Radiographic findings in patients suspected of subacromial impingement syndrome: prevalence and reliability.

OBJECTIVE: Aims were to (i) report prevalence and (ii) evaluate reliability of the radiographic findings in examinations of patients suspected of subacromial impingement syndrome (SIS), performed before a patient's first consultation at orthopaedic department. MATERIALS AND METHODS: This cross-sectional study examined radiographs from 850 patients, age 18 to 63 years, referred to orthopaedic clinic on suspicion of SIS. Prevalence (%) of radiographic findings were registered. Inter- and intrarater reliability was analysed using expected and observed agreement (%), kappa coefficients, Bland-Altman plots, or intraclass coefficients. RESULTS: A total of 850 patients with a mean age of 48.2 years (SD = 8.8) were included. Prevalence of the radiographic findings was as follows: calcification 24.4%, Bigliani type III (hooked) acromion 15.8%, lateral/medial acromial spurs 11.1%/6.6%, acromioclavicular osteoarthritis 12.0%, and Bankart/Hill-Sachs lesions 7.1%. Inter- and intrarater Kappa values for most radiographic findings ranged between 0.40 and 0.89; highest values for the presence of calcification (0.85 and 0.89) and acromion type (0.63 and 0.66). The inter- and intrarater intraclass coefficients ranged between 0.41 and 0.83; highest values for acromial tilt (0.79 and 0.83) and calcification area (0.69 and 0.81). CONCLUSION: Calcification, Bigliani type III (hooked) acromion, and acromioclavicular osteoarthritis were prevalent findings among patients seen in orthopaedic departments on suspicion of SIS. Spurs and Bankart/Hill-Sachs lesions were less common. Optimal reliabilities were found for the presence of calcification, calcification area, and acromial tilt. Calcification qualities, acromion type, lateral spur, and acromioclavicular osteoarthritis showed suboptimal reliabilities. Newer architectural measures (acromion index and lateral acromial angle) performed well with respect to reliability.

Hip osteoarthritis and occupational mechanical exposures: a systematic review and meta-analysis.

OBJECTIVES: The aim was to conduct a systematic review and meta-analysis investigating the association between occupational mechanical exposures and hip osteoarthritis. METHODS: The study was registered in PROSPERO. A systematic literature search was conducted in six databases to identify relevant articles. Two authors independently excluded articles, extracted data, assessed the risk of bias of each included article, and graded the level of evidence. We conducted a meta-analysis using random-effects model and performed a sensitivity analysis stratifying articles based on the risk of bias assessment, study design, and the outcome measurement. RESULTS: Twenty-four articles were eligible for inclusion. The highest pooled odds ratio (OR) was found for combined mechanical exposures [OR 1.7, 95% confidence interval (CI) 1.4-2.0], non-neutral postures (OR 1.7, 95% CI 1.4-2.1), lifting/carrying loads (OR 1.6, 95% CI 1.3-1.9), and climbing stairs (OR 1.6, 95% CI 1.1-2.2). The range of pooled OR for the remaining mechanical exposures (eg, standing, walking, kneeling, squatting, and sitting) was 0.6-1.6. Grading the quality of evidence, a moderate level of evidence was found for the combined mechanical exposures and for lifting/carrying loads. The remaining exposure categories were graded as having either low or very low levels of evidence. CONCLUSIONS: Considerable heterogeneity was observed across the included studies, and high-quality literature using objective exposure measurements is warranted. Despite various limitations affecting the comparability, occupational mechanical exposures seem to influence the likelihood of developing hip osteoarthritis.

Patient Preferences and Their Effects on Rehabilitation Outcomes: A Secondary Analysis of a Randomized Controlled Trial.

