The effectiveness and cost-effectiveness of strength and balance Exergames to reduce falls risk for people aged 55 years and older in UK assisted living facilities: a multi-centre, cluster randomised controlled trial.

BACKGROUND: Falls are the leading cause of fatal and non-fatal unintentional injuries in older people. The use of Exergames (active, gamified video-based exercises) is a possible innovative, community-based approach. This study aimed to determine the effectiveness of a tailored OTAGO/FaME-based strength and balance Exergame programme for improving balance, maintaining function and reducing falls risk in older people. METHODS: A two-arm cluster randomised controlled trial recruiting adults aged 55 years and older living in 18 assisted living (sheltered housing) facilities (clusters) in the UK. Standard care (physiotherapy advice and leaflet) was compared to a tailored 12-week strength and balance Exergame programme, supported by physiotherapists or trained assistants. Complete case analysis (intention-to-treat) was used to compare the Berg Balance Scale (BBS) at baseline and at 12 weeks. Secondary outcomes included fear of falling, mobility, fall risk, pain, mood, fatigue, cognition, healthcare utilisation and health-related quality of life, and self-reported physical activity and falls. RESULTS: Eighteen clusters were randomised (9 to each arm) with 56 participants allocated to the intervention and 50 to the control (78% female, mean age 78 years). Fourteen participants withdrew over the 12 weeks (both arms), mainly for ill health. There was an adjusted mean improvement in balance (BBS) of 6.2 (95% CI 2.4 to 10.0) and reduced fear of falling (p = 0.007) and pain (p = 0.02) in the Exergame group. Mean attendance at sessions was 69% (mean exercising time of 33 min/week). Twenty-four percent of the control group and 20% of the Exergame group fell over the trial period. The change in fall rates significantly favoured the intervention (incident rate ratio 0.31 (95% CI 0.16 to 0.62, p = 0.001)). The point estimate of the incremental cost-effectiveness ratio (ICER) was £15,209.80 per quality-adjusted life year (QALY). Using 10,000 bootstrap replications, at the lower bound of the NICE threshold of £20,000 per QALY, there was a 61% probability of Exergames being cost-effective, rising to 73% at the upper bound of £30,000 per QALY. CONCLUSIONS: Exergames, as delivered in this trial, improve balance, pain and fear of falling and are a cost-effective fall prevention strategy in assisted living facilities for people aged 55 years or older. TRIAL REGISTRATION: The trial was registered at ClinicalTrials.gov on 18 Dec 2015 with reference number NCT02634736 .

Evaluating audio-visual falls prevention messages with community-dwelling older people using a World Café forum approach.

BACKGROUND: Falls risk increases sharply with older age but many older people are unaware or underestimate their risk of falling. Increased population-based efforts to influence older people's falls prevention behavior are urgently needed. The aim of this study was to obtain a group of older people's collective perspectives on newly developed prototypes of audio-visual (AV) falls prevention messages, and evaluate changes in their falls prevention behaviour after watching and discussing these. METHODS: A mixed-method study using a community World Café forum approach. RESULTS: Although the forum participants (n = 38) mostly responded positively to the three AV messages and showed a significant increase in their falls prevention capability and motivation after the forum, the participants collectively felt the AV messages needed a more inspirational call to action. The forum suggested this could be achieved by means of targeting the message and increasing the personal connection. Participants further suggested several alternatives to online falls prevention information, such as printed information in places in the community, as a means to increase opportunity to seek out falls prevention information. CONCLUSIONS: Falls prevention promotion messages need to be carefully tailored if they are to be more motivating to older people to take action to do something about their falls risk. A wider variety of revised and tailored AV messages, as one component of a community-wide falls prevention campaign, could be considered in an effort to persuade older people to take decisive action to do something about their falls risk. TRIAL REGISTRATION: This study was registered prospectively: NCT03154788. Registered 11 May 2017.

Feasibility of trial procedures for a randomised controlled trial of a community based group exercise intervention for falls prevention for visually impaired older people: the VIOLET study.

