Patient gender does not influence referral to an orthopaedic surgeon by advanced practice orthopaedic providers: a prospective observational study in Canada.

BACKGROUND: The role of an advanced practice physiotherapist has been introduced in many countries to improve access to care for patients with hip and knee arthritis. Traditional models of care have shown a gender bias, with women less often referred and recommended for surgery than men. This study sought to understand if patient gender affects access to care in the clinical encounter with the advanced practice provider. Our objectives were: (1) To determine if a gender difference exists in the clinical decision to offer a consultation with a surgeon; (2) To determine if a gender difference exists in patients' decisions to accept a consultation with a surgeon among those patients to whom it is offered; and, (3) To describe patients' reasons for not accepting a consultation with a surgeon. METHODS: This was a prospective study of 815 patients presenting to a tertiary care centre for assessment of hip and knee arthritis, with referral onward to an orthopaedic surgeon when indicated. We performed a multiple logistic regression analysis adjusting for severity to address the first objective and a simple logistic regression analysis to answer the second objective. Reasons for not accepting a surgical consultation were obtained by questionnaire. RESULTS: Eight hundred and fifteen patients (511 women, 304 men) fulfilled study eligibility criteria. There was no difference in the probability of being referred to a surgeon for men and women (difference adjusted for severity = - 0.02, 95% CI: - 0.07, 0.02). Neither was there a difference in the acceptance of a referral for men and women (difference = - 0.05, 95% CI: - 0.09, 0.00). Of the 14 reasons for declining a surgical consultation, 5 showed a difference with more women than men indicating a preference for non-surgical treatment along with fears/concerns about surgery. CONCLUSIONS: There is no strong evidence to suggest there is a difference in proportion of males and females proceeding to surgical consultation in the model of care that utilizes advanced practice orthopaedic providers in triage. This study adds to the evidence that supports the use of suitably trained alternate providers in roles that reduce wait times to care and add value in contexts where health human resources are limited. The care model is a viable strategy to assist in managing the growing backlog in orthopaedic care, recently exacerbated by the COVID-19 pandemic.

Discordance between self-report and performance-based outcomes: Contribution of psychosocial factors.

The purpose of this study was to examine the role of psychosocial factors in the discordance between perceived and observed physical disability in patients with osteoarthritis of the hip or knee joint. This was a cross-sectional study of patients seen for consideration of joint arthroplasty surgery. Patients completed a psychosocial outcome measure, a patient self-reported functional scale, and two performance-based tests. Data of 121 patients, mean age, 67 (8), 81 (67%) females were used for analysis. The fear avoidance and positive affect domains had the strongest association with the discordance between the self-report and both performance outcome measures. Age, gender, and severity of osteoarthritis were associated with discordance in relation to walking. Fear avoidance beliefs and positive affect play important roles in perception of pain and function. Age, gender, and severity of arthritis should be taken into consideration for a more holistic approach to arthritis care.

Virtual performance measure in osteoarthritis: An innovative transformation of patient care.

Objectives: The purpose of this study was to develop and establish reliability and validity of a virtual performance measure (VPM) score that encompassed 10 videos in patients with osteoarthritis of the knee joint. Patients' experience and satisfaction were documented. Design: Forty videos were chosen for 10 functional tasks, with four videos showing increasing difficulty for each task. Patients were requested to choose the video that best reflected their own situation. Clinical and radiological findings and self-report and performance measures were completed. Results: Data of 100 patients, 70 (70%) females, mean age: 65 â€‹± â€‹9 were examined. The Cronbach's alpha coefficient that examined internal consistency of the VPM score was 0.92. The intraclass correlation value of 0.82 was obtained for test-retest reliability. Factor analysis showed three distinct domains. There was moderate correlations between the VPM score and the self-report and actual performance measures ranging from r â€‹= â€‹0.46 to 0.66. The VPM summated score of 10 activities was able to differentiate between candidates and non-candidates for knee arthroplasty, with the area under the curve value of 0.90 indicating excellent predictive validity. The overall patient experience and satisfaction was positive with 67% of participants feeling that virtual care could have an impact on minimizing physical presence in the clinic or hospital. Conclusions: The VPM is a reliable and valid outcome measure in patients with osteoarthritis of the knee joint. This digital tool has the potential to transform osteoarthritis care by providing a valid remote measurement of real-life functional limitations and reduce the burden of time consuming in-person tests.

Patients' perceptions of navigating "the system" for arthritis management: are they able to follow our recommendations?