OBJECTIVE: To assess the effect of aligning patients' preferences with specific rehabilitation delivery modes on rehabilitation outcomes. DESIGN: A secondary analysis of a randomized controlled trial (RCT). METHODS: The study cohort comprised 208 patients referred for physiotherapy rehabilitation after non-surgical or surgical interventions for rotator cuff injury, shoulder impingement, or acromioclavicular osteoarthritis. Participants were randomly assigned to one of three rehabilitation modalities: 1) group-based exercise, 2) individual exercise, or 3) home exercise. In this study, participants were categorized into two groups: "matched preference" (MP) and "unmatched preference" (UP). The primary outcome measure was change in function, measured with the shortened Disabilities of the Arm, Shoulder and Hand (QuickDASH). Secondary outcome measures were change in pain, assessed using the Numeric Rating Scale (NRS), mental well-being measured with the World Health Organization Well-Being Index (WHO-5), health-related quality of life assessed using the EuroQol-5Domain questionnaire (EQ-5D), fear avoidance assessed using the Örebro Musculoskeletal Pain Questionnaire (ÖMPQ), and overall treatment satisfaction. Outcomes were assessed at 3 and 6 months. RESULTS: The primary outcome measure, QuickDASH, showed no significant differences between groups at either 3 months (-3.0 [-8.2 to 2.3]) or 6 months (0.5 [-5.7 to 6.7]). Additionally, no significant differences were observed in the secondary outcome measures. CONCLUSION: Matching patients' preferences for specific rehabilitation delivery modes did not seem to effect rehabilitation outcomes.

Change in number of pain sites - which factors are important? A 12-year prospective cohort study.

BACKGROUND: Pain in multiple body sites is common and often persistent. The purpose of this prospective study was to examine the change in the number of pain sites (NPS) over time and to evaluate to which extent clinical, demographic, lifestyle and health-related factors predict a change in NPS. METHODS: This was a population-based longitudinal cohort study of adults (n = 2,357). Data on pain, demographic, lifestyle, and health-related variables were collected by questionnaires in 2008 and 2020 and register data from 2006 to 2017. Data was analysed with linear regression. RESULTS: We found a mean decrease in NPS over the 12-year follow-up period (-0.36 (95% CI; -0.44; -0.27) and 56% of this sample reported no change or only one pain site increase/decrease over 12 years. While participants reporting pain for less than 3 months at baseline had almost no change in NPS (-0.04 (95% CI; -0.18; 0.10)), participants with pain for longer than 3 months decreased by -0.51 (95% CI; -0.62; -0.41). Age at baseline (20-49 years), pain intensity, and obesity (BMI ≥ 30) were associated with an increase in NPS over the follow-up period. CONCLUSIONS: NPS is relatively stable over time. We found a small mean decrease in NPS over 12 years varying between participants with pain for longer than 3 months and pain for less than 3 months respectively. The results also indicate that pain intensity, age, and obesity could be relevant factors to consider when predicting change in NPS.

Predicting outcomes across treatment settings in patients with shoulder pain referred to physiotherapy: a secondary analysis of two comparable prospective cohort studies.

Objective: Previous studies have examined factors that may contribute to predicting outcomes for patients with shoulder pain. However, there is still a lack of consensus on which factors predict the results and whether there are differences based on the treatment setting. Thus, this study aimed to analyse and compare how baseline variables are associated with future outcomes in patients with shoulder pain in primary and secondary care settings. Methods: This study conducted a secondary analysis of two observational prospective cohort studies involving patients with shoulder pain in primary care (n=150) and secondary care (n=183). Multiple regression analyses were employed, with one interaction term at a time, to examine potential differences in association with baseline characteristics and future outcomes between the two settings. Results: Changes in pain and function were statistically significant at 6 months for patients in primary care and secondary care. However, associations for most baseline variables and outcomes did not differ significantly across these two treatment settings. The only statistically significant interactions observed were for the associations between baseline level of pain, function and fear avoidance beliefs and change in pain scores at 6 months, with lower change scores observed among patients in the secondary care. Conclusion: This study revealed that the association with outcomes did not differ across settings for most baseline characteristics. These findings suggest that it could be feasible to generalise the prognostic value of most baseline variables for patients with shoulder, irrespective of the treatment setting.

Long-term follow-up study of work status among patients with work-related mental disorders referred to departments of occupational medicine in Denmark.