BACKGROUND: Visually impaired older people (VIOP) have a higher risk of falling than their sighted peers, and are likely to avoid physical activity. The aim was to adapt the existing Falls Management Exercise (FaME) programme for VIOP, delivered in the community, and to investigate the feasibility of conducting a definitive randomised controlled trial (RCT) of this adapted intervention. METHODS: Two-centre randomised mixed methods pilot trial and economic evaluation of the adapted group-based FaME programme for VIOP versus usual care. A one hour exercise programme ran weekly over 12 weeks at the study sites (Newcastle and Glasgow), delivered by third sector (voluntary and community) organisations. Participants were advised to exercise at home for an additional two hours over the week. Those randomised to the usual activities group received no intervention. Outcome measures were completed at baseline, 12 and 24 weeks. The potential primary outcome was the Short Form Falls Efficacy Scale - International (SFES-I). Participants' adherence was assessed by reviewing attendance records and self-reported compliance to the home exercises. Adherence with the course content (fidelity) by instructors was assessed by a researcher. Adverse events were collected in a weekly phone call. RESULTS: Eighteen participants, drawn from community-living VIOP were screened; 68 met the inclusion criteria; 64 participants were randomised with 33 allocated to the intervention and 31 to the usual activities arm. 94% of participants provided data at the 12 week visit and 92% at 24 weeks. Adherence was high. The intervention was found to be safe with 76% attending nine or more classes. Median time for home exercise was 50 min per week. There was little or no evidence that fear of falling, balance and falls risk, physical activity, emotional, attitudinal or quality of life outcomes differed between trial arms at follow-up. CONCLUSIONS: The intervention, FaME, was implemented successfully for VIOP and all progression criteria for a main trial were met. The lack of difference between groups on fear of falling was unsurprising given it was a pilot study but there may have been other contributory factors including suboptimal exercise dose and apparent low risk of falls in participants. These issues need addressing for a future trial. TRIAL REGISTRATION: Current Controlled Trials ISRCTN ID: 16949845 Registered: 21 May 2015.

Exploring falls prevention capabilities, barriers and training needs among patient sitters in a hospital setting: A pilot survey.

Older patients in hospitals are at high risk of falls. Patient sitters are sometimes employed to directly observe patients to reduce their risk of falling although there is scant evidence that this reduces falls. The primary aim of this pilot survey (n = 31) was to explore the patient sitters' falls prevention capability, self-efficacy and the barriers and enablers they perceived influenced their ability to care for patients during their shifts. Feedback was also sought regarding training needs. Most (90%) participants felt confident in their role. The most frequent reasons for falls identified were patient-related (n = 91, 64%), but the most frequent responses identifying preventive strategies were environment-related (n = 54, 64%), suggesting that the sitters' capability was limited. The main barriers identified to keeping patients safe from falling were patient-related (n = 36, 62%) such as cognitive impairment. However, opportunities that would enable sitters to do their work properly were most frequently categorized as being staff-related (n = 20, 83%), suggesting that the sitters have limited ability to address these barriers encountered. While 74% of sitters reported they had received previous training, 84% of participants would like further training. Patient sitters need more training, and work practice needs to be standardized prior to future research into sitter use for falls prevention.

Optimal timing of hip and knee arthroplasty after bariatric surgery: A systematic review.

Background: Obesity is a risk factor for the development of osteoarthritis and contributes to the increasing demand for total joint arthroplasty (TJA). Because a lower preoperative weight decreases the risk of complications after TJA, and because bariatric surgery (BS) can reduce weight and comorbidity burden, orthopedic surgeons often recommend BS prior to TJA in patients with obesity. However, the optimal timing of TJA after BS in terms of complications, revisions and dislocations is unknown. Methods: PubMed, Embase and Cochrane CENTRAL databases were systematically searched for any type of study reporting rates of complications, revisions and dislocations in patients who had TJA after BS. The included studies' quality was assessed using the Newcastle-Ottawa Scale. Results: Out of the 16 studies eligible for review, eight registry-based retrospective studies of high to moderate quality compared different time periods between BS and TJA and overall their results suggest little differences in complication rates. The remaining eight retrospective studies evaluated only one time period and had moderate to poor quality. Overall, there were no clear differences in outcomes after TJA for the different time frames between BS and TJA. Conclusion: The results of this systematic review suggest that there is limited and insufficient high-quality evidence to determine the optimal timing of TJA after BS in terms of the rates of complications, revisions and dislocations. Given this lack of evidence, timing of TJA after BS will have to be decided by weighing the individual patients' risk factors against the expected benefits of TJA.

