based, learner-focused small group format, with pre- and post-workshop evaluation of EBM skills. RESULTS: Analysis of the pre- and post-Berlin questionnaires of the participants revealed that the pre-workshop Berlin questionnaire score for the group was 4.7+/-2.3, with a post-workshop Berlin score of 7.6+/-1.0 (p<0.001). CONCLUSION: EBM workshops can be locally-tailored in developing countries, where access to such workshops is generally not available. Workshops can serve to promote EBM skills in faculty, who can then help to disseminate and model concepts. The process increases awareness and interest in EBM, which in this case resulted in formation of a national platform for EBM.

Paving the way for evidence-based medicine in Pakistan.

Evidence-based Medicine (EBM) is the process of systematically reviewing, appraising and using clinical research findings to aid the delivery of optimal clinical care to patients. EBM has become popular due to: the need for valid information about diagnosis, prognosis, therapy and prevention during patient care; traditional sources such as textbooks and expert opinion being frequently out-of-date; and knowledge of current best evidence declining with time from graduation from medical college. EBM has become feasible for practicing clinicians due to: new strategies for appraising studies; availability of systematic reviews (summaries) of current best evidence; and information technology (computers with Internet access). In a resource-limited country such as Pakistan, an evidence-based approach can be cost-effective by reducing clinical practices that have no proven benefit. Commonly perceived obstacles to EBM include limited access to computers, the Internet and online resources. Reliable resources of EBM are available (such as The Cochrane Database of Systematic Reviews http://www.cochrane.org) although many of these require paid subscriptions. Another difficulty is the issue of applicability of data from other countries to patients in our setting with different socio-economic factors. Other barriers to EBM in developing countries include: inexperience in small-group learning, limited time to attend workshops, and the lack of role models for practicing EBM. We have also tried to address the common fallacies related to EBM in the hope of greater use of these skills by busy clinicians as well as academic researchers.