OBJECTIVES: To describe the 5 year work status in patients referred for suspected work-related common mental disorders. To develop a prognostic model. DESIGN: Register-based nationwide longitudinal follow-up study. SETTING: All departments of occupational medicine in Denmark. PARTICIPANTS: 17 822 patients aged 18-67 years, seen for the first time at a Department of Occupational Medicine in Denmark from 2000 to 2013 and diagnosed with stress, depression, post-traumatic stress disorder, anxiety or other mental disorders. INTERVENTIONS: All patients were seen for diagnostic assessment and causal evaluation of the work-relatedness of their disorders. Some departments offered patients with stress disorders psychological treatment, which, however, was not organised according to patient selection or type of treatment. PRIMARY AND SECONDARY OUTCOME MEASURES: Register data were collected for 5 year periods before and after the patients' first assessment at a department. Weekly percentages of patients are presented according to work status. The outcome in the prognostic model was a high Work Participation Score (ie, working>75% of potential work weeks/year) at 5 year follow-up. RESULTS: For all subgroups of patients, a high proportion were working (>75%) 1-5 years before assessment, and all experienced a large reduction in work status at time of assessment. At 1 year follow-up, almost 60% of patients with stress were working, whereas in the other patient subgroups, less than 40% were working. In the following years, practically no increase was observed in the percentage of patients working in any of the subgroups. Based on these 5 year follow-up data, we developed a work participation model with only moderate discrimination and calibration. CONCLUSIONS: In Denmark, not all return to previous work status 5 years after a referral due to a suspected work-related common mental disorder. We developed a prognostic model with only moderate discrimination and calibration for long-term work participation after suggested work-related common mental disorders.

Patient-reported outcome measures as determinants for the utilization of health care among outpatients with epilepsy: a prognostic cohort study.

BACKGROUND: Patient-reported outcome (PRO) measures can inform clinical decision making and planning of treatment in the health care system. The aim of this study was to examine whether patient-reported health domains influence the use of health care services in outpatients with epilepsy. METHODS: This was a prognostic cohort study of 2,426 epilepsy outpatients referred to PRO-based follow-up at the Department of Neurology, Aarhus University Hospital, Denmark. Patients filled out a questionnaire covering health literacy areas, self-efficacy, well-being and general health. The main outcome was a record of contact to the epilepsy outpatient clinic, inpatient ward and/or emergency room within 1 year, retrieved from health register data. Associations were analysed by multivariable binomial logistic regression. RESULTS: A total of 2,017 patients responded to the questionnaire and 1,961 were included in the final analyses. An outpatient contact was more likely among patients with very low health literacy ('social support'): odds ratio (OR) 1.5 (95% CI: 1.1-2.1), very low and low self-efficacy: OR 1.7 (95% CI: 1.2-2.3) and OR 1.4 (95% CI: 1.0-1.8), low and medium well-being: OR 2.2 (95% CI: 1.6-3.0) and OR 1.4 (95% CI: 1.1-1.9), and patients rating their general health as fair: OR 2.8 (95% CI: 1.7-4.6). Inpatient contact and emergency room contact were associated with the health domains of self-efficacy and general health. CONCLUSIONS: PRO questionnaire data indicated that patients with low health literacy ("social support"), well-being, self-efficacy and self-rated general health had an increased use of health care services at 1 year.These results suggest that PRO measures may provide useful information in relation to the possibility of proactive efforts and prevention of disease-related issues and to help identify efficiency options regarding resource utilization.

The use of patient reported outcomes (PRO) measures to monitor and plan treatment in health care has become increasingly common in recent years. In this study, we examined whether PRO measures of patients self-perceived levels of health knowledge, confidence in managing their health, overall sense of well-being, and general perception of their health could predict the need for contact in an epilepsy outpatient clinic during a 12 months' period. An outpatient contact was more likely among patients with lower levels of health literacy, well-being, self-efficacy and self-rated general health. The study indicates that PRO measures may hold useful information to inform clinical decision making and planning of care among outpatients with epilepsy.

Occupational mechanical exposures as risk factor for chronic low-back pain: a systematic review and meta-analysis.