Mid-term outcomes of acute and delayed total knee arthroplasty following tibial plateau fractures: A matched cohort study.

INTRODUCTION: Patients who sustain a tibial plateau fracture (TPF) have a higher risk of receiving total knee arthroplasty (TKA). Rarely, TKA is used as acute treatment for TPFs. This study aimed to compare both acute and delayed TKA following TPF with matched patients undergoing elective TKA for osteoarthritis. MATERIALS AND METHODS: A retrospective study was conducted including patients with either acute TKA as the primary treatment for TPF, or unplanned delayed TKA due to posttraumatic osteoarthritis. Both groups were matched to controls undergoing TKA for osteoarthritis. Questionnaires were completed cross-sectionally. Knee injury and Osteoarthritis Outcome Score - Physical Function Short Form (KOOS-PS), Oxford Knee Score (OKS), EQ-5D-5L, and complications were compared. RESULTS: Thirty-four TPF patients (12 acute TKA, 22 delayed TKA) were matched 1:1. Mean age was 67.2 ± 9.9 years, 82% was female, and mean follow-up was 5.0 ± 2.9 years. No differences were found for the acute group compared to their controls (median KOOS-PS 73.1 vs. 69.3, p = 0.977; median OKS 43 vs. 45, p = 0.246; median EQ-5D-5L 0.87 vs. 1.00, p = 0.078). In the delayed group, scores were inferior compared to their controls (median KOOS-PS 63.9 vs 78.0, p = 0.003; median OKS 39 vs 44, p = 0.001; median EQ-5D-5L 0.81 vs 0.87, p = 0.008). Complications showed no significant differences. CONCLUSION: Acute TKA for TPF shows no difference to a matched group of elective TKA, but delayed TKA following TPF yields worse results at mean 5-year follow-up. This suggests that TPFs in patients with a high risk of ultimately requiring TKA may benefit from primary treatment with TKA.

Usability of a novel Hounsfield units measurement procedure to quantify intercorporal bone graft remodeling in patients after posterior lumbar interbody fusion: a case series.

BACKGROUND: There is a lack of knowledge about the biological process of intercorporal bone graft remodeling after posterior lumbar interbody fusion surgery and whether this process is associated with changes in back pain and intercorporal fusion status. As an alternative to the commonly used but unreliable fusion criteria, Hounsfield units can be used to quantify biological activity and changes in bone mineral content. However, studies assessing Hounsfield units conducted to date do not provide sufficient details about how the bone grafts were segmented to measure the Hounsfield units to allow for replication, and did not assess individual patient trends in graft changes over time. Using the data of nine patients after posterior lumbar interbody fusion, a novel Hounsfield units measurement procedure was developed and used to explore its usability to quantify the bone graft remodeling process. CASE DETAILS: We report a case series of nine patients (six male, three female, mean age 64 years, all Caucasian) who all had computed tomography scans performed at 1 and 2 years after posterior lumbar interbody fusion surgery. Overall, seven out of the nine (78%) cases had a 3-41% increase in their bone grafts' Hounsfield units between 1 and 2 years after surgery. The cases showed large interindividual variability in their Hounsfield units values over time, which coincided with varying levels of back pain and intercorporal fusion status. CONCLUSION: The Hounsfield units measurement procedure used for this case series may be useful to quantify intercorporal bone graft remodeling in patients after posterior lumbar interbody fusion, and may be used as an adjunct diagnostic measure to monitor bone graft remodeling over time. Future research is warranted to explore how to interpret bone graft Hounsfield units-values and Hounsfield units trajectories in light of clinical variables or intercorporal fusion status.

Clinical Utility of An Intervertebral Motion Metric for Deciding on the Addition of Instrumented Fusion in Degenerative Spondylolisthesis.

