The cost impact of a quality-assured mechanical assessment in primary low back pain care.

: The escalating cost of low back pain (LBP) care has not improved outcomes. Our purpose: to compare costs between LBP care guided by a quality-assured mechanical assessment (MC) and usual community care (CC).: Administrative claims data analysis.

Detection of femoroplasty on pre- and post-arthroscopic comparison radiographs following treatment of femoroacetabular impingement syndrome: multi-reader accuracy and agreement study.

Objective: To assess diagnostic accuracy and agreement among radiologists in detecting femoroplasty on pre- and post-arthroscopic comparison frog lateral and anteroposterior (AP) pelvic radiographs after treatment of femoroacetabular impingement (FAI) syndrome.

Materials And Methods: In this retrospective, cross-sectional study, 86 patients underwent hip arthroscopy (52 with and 34 without femoroplasty) for treatment of FAI syndrome. Three radiologists blinded to clinical data and chronological order of the pre- and post-arthroscopic comparison radiographs independently examined AP pelvis and frog lateral radiographs to detect femoroplasty changes.

Risk Factors for Reoperation in Patients Treated Surgically for Degenerative Spondylolisthesis: A Subanalysis of the 8-year Data From the SPORT Trial.

Study Design: Retrospective analysis of prospective data from the degenerative spondylolisthesis (DS) arm of the Spine Patient Outcomes Research Trial.

Objective: The aim of this study was to identify risk factors for reoperation in patients treated surgically for DS and compare outcomes between patients who underwent reoperation with nonreoperative patients.

Summary Of Background Data: Several studies have examined outcomes following surgery for DS, but few have identified risk factors for reoperation.

Risk Factors for Reoperation in Patients Treated Surgically for Lumbar Stenosis: A Subanalysis of the 8-year Data From the SPORT Trial.

Study Design: A retrospective subgroup analysis was performed on surgically treated patients from the lumbar spinal stenosis (SpS) arm of the Spine Patient Outcomes Research Trial (SPORT), randomized, and observational cohorts.

Objective: To identify risk factors for reoperation in patients treated surgically for SpS and compare outcomes between patients who underwent reoperation with those who did not.

Summary Of Background Data: SpS is one of the most common indications for surgery in the elderly; however, few long-term studies have identified risk factors for reoperation.

Risk Factors for Reoperation in Patients Treated Surgically for Intervertebral Disc Herniation: A Subanalysis of Eight-Year SPORT Data.

Background: Lumbar discectomy and laminectomy in patients with intervertebral disc herniation (IDH) is common, with variable reported reoperation rates. Our study examined which baseline characteristics might be risk factors for reoperation and compared outcomes between patients who underwent reoperation and those who did not.

Methods: We performed a retrospective subgroup analysis of patients from the IDH arm of the Spine Patient Outcomes Research Trial (SPORT) randomized and observational cohorts.

Early Patient Outcomes After Primary Total Knee Arthroplasty with Quadriceps-Sparing Subvastus and Medial Parapatellar Techniques: A Randomized, Double-Blind Clinical Trial.

Background: Techniques that reduce injury to the knee extensor mechanism may cause less pain and allow faster recovery of knee function after primary total knee arthroplasty. A quadriceps-sparing (QS) subvastus technique of total knee arthroplasty was compared with medial parapatellar arthrotomy (MPPA) to determine which surgical technique led to better patient-reported function and less postoperative pain and opioid utilization.

Methods: In this prospective, double-blind study, 129 patients undergoing total knee arthroplasty were randomized to the QS or the MPPA group after skin incision.

In-hospital mortality from femoral shaft fracture depends on the initial delay to fracture fixation and Injury Severity Score: a retrospective cohort study from the NTDB 2002-2006.

Background: Optimal surgical timing for definitive treatment of femur fractures in severely injured patients remains controversial. This study was performed to examine in-hospital mortality for patients with femur fractures with regard to surgical timing, Injury Severity Score (ISS), and age.

Methods: The National Trauma Data Bank version 7.

Goals, symptoms, signs, and treatments among women with pelvic floor disorders.

Objective: This study aimed to identify associations between patient-centered goals and pelvic floor measures and treatment choice.

Methods: A retrospective study of women seen for a pelvic floor disorder by a single surgeon in a specialty clinic from January 2008 to December 2009 was done. Goals were categorized as information-seeking, improving across any of 6 pelvic floor symptom categories, and "other.

Use of the assessment-diagnosis-treatment-outcomes model to improve patient care.

Objectives: The primary aim of this review was to compare and contrast the principles of the Assessment-Diagnosis-Treatment-Outcomes (ADTO) model with clinical prediction rules, shared decision making, and practice guidelines and provide a framework for validating medical simulations.

Methods: Comparing and contrasting the various methods and tools used by the clinical community and patients to help make informed decisions regarding health care options.