PURPOSE: To understand whether a visit to a Hip/Knee Arthritis Assessment Centre (AC), where non-surgical candidates with arthritis are directed toward community resources and provided with a conservative treatment "prescription," contributes to patients' self-management and ability to access community resources. METHODS: A purposive sample of non-surgical patients was contacted 3-10 months after their AC visit. Three focus groups (n=20) and 20 semi-structured telephone interviews were conducted. Transcripts were systematically coded and analyzed using a qualitative descriptive research methodology. RESULTS: While participants generally reported that the AC visit improved self-management, analysis identified an emergent theme about the inadequacy of conservative management in general, subdivided into two sub-themes related to (1) limited access to high-quality, non-surgical treatment, such as physiotherapy and (2) health care providers' attitudes and approaches, which do not embrace chronic disease prevention and management. CONCLUSIONS: An AC visit contributes to arthritis self-management; however, the current health care system does not adequately support conservative treatment of chronic conditions. Treatment guidelines need to be tailored to the local health care context in which they are applied.

Objectif: Pour comprendre si une visite à un centre d'évaluation de l'arthrite de la hanche ou du genou, où des personnes qui ne sont pas candidates a grave; une intervention chirurgicale et ont de l'arthrite sont dirigées vers des ressources communautaires et reçoivent une « ordonnance ¼ portant sur un traitement de conservation, contribue à l'autoprise en charge par les patients et à leur capacité d'avoir accès aux ressources communautaires. Méthodes: On a communiqué, pendant 3 à 10 mois après leur visite au centre d'évaluation, avec un échantillon choisi à dessein de patients non candidats à une intervention chirurgicale. On a organisé trois groupes de discussion (n=20) et procédé à 20 entrevues téléphoniques semi structurées. Les comptes rendus ont été codés systématiquement et analysés au moyen d'une méthodologie de recherche descriptive qualitative. Résultats: Les participants ont signalé en général que les visites au centre d'évaluation amélioraient l'autoprise en charge, mais l'analyse a dégagé un thème émergent au sujet de l'insuffisance de la prise en charge conservatrice en général, subdivisé en deux sous-thèmes portant sur (1) l'accès limité à un traitement non chirurgical de grande qualité comme la physiothérapie et (2) les attitudes et les approches des fournisseurs de soins de santé qui n'adoptent pas la prévention et la prise en charge des maladies chroniques. Conclusions: Une visite à un centre d'évaluation contribue à l'autoprise en charge de l'arthrite, mais le système de santé actuel n'appuie pas adéquatement un traitement conservateur des problèmes chroniques. Il faut personnaliser les lignes directrices sur le traitement en fonction du contexte local des soins de santé où elles sont appliquées.

Immigration and its impact on daily occupations: a scoping review.

Immigrants often adopt new and unfamiliar occupations in an attempt to adapt to their new culture. Occupations provide a means for participation in the host country and play a significant role in formulating a person's identity. This scoping review sought to identify the current knowledge on immigration and its impact on occupations. A scoping review for peer-reviewed articles published between 2000 and 2010 in English or French was completed. Thirty-six articles met the inclusion criteria. Four themes were identified: 1) role change; 2) work; 3) identity; and 4) health and well-being. Limitations include the lack of a consistent definition of occupation, research primarily being conducted in the North American context and the limited number of occupational therapy based articles. Future research should focus on a systematic review of the lived experiences of immigrants and their occupational contexts, and how this can inform policy development.

Association of low back pain, impairment, disability & work limitations in nurses.

INTRODUCTION: Health care professionals use measures of pain and impairment to identify potential disability and subsequently to predict workers' ability to do their work. However, there is little evidence that measures used are associated with ability to do one's job. METHODS: A cross-sectional study was conducted. Nurses (n = 100) were classified into either off/modified work (due to LBP) or regular work groups. Trunk ROM, trunk muscular endurance, pain and disability were measured relative to the outcomes work status and Work Limitations Questionnaire (WLQ) score. RESULTS: Regression analyses which included Roland Morris Questionnaire (RMQ, disability) and Sørenson (back extensor endurance) in the final models correctly classified the work status of 87% of the participants and accounted for 60% of variance in the WLQ score. CONCLUSIONS: Use of the RMQ and Sørenson test as diagnostic and prognostic tools should be considered in assisting return to work and treatment decision-making in female nurses with LBP.

5-heteroatom substituted pyrazoles as canine COX-2 inhibitors. Part 1: Structure-activity relationship studies of 5-alkylamino pyrazoles and discovery of a potent, selective, and orally active analog.

Structure-activity relationship (SAR) studies of the novel 2-[3-di and trifluoromethyl-5-alkylamino pyrazo-1-yl]-5-methanesulfonyl (SO(2)Me)/sulfamoyl (SO(2)NH(2))-pyridine derivatives for canine COX enzymes are described. The studies led to the identification of 2e as lead with potent in vitro activity, selectivity, and in vivo activity in dogs and cats.