Postprocedure protocols after intraarticular orthobiologic injections-A scoping review.

Osteoarthritis is a chronic degenerative disease affecting 500 million people throughout the world. Although orthobiologics have been proposed as a symptom and disease modifying treatment for osteoarthritis, there is significant heterogeneity in the results of the orthobiologic procedures in the literature. One possible explanation for the heterogeneity is the inconsistent reporting and description of the postorthobiologic protocols. The goal of this scoping review was to identify the current literature on the use of orthobiologics for osteoarthritis and critically evaluate the postorthobiologic protocol within these studies. A total of 200 identified studies met inclusion criteria. In 37.5% of studies, there was no mention of a postorthobiologic protocol. Of the 125 studies that did mention a postorthobiologic protocol, only 38.4% included a rehabilitation protocol, 21.6% included postprocedure weightbearing restrictions, and only 2 (1.6%) mentioned the use of durable medical equipment. Nonsteroidal anti-inflammatory drug restriction was described in 91.2% of study protocols, whereas corticosteroids and immunosuppressants were restricted in 84.8% and 19.2% of protocols, respectively. The results of this scoping review demonstrate the inconsistent reporting of postorthobiologic procedure protocols in the literature, with significant heterogeneity in those that are described. These findings highlight the need for future research and improved reporting of postorthobiologic protocols.

Minimal Clinically Important Change of Movement Pain in Musculoskeletal Pain Conditions.

Movement pain, which is distinct from resting pain, is frequently reported by individuals with musculoskeletal pain. There is growing interest in measuring movement pain as a primary outcome in clinical trials, but no minimally clinically important change (MCIC) has been established, limiting interpretations. We analyzed data from 315 participants who participated in previous clinical trials (65 with chronic Achilles tendinopathy; 250 with fibromyalgia) to establish an MCIC for movement pain. A composite movement pain score was defined as the average pain (Numeric Rating Scale: 0-10) during 2 clinically relevant activities. The change in movement pain was calculated as the change in movement pain from pre-intervention to post-intervention. A Global Scale (GS: 1-7) was completed after the intervention on perceived change in health status. Participants were dichotomized into non-responders (GS ≥4) and responders (GS <3). Receiver operating characteristic curves were calculated to determine threshold values and corresponding sensitivity and specificity. We used the Euclidean method to determine the optimal threshold point of the Receiver operating characteristic curve to determine the MCIC. The MCIC for raw change in movement pain was 1.1 (95% confidence interval [CI]: .9-1.6) with a sensitivity of .83 (95% CI: .75-.92) and specificity of .79 (95% CI: .72-.86). For percent change in movement pain the MCIC was 27% (95% CI: 10-44%) with a sensitivity of .79 (95% CI: .70-.88) and a specificity of .82 (95% CI: .72-.90). Establishing an MCIC for movement pain will improve interpretations in clinical practice and research. PERSPECTIVE: A minimal clinically important change (MCIC) of 1.1- points (95% CI: .9-1.6) for movement pain discriminates between responders and non-responders to rehabilitation. This MCIC provides context for interpreting the meaningfulness of improvement in pain specific to movement tasks.

Application of flipped classroom pedagogy to the human gross anatomy laboratory: Student preferences and learning outcomes.

To improve student preparedness for anatomy laboratory dissection, the dental gross anatomy laboratory was transformed using flipped classroom pedagogy. Instead of spending class time explaining the procedures and anatomical structures for each laboratory, students were provided online materials to prepare for laboratory on their own. Eliminating in-class preparation provided the opportunity to end each period with integrative group activities that connected laboratory and lecture material and explored clinical correlations. Materials provided for prelaboratory preparation included: custom-made, three-dimensional (3D) anatomy videos, abbreviated dissection instructions, key atlas figures, and dissection videos. Data from three years of the course (n = 241 students) allowed for analysis of students' preferences for these materials and detailed tracking of usage of 3D anatomy videos. Students reported spending an average of 27:22 (±17:56) minutes preparing for laboratory, similar to the 30 minutes previously allocated for in-class dissection preparation. The 3D anatomy videos and key atlas figures were rated the most helpful resources. Scores on laboratory examinations were compared for the three years before the curriculum change (2011-2013; n = 242) and three years after (2014-2016; n = 241). There was no change in average grades on the first and second laboratory examinations. However, on the final semi-cumulative laboratory examination, scores were significantly higher in the post-flip classes (P = 0.04). These results demonstrate an effective model for applying flipped classroom pedagogy to the gross anatomy laboratory and illustrate a meaningful role for 3D anatomy visualizations in a dissection-based course. Anat Sci Educ 11: 385-396. © 2017 American Association of Anatomists.