Results: The ADTO model provides an excellent theoretical framework to analyze and conceptualize the interrelationships between clinicians and patients as they go through the process of determining best practices.

Pilot comparative effectiveness study of surface perturbation treadmill training to prevent falls in older adults.

Background: Falls are the leading cause of fatal and non-fatal injuries among older adults. Exercise programs appear to reduce fall risk, but the optimal type, frequency, and duration of exercise is unknown. External perturbations such as tripping and slipping are a major contributor to falls, and task-specific perturbation training to enhance dynamic stability has emerged as a promising approach to modifying fall risk.

Patient-centered evaluation of outcomes from rehabilitation for chronic disabling spinal disorders: the impact of personal goal achievement on patient satisfaction.

Background Context: The multiplicity of biopsychosocial and economic facets of chronic disabling back and/or neck pain complicates the treatment outcomes measurement. Our previous work showed that personal functional goal achievement contributed more toward patient satisfaction with the outcome than did traditional self-reports of pain and physical function or measured strength, flexibility, and endurance among functional restoration program (FRP) graduates with chronic disabling back and/or neck pain.

Purpose: The primary goal was to compare the impact on patient satisfaction of pain and functional goal achievement versus self-reports of pain and physical function.

Influence of directional preference on two clinical dichotomies: acute versus chronic pain and axial low back pain versus sciatica.

Objective: To determine whether outcomes from treatment determined by subjects' directional preference (ie, reduction in back and/or leg pain, by performing a single direction of repeated end-range lumbar movement) would vary based on pain duration, location, or neurologic status.

Design: A secondary analysis of data from a multicenter randomized clinical trial.

Setting: Eleven physical therapy departments or clinics in 5 countries, with referrals for both acute and chronic low back pain.

Complex pediatric cervical spine surgery using smaller nonspinal screws and plates and intraoperative computed tomography.

Object: The treatment of craniocervical instability in children is often challenging due to their small spine bones, complex anatomy, and unique syndromes. The authors discuss their surgical experience with 33 cases in the treatment of 31 children (≤ 17 years of age) with craniocervical spine instability using smaller nontraditional titanium screws and plates, as well as intraoperative CT.

Methods: All craniocervical fusion procedures were performed using intraoperative fluoroscopic imaging and electrophysiological monitoring.

Injury patterns causing isolated foot compartment syndrome.

Background: The true incidence and primary predictors of foot compartment syndrome remain controversial. Our aim was to better define the overall incidence of foot compartment syndrome in relation to the frequency and location of various foot injuries. We hypothesized that (1) the incidence would increase in proportion to the number of anatomic locations of injury, (2) the incidence would be higher in association with hindfoot and crush injuries compared with any other injury categories, and (3) not only would the incidence associated with calcaneal fractures be lower than the often quoted 10% but foot compartment syndrome would also be fairly uncommon after such fractures.

Mortality rates following trauma: The difference is night and day.

Background: Although most medical centers are equipped for 24-h care, some "middle of the night" services may not be as robust as they are during daylight hours. This would have potential impact upon certain outcome measurements in trauma patients. The purpose of this paper was to assess the effect of patient arrival time at hospital emergency departments on in-hospital survival following trauma.

Do seat belts and air bags reduce mortality and injury severity after car accidents?

We studied National Trauma Data Bank data to determine the effectiveness of car safety devices in reducing mortality and injury severity in 184,992 patients between 1988 and 2004. Safety device variables were seat belt used plus air bag deployed; only seat belt used; only air bag deployed; and, as explicitly coded, no device used. Overall mortality was 4.

The effect of hospital setting and teaching status on outcomes after hip fracture.

This study used the National Inpatient Sample database for 1998 through 2003 to identify patients who were aged 65 years or older and had undergone surgical treatment for an isolated femoral neck or intertrochanteric hip fracture. Hospital setting (urban vs rural) and teaching status (teaching vs nonteaching) were the primary independent variables studied. The final cohort consisted of 226,239 patients.

Effects of viewing an evidence-based video decision aid on patients' treatment preferences for spine surgery.

Study Design: Secondary analysis within a large clinical trial.

Objective: To evaluate the changes in treatment preference before and after watching a video decision aid as part of an informed consent process.

Summary Of Background Data: A randomized trial with a similar decision aid in herniated disc patients had shown decreased rate of surgery in the video group, but the effect of the video on expressed preferences is not known.

Trends and variation in incidence, surgical treatment, and repeat surgery of proximal humeral fractures in the elderly.

Background: the treatment of proximal humeral fractures in the elderly remains controversial. Options include nonoperative treatment, open reduction with internal fixation (ORIF), and hemiarthroplasty. Locking plate technology has expanded the indications for ORIF for certain fracture types in osteoporotic bone.