STUDY DESIGN: A prospective single-arm clinical study. OBJECTIVE: To explore the clinical utility of an intervertebral motion metric by determining the proportion of patients for whom it changed their surgical treatment plan from decompression only to decompression with fusion or vice versa. SUMMARY OF BACKGROUND DATA: Lumbar spinal stenosis (LSS) from degenerative spondylolisthesis is commonly treated with decompression only or decompression with additional instrumented fusion. An objective diagnostic tool capable of establishing abnormal motion between lumbar vertebrae to guide decision-making between surgical procedures is needed. To this end a metric, based on the vertebral sagittal plane translation-per-degree-of-rotation (TPDR) calculated from flexion-extension radiographs, was developed. METHODS: First, spine surgeons documented their intended surgical plan. Subsequently, the participants' flexion-extension radiographs were taken. From these the TPDR was calculated and reported as a Sagittal Plane Shear Index (SPSI). The SPSI metric of the spinal level intended to treat was used to decide if the intended surgical plan needed to be changed or not. RESULTS: SPSI was determined for 75 participants. Of these, 51 (68%) had an intended surgical plan of decompression only and 24 (32%) decompression with fusion. In 63% of participants the SPSI was in support of their intended surgical plan. For 29% of participants the surgeon changed the surgical plan after the SPSI metric became available to them. A suggested change in surgical plan was overruled in 8% of participants. The final surgical plan was decompression only for 59 (79%) and decompression with fusion for 16 (21%) participants. CONCLUSION: The 29% change in intended surgical plans suggested that SPSI was considered by spine surgeons as an adjunct metric in deciding whether to perform decompression only or or to add instrumented fusion. This change exceeded the a priori defined 15% considered necessary to show potential clinical utility of SPSI.

The concurrent validity and reliability of virtual reality to measure shoulder flexion and scaption range of motion.

BACKGROUND: Shoulder pain commonly has a detrimental impact on patient's work and social activities. Although pain is the most common reason for seeking care, a reduction in shoulder range of motion (ROM) is another common impairment. ROM assessment is used as an evaluation tool and multiple methods are available to measure shoulder ROM. Virtual reality (VR) has been introduced into shoulder rehabilitation, mostly when exercise and ROM measurement is indicated. This study evaluated the concurrent validity and system reliability of active ROM measurements of VR for people with and without shoulder pain. METHODS: Forty volunteers participated in this study. Virtual goniometry was used to assess active shoulder ROM. Participants performed flexion and scaption to six predetermined angles. Measurements from the VR goniometer and smartphone inclinometers were recorded simultaneously. To assess reliability, two identical test sequences were performed. RESULTS: The concurrent validity ICCs were 0.93 for shoulder flexion and 0.94 for shoulder scaption. The VR goniometer application on average systematically overestimated the ROM compared to the smartphone inclinometer. The mean difference between goniometer values was -11.3 degrees for flexion and -10.9 for scaption. The system reliability was excellent with an overall ICC of 0.99 for the flexion movements and 0.99 for the scaption movements. CONCLUSION: Although the VR system demonstrated excellent reliability, and high ICC's for concurrent validity, the large range between the lower and upper 95% CI limits suggests it lacks measurement precision. This suggests VR, as used in this study, should not be used interchangeably with other measurement tools. CONTRIBUTION OF THE PAPER.

No difference in bacterial contamination of hip capsule sutures and control sutures in hip arthroplasty surgery.

BACKGROUND: Perioperative preventive measures are important to further reduce the rate of periprosthetic joint infections (PJI) in patients undergoing total hip arthroplasty (THA). During THA surgery, joint capsule sutures are commonly placed to optimize exposure and reinsertion of the capsule. Bacterial contamination of these sutures during the procedure poses a potential risk for postoperative infection. In this exploratory study, we assessed the contamination rate of capsule sutures compared to the contamination of the remains of exchanged control sutures at the time of closure. METHODS: In 100 consecutive patients undergoing primary THA capsule sutures were exchanged by sterile sutures at the time of capsule closure. Both the original sutures and the remainder of the newly placed (control) sutures were retrieved, collected and cultured for ten days. Types of bacterial growth and contamination rates of both sutures were assessed. RESULTS: Sutures from 98 patients were successfully collected and analyzed. Bacterial growth was observed in 7/98 (7.1%) of the capsule sutures versus 6/98 (6.1%) of the control sutures, with a difference of 1% [CI -6-8]. There was no clear pattern in differences in subtypes of bacteria between groups. CONCLUSIONS: This study showed that around 7% of capsule sutures used in primary THA were contaminated with bacteria and as such exchange by new sutures at the time of capsule closure could be an appealing PJI preventive measure. However, since similar contamination rates were encountered with mainly non-virulent bacteria for both suture groups, the PJI preventive effect of this measure appears to be minimal.

