Publications by authors named "Toby O Smith"

Objectives: This systematic review aims to determine the effectiveness of ambulance transportation versus helicopter transportation on mortality for trauma patients.

Methods: A systematic review of published and unpublished databases (to August 2023) was performed. Studies, reporting mortality, for people who experienced trauma and were transported to a trauma unit by ambulance or helicopter were eligible.

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Background And Objective: Post-operative periprosthetic femoral fractures (POPFF) present a growing challenge for healthcare services, but there are limited national data on patient profiles, short-term outcomes, and post-discharge follow-up. We aimed to fill these gaps.

Methods: Using Hospital Episode Statistics (HES), we identified POPFF discharges from hospitals in England for patients aged 18 and above between April 2016 and December 2022.

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Background: In the UK, one in four patients are in work at the time of their hip or knee replacement surgery. These patients receive little support about their return to work (RTW). There is a need for an occupational support intervention that encourages safe and sustained RTW which can be integrated into National Health Service practice.

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Article Synopsis
  • Tibial plateau fractures are complex knee injuries that are challenging to treat, often requiring surgical fixation and sometimes bone defect fillers, but there is no established best practice for either approach.
  • The study aimed to evaluate the effectiveness and potential risks of various surgical methods and filler materials for these fractures by analyzing data from randomized controlled trials and quasi-RCTs.
  • Ultimately, 15 trials with 948 adult participants were included, focusing on outcomes like quality of life, limb function, and the rate of complications such as reoperations.
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Objective: To investigate whether a combined hip and knee muscle strengthening program is superior to a knee strengthening program for people after lateral patellar dislocation (LPD).

Design: Single-blind, superiority, randomized controlled trial with 48 weeks follow-up.

Setting: Physiotherapy out-patient clinic.

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Purpose: This systematic review aimed to understand older people's perspectives of associated fear-avoidant beliefs following upper limb fracture.

Methods: Published and unpublished literature databases were systematically searched from inception to 1st April 2023. Qualitative studies reporting the perspectives of fear-avoidant beliefs or behaviours in people who had sustained an upper limb fracture were eligible.

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Objectives: To assess the feasibility of conducting a pragmatic, multicentre randomised controlled trial (RCT) to test the clinical and cost-effectiveness of an informal caregiver training programme to support the recovery of people following hip fracture surgery.

Design: Two-arm, multicentre, pragmatic, open, feasibility RCT with embedded qualitative study.

Setting: National Health Service (NHS) providers in five English hospitals.

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Background: Chronic pain is a major challenge for some people after total knee replacement (TKR). The changing impact of this complication during the first post-operative year remains unclear. This analysis aimed to examine how physical activity and health-related quality of life (HRQoL) evolved over the first year after TKR for patients with and without post-operative chronic knee pain.

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Chronic pain (CP) and mental illness (MI) are leading causes of years lived with disability and commonly co-occur. However, it remains unclear if available interventions are effective in improving pain outcomes in patients with co-existing CP and MI. This systematic review synthesised evidence for the effectiveness of interventions to improve pain outcomes for people with comorbid CP and clinically diagnosed MI.

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Article Synopsis
  • - The objective of the study was to review how subchondral bone in osteoarthritis (OA) is assessed using computed tomography (CT) and to understand current practices in this area from 2010 to early 2023.
  • - A total of 202 studies were analyzed, identifying four types of CT modalities and categorizing bone assessment parameters into six main areas, including microstructure and mechanical properties.
  • - The study emphasized the need for standardized measurement methods and better quantification of parameters to enhance sensitivity and reliability in evaluating OA progression, which could improve their clinical relevance.
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Background: Nurses make complex triage decisions within emergency departments, which significantly affect patient outcomes. Understanding how nurses make these decisions and why they deviate from triage algorithms facilitates interventions that work with their decision-making processes, increasing acceptability and effectiveness.

Aims: This qualitative systematic review aimed to understand decision-making processes emergency nurses use to make acuity decisions during triage assessment at initial patient presentation.

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Introduction: Digital delivery of pre-operative total knee replacement (TKR) education and prehabilitation could improve patient outcomes pre- and post-operatively. Rigorously developing digital interventions is vital to help ensure they achieve their intended outcomes whilst mitigating their potential drawbacks.

Objective: To develop a pre-operative TKR education and prehabilitation digital intervention, the 'Virtual Knee School' (VKS).