OBJECTIVES: The association between occupational mechanical exposures and low-back pain (LBP) has been studied in several systematic reviews. However, no systematic review addressing chronic LBP exists. The aim of this systematic review and meta-analysis was to examine the association between occupational mechanical exposures and chronic LBP. METHODS: The study was registered in PROSPERO. We used an existing systematic review to identify articles published before January 2014. For studies published between January 2014 and September 2022, a systematic literature search was conducted in six databases. Two authors independently excluded articles, extracted data, and assessed risk of bias and level of evidence (GRADE). Meta-analyses were conducted using random-effects models comparing highest versus lowest exposure group with sensitivity analyses based on study quality (low/moderate versus high risk of bias), study design (cohort versus case-control), and outcome definition (non-specific LBP versus specific chronic LBP). RESULTS: Twenty-six articles were included. Highest pooled odd ratios (OR) were found for combined mechanical exposures [OR 2.2, 95% confidence interval (CI) 1.4-3.6], lifting/carrying loads (OR 1.7, 95% CI 1.4-2.2), and non-neutral postures (OR 1.5, 95% CI 1.2-1.9). For the remaining mechanical exposures (ie, whole-body vibrations, standing/walking, and sitting), OR ranged between 1.0 and 1.4. In the sensitivity analyses, generally, higher pooled OR were found in low/moderate risk of bias studies, case-control studies, and studies of specific chronic LBP. CONCLUSIONS: Moderate evidence of an association was found for lifting/carrying loads, non-neutral postures, and combined mechanical exposures. Low or very low evidence was found for whole-body vibrations, standing/walking, and sitting. Studies using standardized exposure definition, metric, and technical measurements are highly warranted.

Developing prognostic models for health care utilization in patients with work-related mental health problems.

BACKGROUND: The long-term prognosis for employees with work-related mental health problems is unclear. We aim to describe long-term trends in health care utilization (HCU) and develop multivariable prognostic models for long-term mental health care utilization. METHODS: From the Danish Occupational Medicine Cohort we included mental health patients (N = 17,822) assessed from 2000 to 2013 at Departments of Occupational Medicine. Outcomes were general health (general practitioner, somatic hospital) and mental health (psychiatrist/psychologist, psychiatric hospital) HCU obtained from registries five years before/after assessment. The 10-year period was divided into phases relative to assessment: 5 - 3 years before, 2 years before/after, and 3-5 years after. We developed gender-stratified Lasso-penalized multivariable prognostic models for HCU 3-5 years after assessment assessing both calibration and discrimination. RESULTS: Prevalent HCU for general practitioner, psychiatrist/psychologist and psychiatric hospital services was relatively stable 5 - 3 years prior to assessment, then rising during the 2 years before/after. At 3-5 years after assessment prevalent general practitioner HCU declined to previous levels, while prevalent HCU for psychologist/psychiatrist and psychiatric hospital services remained elevated compared to previous levels during years 5 - 3. Prognostic models for long-term psychologist/psychiatrist and psychiatric hospital HCU indicated acceptable calibration and modest discrimination. CONCLUSIONS: Prevalent HCU rose two years before/after assessment and remained elevated for psychiatrist/psychologist and psychiatric hospital HCU 3-5 years after. Gender-stratified prognostic models were developed for long-term mental health HCU, but discrimination and calibration should be further improved before out-of-sample application for personal prognosis. TRIAL REGISTRATION: The study was registered at clinicaltrials.gov (Identifier: NCT04459793) prior to analyses.

Association between occupational exposures and chronic low back pain: Protocol for a systematic review and meta-analysis.

INTRODUCTION: The association between occupational mechanical exposures and chronic low back pain (LBP) has been widely studied, however, few systematic reviews have evaluated the evidence of an association. Furthermore, little is known of the impact of occupational psychosocial exposures on chronic LBP. The aim of this systematic review and meta-analysis is to study the association between occupational mechanical and psychosocial exposures and chronic LBP. METHODS: The study will be conducted as a systematic review using another systematic review published in 2014 as basis and has been registered in the International Prospective Register of Systematic Reviews (PROSPERO) with registration number CRD42021281996. A systematic literature search will be performed in 6 scientific databases to identified potential relevant studies published after 2014. Studies will systematically be excluded through a screening process performed independently by 2 reviewers. Exposures will include occupational mechanical and psychosocial exposures, and outcome will include chronic LBP (LBP ≥3 months, "degenerative" diseases, and lumbosacral radiculopathy). Study population will include persons in or above working age, and study designs will comprise cohort and case-control studies. The quality of each included study will be methodologically assessed by 2 independent reviewers and level of evidence of an association will be graded using the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) system. In meta-analyses, effect sizes will be addressed using random-effect models, sensitivity analyses will explore the robustness of the meta-analysis, and heterogeneity assessed. DISCUSSION: This systematic review and meta-analysis will assess the evidence available of the association between occupational mechanical and psychosocial exposures and chronic LBP. The review can provide essential knowledge on the association, exposure-response relationships, thresholds, which may pave the way for political decisions on the occupational environment and the labour market insurance policy.