External Validation of Prediction Models for Surgical Complications in People Considering Total Hip or Knee Arthroplasty Was Successful for Delirium but Not for Surgical Site Infection, Postoperative Bleeding, and Nerve Damage: A Retrospective Cohort Study.

Although several models for the prediction of surgical complications after primary total hip or total knee replacement (THA and TKA, respectively) are available, only a few models have been externally validated. The aim of this study was to externally validate four previously developed models for the prediction of surgical complications in people considering primary THA or TKA. We included 2614 patients who underwent primary THA or TKA in secondary care between 2017 and 2020. Individual predicted probabilities of the risk for surgical complication per outcome (i.e., surgical site infection, postoperative bleeding, delirium, and nerve damage) were calculated for each model. The discriminative performance of patients with and without the outcome was assessed with the area under the receiver operating characteristic curve (AUC), and predictive performance was assessed with calibration plots. The predicted risk for all models varied between <0.01 and 33.5%. Good discriminative performance was found for the model for delirium with an AUC of 84% (95% CI of 0.82-0.87). For all other outcomes, poor discriminative performance was found; 55% (95% CI of 0.52-0.58) for the model for surgical site infection, 61% (95% CI of 0.59-0.64) for the model for postoperative bleeding, and 57% (95% CI of 0.53-0.61) for the model for nerve damage. Calibration of the model for delirium was moderate, resulting in an underestimation of the actual probability between 2 and 6%, and exceeding 8%. Calibration of all other models was poor. Our external validation of four internally validated prediction models for surgical complications after THA and TKA demonstrated a lack of predictive accuracy when applied in another Dutch hospital population, with the exception of the model for delirium. This model included age, the presence of a heart disease, and the presence of a disease of the central nervous system as predictor variables. We recommend that clinicians use this simple and straightforward delirium model during preoperative counselling, shared decision-making, and early delirium precautionary interventions.

Lumbar Epidural Lipomatosis is Increased in Patients With Morbid Obesity and Subsequently Decreases After Bariatric Surgery.

BACKGROUND: Spinal epidural lipomatosis (SEL) is characterized by symptomatic neurogenic compression from adipose tissue in the spinal canal. The question arises whether patients with morbid obesity have higher volumes of epidural adipose tissue (EAT) in their lumbar spinal canal compared with patients with a normal weight, and to what extent this decreases after bariatric surgery. METHODS: In this explorative study the lumbar EAT volume was assessed in 25 patients with morbid obesity (body mass index [BMI] >40) using available lumbar magnetic resonance imaging (MRI) prior to their bariatric surgery. An age- and sex-matched control group (n = 25) of patients with a normal weight (BMI 20-25) was used for comparison. Participants from the obesity group underwent a postoperative control MRI. RESULTS: The mean volume of EAT per MRI slice of the group of patients with obesity was significantly higher than for the group of patients with normal weight (mean: 83.3 ± 30.7 mm3 vs. mean 56.5 ± 25 mm3; P < 0.001). Fifteen participants with obesity (15 of 25) agreed to undergo a follow-up MRI. There was a significant decrease in EAT volume per MRI slice for these 15 participants (mean 82 ± 25.5 mm3 vs. 46 ± 20.0 mm3; P < 0.001) over time up to 3.6 (range: 1.2-6.0) years after bariatric surgery. CONCLUSIONS: Patients with obesity have significantly larger volumes of EAT in comparison with patients with normal weight. After bariatric surgery, a significant weight loss coincided with a significant volumetric reduction of this adipose tissue in the spinal canal. Future prospective studies in patients with symptomatic SEL may elucidate whether decreases in EAT volume influence concurrent neurogenic claudication symptoms.

The concordance between preoperative synovial fluid culture and intraoperative tissue cultures in periprosthetic joint infection: a systematic review.