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Purpose: To determine the provision and its change over time in unpaid care for people following hip fracture.

Methods: Data were sought from the English Longitudinal Study of Ageing (ELSA) cohort. We identified participants who self-reported experiencing a hip fracture, who had clinical and caregiving data in the previous and subsequent two data collection waves.

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Aims: The aim of this study was to capture 12-month outcomes from a representative multicentre cohort of patients undergoing total ankle arthroplasty (TAA), describe the pattern of patient-reported outcome measures (PROMs) at 12 months, and identify predictors of these outcome measures.

Methods: Patients listed for a primary TAA at 19 NHS hospitals between February 2016 and October 2017 were eligible. PROMs data were collected preoperatively and at six and 12 months including: Manchester-Oxford Foot and Ankle Questionnaire (MOXFQ (foot and ankle)) and the EuroQol five-dimension five-level questionnaire (EQ-5D-5L).

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Purpose: To examine the association between physiotherapy access after hip fracture and discharge home, readmission, survival, and mobility recovery.

Methods: A 2017 Physiotherapy Hip Fracture Sprint Audit was linked to hospital records for 5383 patients. Logistic regression was used to estimate the association between physiotherapy access in the first postoperative week and discharge home, 30-day readmission post-discharge, 30-day survival and 120-days mobility recovery post-admission adjusted for age, sex, American Society of Anesthesiology grade, Hospital Frailty Risk Score and prefracture mobility/residence.

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Article Synopsis
  • Walk With Ease (WWE) is a 6-week walking program from the US designed for adults with arthritis, and it can be done either with a teacher or on your own.
  • A study was done to see if WWE would work well in the UK, where it is not very known.
  • Most people liked the program and found it helpful, with many saying they would tell their friends and family about it, showing it could help more people in the UK stay healthy.
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Introduction: Robotic-assisted knee replacement systems have been introduced to healthcare services worldwide in an effort to improve clinical outcomes for people, although high-quality evidence that they are clinically, or cost-effective remains sparse. Robotic-arm systems may improve surgical accuracy and could contribute to reduced pain, improved function and lower overall cost of total knee replacement (TKR) surgery. However, TKR with conventional instruments may be just as effective and may be quicker and cheaper.

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  • The OMERACT Foot and Ankle Working Group is creating a core outcome set to improve treatment assessments for foot and ankle disorders in rheumatic and musculoskeletal diseases, as existing evidence is insufficient.* -
  • A scoping review analyzed 150 studies focusing on various interventions for these disorders, primarily involving conditions like rheumatoid arthritis and osteoarthritis, with foot/ankle pain being the most commonly measured outcome.* -
  • The project aims to incorporate findings and feedback from a virtual meeting to refine the core outcome set, ensuring it effectively addresses the diverse outcome domains identified.*
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Objective: To determine the feasibility of a randomised controlled trial to estimate the effectiveness and cost-effectiveness of a rehabilitation intervention following neck dissection (ND) after head and neck cancer (HNC).

Design: Two-arm, open, pragmatic, parallel, multicentre, randomised controlled feasibility trial.

Setting: Two UK NHS hospitals.

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Background: Pain management for people with dementia is challenging. There is limited understanding on the experiences of pain management from people with dementia, but also from those who support them. This study synthesised the qualitative evidence to explore the perspectives of people with dementia, their family, friends, carers and healthcare professionals to pain management.

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Background: Foot and ankle involvement is common in rheumatic and musculoskeletal diseases (RMDs). High-quality evidence is lacking to determine the effectiveness of treatments for these disorders. Heterogeneity in the outcomes used across clinical trials and observational studies hinders the ability to compare findings, and some outcomes are not always meaningful to patients and end-users.

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Background: Patellar (knee cap) dislocation occurs when the patella disengages completely from the trochlear (femoral) groove. It affects up to 42/100,000 people, and is most prevalent in those aged 20 to 30 years old. It is uncertain whether surgical or non-surgical treatment is the best approach.

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Objectives: To determine if a newer design of total knee replacement (TKR) (Journey II BCS) produces superior patient-reported outcomes scores and biomechanical outcomes than the older, more established design (Genesis II).

Setting: Patients were recruited from an NHS University Hospital between July 2018 and October 2019 with surgery at two sites. Biomechanical and functional capacity measurements were at a University Movement and Exercise Laboratory.

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