The usefulness of the STarT back screening tool and single-item general health measures when predicting future disability in patients with low back pain treated in Danish primary care physiotherapy.

INTRODUCTION: The extent to which disease specific screening tools or other health measures add to the predictive value of common clinical factors (pain, disability and socio-demographics) has been sparsely investigated. The aim of this study was to investigate whether a disease specific screening tool and a single-item general health measure adds predictive value to basic information collected in primary physiotherapy care when predicting future disability in patients with low back pain. MATERIAL AND METHODS: This longitudinal cohort study included 354 patients with low back pain from Danish primary care physiotherapy. Information was collected on socio-demographics, common clinical factors, The STarT Back Screening Tool (SBT) and general health perceptions measured as a single item from the SF-36 (GH-1). Disability at 6-month follow-up, measured by the Roland-Morris Disability Questionnaire, was predicted using multiple linear regression models. RESULTS: Clinical factors and baseline disability level explained 28.3% of the variance in 6-month disability scores. With SBT and GH-1 added separately to the baseline model, the explained variance increased by 2.1% (p = 0.01) and 3.6% (p < 0.001), respectively. CONCLUSION: The added value of the disease specific screening tools or the single-item general measure when predicting disability in patients with low back pain was generally small. Moreover, the predictive value of the single-item general measure seems comparable to and slightly better than the disease specific screening tool. Overall these findings may question the clinical utility of such measures.

The risk of an incident hospital contact with a musculoskeletal disorder in Danish occupational fishers: a register-based study.

BACKGROUND: The prevalence of musculoskeletal disorders (MSDs) among occupational fishers is high, yet knowledge of the risk factors is scarce and inconsistent. The aim of this study was to investigate the risk from various work-related characteristics on incident hospital contact due to a musculoskeletal disorders and other pain disorders among Danish occupational fishers. METHODS: This register-based study comprised data from the Danish Occupational Cohort with eXposure (DOC*X) for all persons registered as occupational fishers between 1994 and 2017. Time-to-event analysis with Cox regression model was used with age as the time scale. RESULTS: Among the 15,739 fishers, 40% (n = 5,669 cases) had an incident hospital contact with an MSD during follow-up. Back disorders were the dominant complaint. Male fishers working less than 5 years or more than 15 years had higher risks of MSD (HR 2.40 (95% CI: 2.06, 2.80), HR: 2.04 (95% CI: 1.76, 2.35), respectively, than those working for over 20 years. Period effects confounded and reduced the risk from occupational seniority. CONCLUSION: Fishers occupational seniority vary in risk of MSDs across working life. Results showed a nonlinear relationship between the highest risk for fishers working less than 5 years and the lowest risk working more than 20 years as occupational fisher. More years in the workforce, a captain education, and primarily working part time significantly reduced the risk of experiencing a first MSDs for men. Healthy worker effect was documented.

Musculoskeletal Health Climate Is a Prognostic Determinant of Sickness Absence Among Female Eldercare Workers: A Prospective Cohort Study.

OBJECTIVES: The present study investigated the association between musculoskeletal health climate, that is, the shared perceptions among workers concerning musculoskeletal health, and sickness absence. METHODS: Questionnaire data on two domains of musculoskeletal health climate, perceived management priority (PMP) and pain acceptance at work (PAW), were collected at baseline. Data on sickness absence were extracted at 1-year follow-up. Data were analyzed using negative binomial multivariable regression. RESULTS: The final study population comprised 390 female eldercare workers. Compared with participants with low PMP scores, participants with high PMP scores had lower risk of sickness absence (incidence rate ratio, 0.6; 95% confidence interval, 0.4-0.9). Participants with high PAW scores had higher risk of sickness absence than participants with low PAW scores (incidence rate ratio, 1.4; 95% confidence interval, 0.9-2.2). CONCLUSIONS: The results showed an association between the musculoskeletal health climate and sickness absence.