Background: this systematic review aims to evaluate the concordance between preoperative synovial fluid culture and intraoperative tissue cultures in patients with periprosthetic joint infection (PJI) undergoing total hip (THA) or knee arthroplasty (TKA) revision surgery. Methods: this review was conducted in accordance with the preferred reporting items for a systematic review and meta-analysis of diagnostic test accuracy studies (PRISMA-DTA) statement. Cochrane, Embase, PubMed, and Web of Science databases were searched to identify studies involving patients who had THA or TKA revision surgery for PJI and for whom preoperative synovial fluid culture and intraoperative tissue cultures were performed. Studies were only included if the diagnosis of PJI was based on the EBJIS (the European Bone and Joint Infection Society) or MSIS (Musculoskeletal Infection Society) criteria. Risk of bias was assessed using an amended version of Joanna Briggs Institute's (JBI) critical appraisal checklist for case series. Results: seven studies were included in this review comprising 1677 patients. All studies had a retrospective study design and five studies explored patients undergoing revision surgery of THA or TKA. Concordance rates varied between 52 % and 79 %, but different authors defined and calculated concordance differently. Six studies were judged as having an unclear to high risk of bias and one study as having a low risk of bias. Conclusions: the included studies showed a wide range of concordance rates between preoperative synovial fluid culture and intraoperative tissue cultures and the majority of studies had a high risk of bias. Higher-quality studies are warranted to obtain a more accurate estimate of this concordance rate. We recommend continuing the use of a system such as the EBJIS definition or MSIS criteria when diagnosing PJI.

Arm motor control as predictor for hypertonia after stroke: a prospective cohort study.

OBJECTIVES: To analyze the development of hypertonia in the hemiparetic elbow flexors, and to explore the predictive value of arm motor control on hypertonia in a cohort of first-ever stroke survivors in the first 6 months poststroke. DESIGN: A prospective cohort study. SETTING: A cohort of stroke survivors from a large, university-affilliated hospital in The Netherlands. PARTICIPANTS: Patients (N=50) with first-time ischemic strokes and initial arm paralysis who were admitted to a stroke unit. INTERVENTIONS: Not applicable. MAIN OUTCOME MEASURES: At 48 hours, 10 to 12 days, 3 and 6 months poststroke, hypertonia and arm motor control were assessed using the Modified Ashworth Scale and the Fugl-Meyer Assessment arm score. RESULTS: The incidence rate of hypertonia reached its maximum before the third month poststroke (30%). Prevalence was 42% at 3 and 6 months. Participants with poor arm motor control at 48 hours poststroke were 13 times more likely to develop hypertonia in the first 6 months poststroke than those with moderate to good arm motor control. These results were not confounded by the amount of arm function training received. CONCLUSIONS: Hypertonia develops in a large proportion of patients with stroke, predominantly within the first 3 months poststroke. Poor arm motor control is a risk factor for the development of hypertonia.

Views and experiences of visually impaired older people and exercise instructors about the Falls Management Exercise programme: a qualitative study.

PURPOSE: To gain insight into visually impaired older people's views regarding acceptability of an adapted Falls Management Exercise programme, and to explore Postural Stability Instructors's perspectives on provision of the programme. MATERIALS AND METHODS: Data from this qualitative study comprised interviews with nine visually impaired older people and two Postural Stability Instructors. Data were analysed using thematic analysis. RESULTS: Themes identified from interviews with the participants related to self-perception, exercise-related factors and facilitators to participation. Participants positioned themselves as not old or at risk of falls, felt exercises were not challenging enough and recommended that home exercise materials be offered in individually tailored formats. Themes identified from interviews with the instructors related to programme adaptations for visual impairments, exercises and facilitators to participation. Instructors recommended stratifying groups into levels of ability. Social time after the exercise sessions was deemed key in programme adherence by both participants and instructors. CONCLUSIONS: Visually impaired older people have similar barriers and facilitators to group-based falls prevention sessions as older people without visual impairment, but seem to have more difficulties in motivation to exercise at home. Both participants and instructors felt the main facilitator to adherence to group exercise sessions was the social time.Implications for rehabilitationVisually impaired older people have similar barriers and facilitators to group-based falls prevention sessions as older people without visual impairment, but seem to have more difficulties in motivation to exercise at home.Key recommended adaptations for falls prevention interventions in visually impaired older people include offering individually-tailored home exercise materials, stratifying groups into level of ability and involving social time.The social time after the exercise sessions was key in programme adherence.

The (un)necessity of regular postoperative follow-up of hemiarthroplasty for femoral neck fractures.

BACKGROUND: Postoperative follow-up after hemiarthroplasty is part of routine based practice. However, these visits appear to be a significant burden since it concerns a frail population. The aim of this study was to confirm the current common practice regarding postoperative visits of patients treated with hemiarthroplasty and to evaluate the complication detection rate at these visits. METHODS: A national short survey was conducted among orthopedic surgeons working in 26 large Dutch teaching hospitals to test the hypothesis that postoperative follow-up is indeed common practice. Furthermore, a retrospective patient review was performed in all hemiarthroplasties implanted between January 2014 and December 2019. RESULTS: The response of the national survey was complete and showed that postoperative follow-up in patients treated with hemiarthroplasty is part of standard care according to 89% of respondents. A total of 1055 hips (1026 patients) were implanted with hemiarthroplasty during the studied period. Implant-related complications were identified in 68 hemiarthroplasties, with 31 of these hips going on to reoperation. Only 2 of these complications were picked up at standard planned follow-up leading to a complication detection rate of 0.3%. In contrast, complication detection rates of 47% and 16% were found at unplanned visits at the Emergency Department and the outpatient department, respectively. CONCLUSIONS: Postoperative follow-up in patients treated with hemiarthroplasty is still the standard of care. However, this study revealed that the majority of implant-related complications are detected at unplanned visits and almost no at standard follow-up visits. Postoperative follow-up of patients treated with hemiarthroplasty could be abandoned in this frail population.

The influence of bariatric surgery on hip and knee joint pain: a systematic review.

Obesity increases the risk of osteoarthritis and the chance of needing joint replacement arthroplasty to reduce lower limb joint pain. Although nonsurgical weight loss interventions can reduce hip and knee joint pain, bariatric surgery may be a more feasible treatment option for people with severe obesity. However, it is unclear whether weight loss through bariatric surgery can positively influence hip and knee joint pain. Our objective was to evaluate the influence of bariatric surgery on hip and knee joint pain in people with obesity by conducting a systematic review of the literature. The PubMed, EMBASE, and Cochrane bibliographic databases were searched for studies published between 1947 and September 2019. Risk of bias of the identified studies was independently assessed by 2 reviewers using JBI's Critical Appraisal Checklist for Case Series and the Newcastle-Ottawa Scale. This review included 23 studies, all of which evaluated knee pain and 9 of which also evaluated hip pain. Reported results regarding hip pain intensity and the proportion of participants with hip pain were too limited to draw useful conclusions. Reported results regarding knee pain suggest that weight loss after bariatric surgery reduced knee pain intensity, as well as the proportion of participants with knee pain. The overall risk of bias of the majority of included studies (83%; n = 19) was judged to be unclear to high. Four small studies were judged as having a low risk of bias. Results of this systematic review suggest that bariatric surgery can positively influence hip and knee joint pain, but conclusive evidence is lacking because most of the included studies were judged as having plausible bias overall and in their key domains. Well-designed randomized controlled trials evaluating the influence of bariatric surgery on hip and knee joint pain using standardized joint pain measures are needed.

Does Free-Text Information in Falls Incident Reports Assist to Explain How and Why the Falls Occurred in a Hospital Setting?

OBJECTIVE: The aim of this study was to explore whether information captured in falls reports in incident management systems could be used to explain how and why the falls occurred, with a view to identifying whether such reports can be a source of subsequent learnings that inform practice change. METHODS: An analysis of prospectively collected falls incident reports found in the incident management systems from eight Western Australian hospitals during a stepped-wedge cluster-randomized controlled trial. The falls reported occurred in a cohort of older hospital patients (mean age = 82 y) on rehabilitation wards. Data coded from free-text comments in the incident reports were analyzed using deductive content analysis. RESULTS: In the 493 analyzed falls incident reports, qualitative information describing aspects of the fall that clarified the patient, staff, and environment-related contributory factors was consistently low. Reports infrequently contained information about patients' and staff's call bell use behaviors (13%-19% of reports), fidelity of implementation of the care plan (8%) or environment-related factors such as bed settings (20%), and presence of clutter at the fall location (1%). The patients' account of the fall was present in less than 50% of reports, with an absence of concurrent text, which explained whether patient cognitive impairment was the reason for not obtaining this first-person account of the incident. CONCLUSIONS: Falls reports in hospital incident management systems may not capture adequate information to explain how and why falls occur. This could limit creation of effective feedback loops to drive quality improvement efforts and targeted practice change.