How do people with chronic pain explain their use, or non-use, of pain-related healthcare services? A qualitative study of patient experiences.

PURPOSE: This study aims to explore how people with chronic pain explain their use or non-use of pain-related healthcare services and their expectations of the healthcare provider, and explore how explanations and expectations vary between different levels of pain-related healthcare use. MATERIALS AND METHODS: We conducted 20 individual semi-structured interviews with purposely sampled adults between 39 and 77 years of age with chronic pain. All interviews were audio-recorded, transcribed and analysed using a thematical template analysis approach. RESULTS: Four key drivers for pain-related healthcare use were identified: (1) the healthcare system facilitates clinical pathways, (2) appraisal of pain-related healthcare initiatives influences future use, (3) autonomy, beliefs and values determine healthcare behaviour, and (4) recommendations from others impact healthcare behaviour. Comparing explanations across different pain-related healthcare user groups (high, medium and low) showed that perceived needs, beliefs and values, and appraisal of previous healthcare experiences differed between these groups. CONCLUSIONS: Beliefs, pain characteristics, recommendations, and the search for a diagnostic label, often initiate pain-related healthcare use. Healthcare is modified by two interconnected systems: (1) perceived needs, beliefs and values and (2) previous healthcare experiences. Differences related to these systems could explain some of the variance in pain-related healthcare use.Implications for RehabilitationDifferent use of pain-related healthcare services for people with chronic pain could be related to differences in perceived needs, beliefs and values and appraisal of previous healthcare.It may be helpful to explore the perceived needs and beliefs of those seeking healthcare due to chronic pain.Previous healthcare experiences may impact and should be explored.

Musculoskeletal health climate is associated with musculoskeletal pain and sickness absence among workers: a cross-sectional study.

OBJECTIVES: This study aimed to investigate whether a musculoskeletal health climate, expressing the shared perceptions among workers concerning musculoskeletal health, is associated with number of musculoskeletal pain sites and sickness absence. DESIGN: Cross-sectional study. SETTING: Six slaughterhouses from 2 companies in Denmark and 6 home-nursing units and 12 nursing homes from 1 municipality in Jutland, Denmark. PARTICIPANTS: A total of 1092 slaughter house workers and 410 care workers completed an online questionnaire from February to October 2019. OUTCOME MEASURES: The exposure variable was musculoskeletal health climate assessed by two domains; (1) perceived management priority of musculoskeletal health measured by a modified subscale from the Nordic Safety Climate Questionnaire and (2) work group pain acceptance which was a modified version of the activity engagement subscale of the chronic pain acceptance scale. Outcomes variables were number of musculoskeletal pain sites (0-6) and days with sickness absence. RESULTS: The associations between the two subscales, number of musculoskeletal pain sites and sickness absence were calculated using mixed linear and generalised estimating equation regression models. Higher perceived management priority scores were associated with a lower number of musculoskeletal pain sites across both job groups: ß=-.57 (95% CI -0.91 to -0.23) and sickness absence (>5 days) due to musculoskeletal pain prevalence ratio (PR) 0.79 (95% CI 0.57 to 1.08). In contrast higher work group pain acceptance scores were associated with higher number of musculoskeletal pain sites: ß=0.38 (0.11 to 0.66), whereas associations with sickness absences seemed to be modified by job groups; PR 1.59 care workers and PR 0.86 slaughterhouse workers. CONCLUSION: The observed relationship between musculoskeletal health climate, musculoskeletal pain sites and sickness absence indicate that cultural factors should receive increased attention in work place preventive interventions.

Primary Care Physical Therapists' Experiences When Screening for Serious Pathologies Among Their Patients: A Qualitative Study.