Exploring hospital patient sitters' fall prevention task readiness: A cross-sectional survey.

RATIONALE, AIMS, AND OBJECTIVES: Patient sitters provide one-to-one care for hospital patients at high risk of falls. The study aimed to explore patient sitters' task readiness to assist in fall prevention on hospital wards. METHOD: We conducted a cross-sectional survey. Respondents were patient sitters working in five hospitals providing medical, surgical, and aged care. The survey was developed using a theory of health behaviour change and used closed and open-ended items. Qualitative data were analysed using deductive content analysis. RESULTS: Participants (n = 90) identified that patient factors, such as confusion, were the most frequent cause of falls (n = 338, 74%); however, the most frequent strategies identified to prevent falls were focused on the environment (n = 164, 63%). The most frequent barrier participants identified to preventing falls (n = 124, 67%) also pertained to patients, including aggressive patient behaviours. In contrast, staff factors, such as handovers being adequate, were identified as the main enabler for sitters being able to complete their tasks effectively (n = 60, 81%). Participants strongly suggested (71%) that further, preferably practical, training would be helpful, even though 84% reported receiving prior fall prevention training. Nearly all participants (98%) were motivated to prevent their patients from falling. CONCLUSIONS: There is a gap between what patient sitters report as the cause of falls (patient factors) and what was suggested to prevent falls (environment factors). Education and practical training addressing challenging patient behaviours may improve sitters' task readiness to assist in preventing falls on wards. Improving communication and cooperation between patient sitters and nursing staff is also important.

Evaluating a Novel Multifactorial Falls Prevention Activity Programme for Community-Dwelling Older People After Stroke: A Mixed-Method Feasibility Study.

PURPOSE: The overall purpose of this study was to explore participants' and physiotherapists' experiences regarding the acceptability, implementation, and practicality of a novel group-based multifactorial falls prevention activity programme for community-dwelling older people after stroke. Specifically, the purpose was to explore if and how participating could impact on the participants' health-related quality of life (HRQoL) in terms of their daily lived experience regarding physical, mental, emotional and social well-being. A secondary purpose was to explore whether participating in the programme could positively influence participants' balance, strength, falls efficacy, mobility and motor impairment of the trunk. MATERIALS AND METHODS: This was an exploratory mixed-method Phase I feasibility study. A convenience sample of five older community-dwelling people after stroke participated in a novel eight-week multifactorial activity programme which included falls education, a mix of individually tailored and group-based strength and balance exercises, exploring limits of stability and safe landing techniques and a social element. Qualitative data from post-intervention interview transcripts with the participants and the physiotherapists who delivered the programme were thematically analysed using both deductive and inductive approaches to explore the participants' and therapists' experiences with the programme. Quantitative outcomes included balance, strength, falls efficacy, mobility and motor impairment of the trunk. RESULTS: The programme was deemed feasible in terms of acceptability, implementation and practicality by the participants as well as the physiotherapists delivering the programme. The overarching theme regarding HRQoL identified that participating in the programme was perceived to empower the participants living with stroke and positively influenced their daily physical, mental, emotional and social well-being. Participant outcomes showed a change in the direction of improvements in balance, strength, mobility, motor impairment of the trunk and reduced concerns about falling. Subjectively, participants only reported perceived improvements in balance and strength. CONCLUSION: Running a novel multifactorial falls prevention activity programme for older community-dwelling people after stroke was feasible. Participating in the programme helped participants to perceive improved balance, strength and empower them to make meaningful changes, improving their daily lived experiences. A future fully powered study could build on these results to investigate physical improvements, prevention of falls and improvements to domains of HRQoOL.