OBJECTIVE: A vital part of the initial examination performed by a physical therapist is to establish whether the patient would benefit from physical therapist intervention. This process includes knowledge about contraindications for treatment and screening for serious pathologies. However, little is known about the physical therapists' views and thoughts about their own practice when screening for serious pathologies. The purpose of this study was to explore the experience gained by physical therapists when screening for serious pathologies among their patients. METHODS: This was a qualitative study based on individual semi-structured interviews with 9 primary care physical therapists. The interviews were analyzed using reflexive thematic analysis, and generated themes were explained and reported with relevant quotes. RESULTS: Three overall themes were generated: (1) the role of physical therapists in the diagnostic process; (2) responsibility from the individual to the group; and (3) the difficult task of cooperation. The physical therapists described how they relied more on their clinical suspicion than on asking red-flag questions when screening for serious pathologies. They also questioned their differential diagnostic abilities. Finally, they saw a potential to further enhance their confidence in the area by reflecting on the matter with colleagues and by receiving more feedback about their clinical reasoning regarding serious pathologies from general practitioners. CONCLUSION: These findings suggest that physical therapists primarily rely on their clinical suspicion when screening for serious pathologies but at the same time are uncertain about their differential diagnostic abilities. IMPACT: These findings can inform future interventions targeting the physical therapists' abilities to detect serious pathology.

Adenoma and serrated lesion detection with distal attachment in screening colonoscopy: a randomized controlled trial.

BACKGROUND: Adenoma detection rate (ADR) is the single most important measure of quality in colonoscopy, but little is known about the detection rate of serrated lesions (SLDR). To improve ADR, Endocuff Vision (EV) can be used. Studies have shown differing results as to the effect on ADR; an effect on SLDR has not been shown. To investigate the effect of Endocuff Vision on ADR in a screening population, this randomized controlled open label trial with concealed allocation was performed. Randomization to trial group was carried out by the endoscopist using prepared numbered envelopes. METHODS: Patients referred as part of the national bowel screening program at Regional Hospital Herning, Denmark were recruited and allocated to one of two groups: Endocuff Vision colonoscopy (EVC) and standard colonoscopy (SC). Outcomes were ADR, mean number, site, and size of lesions per procedure. SLDR as outcome was added after inclusion had begun. RESULTS: A total of 1178 participants were included, with 1166 (EVC 583 and SC 583) available for analysis. There was no clinical relevant difference in ADR (59.2% [CI 55.1; 63.1] v 60.5% [CI 56.5; 64.4]) or SLDR (13.0% [CI 10.5; 16.0] v 10.3% [CI 8.0; 13.0]) between groups. More serrated lesions were found per procedure (MSP) (0.2 v 0.1, IRR 57% [CI 17; 109]. Removal rate of EV was similar in the two study groups. CONCLUSION: We found no significant effects of the use of Endocuff Vision on ADR, when compared to standard colonoscopy, but more serrated lesions were detected in the Endocuff group. TRIAL REGISTRATION: Clinical Trials NCT04651062.

Effectiveness of a 24-hour access outpatient clinic for patients with chronic conditions in hospital outpatient follow-up: a registry-based controlled cohort study of healthcare utilisation and mortality.

Objective: To evaluate the effectiveness of a 24-hour telephone access outpatient clinic (24-hour access clinic) in terms of healthcare utilisation and mortality in patients with five chronic conditions (chronic obstructive pulmonary disease, atrial fibrillation/flutter, congestive heart failure, inflammatory bowel disease and chronic liver disease). Methods and analysis: This was a registry-based controlled cohort study. The 24-hour access clinic was established at Silkeborg Regional Hospital in Central Denmark Region. The five other regional hospitals served as comparison hospitals. The 24-hour access clinic allowed patients with five chronic conditions with ongoing hospital outpatient follow-up to call the hospital outpatient clinic in case of an exacerbation. Outcomes were use of hospital admissions, length of stay (LOS), outpatient visits, contacts to general practice and all-cause mortality during 18 months of follow-up. Results: The study included 992 the 24-hour access patients and 3878 usual care patients. For the five conditions combined, the 24 hours access patients had fewer all-cause admissions (incidence rate ratio (IRR) 0.81, 95% Cl 0.71 to 0.92), general practice out-of-hours contacts (IRR 0.81, 95% C 0.71 to.92) and shorter LOS (IRR 0.71, 95% CI 0.57 to 0.88). The rate of all-cause outpatient visits tended to be higher (IRR 1.07, 95% CI 0.99 to 1.15). General practice daytime contacts were similar between the groups, and there was no significant difference in mortality. Conclusions: The results suggest that a 24-hour telephone access clinic may lead to enhanced integration of care measured as unplanned acute care substituted with planned outpatient care.