Prof. Jon Tobias's presentation from Osteoporosis 2016: Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude.
Find out more at: https://nos.org.uk/conference
Exercise can be challenging for individuals following a CVA, due to limitations impacting movement; it is essential, however, to managing recovery successfully.
Whole-Body Vibration Training and Older AdultsLyndsay Foisey
This is a public presentation of a research study I performed on whole-body vibration training and older adults. In this study, it was found that strength and functional balance improved in the treatment sample. Presented April 24, 2011.
Evaluating the Effectiveness of Current Pain Management StrategiesWellbe
Pain management of orthopedic surgery patients is being impacted by the changes in health care regulation and reimbursement. There is a need for safer, more effective pain management pathways that can provide opportunities for early discharge without increasing the risk of readmissions or compromising outcomes.
Current pain management strategies for joint replacements, spine surgery and outpatient knee and shoulder procedures will be examined from clinical, safety, satisfaction and cost perspectives. The process of implementing and evaluating these pathways will also be discussed.
Nina Whalen will demonstrate how she evaluated, developed and improved pain management pathways for patients. These pathways include:
– Multimodal pain management for total joint and spine
– Peripheral nerve block utilization for inpatients and outpatients
– Customized pain pathways for special populations
– The use of intraoperative tissue infiltration with medications as a primary pain management strategy in joint replacement surgery
About The Speaker:
Nina Whalen, RN, APN-C, has over 30 years of experience as a nurse practitioner in orthopedic medicine. She has been involved in every phase of patient care at both the clinic and tertiary care levels. In the 1990’s she created and worked in a nurse practitioner hospital program at Presbyterian St Luke’s hospital that provided 24 hour coverage for the needs of hospitalized orthopedic surgery patients. She has worked in research and has co-authored publications in the areas of sports medicine and total joint. She is currently the manager of clinical outcomes at OrthoIndy Hospital (formerly Indiana Orthopaedic Hospital) which is a 38 bed, physician owned, orthopedic specialty hospital in Indianapolis.
Regional Anesthesia and Bundled Payments – Opioid-sparing Pain Management for...Wellbe
Speaker: Sonia Szlyk, MD, Director of Regional Anesthesia, Mid-Atlantic Division, North American Partners in Anesthesia
This webinar will:
-Discuss Enhanced Recovery After Surgery (ERAS) protocols for joint replacement
-Review the positive impact of regional anesthesia throughout the episode of care
-Spotlight the key components of successful value-based orthopedic care – length of stay, discharge to home, patient and surgeon satisfaction
About the Speaker:
Sonia Szlyk, MD, is the Director of Regional Anesthesia for North American Partners in Anesthesia’s Mid-Atlantic division. Dr. Szlyk orchestrates an outcomes-based regional anesthesia service focused on patient and surgeon satisfaction, safety, and efficiency. She oversees regional anesthesia quality metrics, billing compliance, strategic growth, and education. Dr. Szlyk specializes in opioid-sparing ERAS protocols for joint replacement, sports medicine, colorectal, general, and cosmetic surgery. Her initiatives highlight the value of regional anesthesia in the evolving era of bundled payments.
Dr. Szlyk served as the Director of Regional Anesthesia at the Ambulatory Surgery Center of Bethesda, MD where she oversaw the design and implementation of anesthesia services as well as AAAHC accreditation. The center’s comprehensive pain management program included ultrasound-guided peripheral nerve blocks and catheters for outpatient knee and hip replacements, and sports medicine procedures.
Dr. Szlyk is a board-certified anesthesiologist. She completed medical school and anesthesia residency at the George Washington University School of Medicine and was a Clinical Instructor in regional anesthesia at Stanford University Hospital.
Prof. Jon Tobias's presentation from Osteoporosis 2016: Day-to-day levels of high impact physical activity are positively related to lower limb bone strength in older women: findings from a population based study using accelerometers to classify impact magnitude.
Find out more at: https://nos.org.uk/conference
Exercise can be challenging for individuals following a CVA, due to limitations impacting movement; it is essential, however, to managing recovery successfully.
Whole-Body Vibration Training and Older AdultsLyndsay Foisey
This is a public presentation of a research study I performed on whole-body vibration training and older adults. In this study, it was found that strength and functional balance improved in the treatment sample. Presented April 24, 2011.
Evaluating the Effectiveness of Current Pain Management StrategiesWellbe
Pain management of orthopedic surgery patients is being impacted by the changes in health care regulation and reimbursement. There is a need for safer, more effective pain management pathways that can provide opportunities for early discharge without increasing the risk of readmissions or compromising outcomes.
Current pain management strategies for joint replacements, spine surgery and outpatient knee and shoulder procedures will be examined from clinical, safety, satisfaction and cost perspectives. The process of implementing and evaluating these pathways will also be discussed.
Nina Whalen will demonstrate how she evaluated, developed and improved pain management pathways for patients. These pathways include:
– Multimodal pain management for total joint and spine
– Peripheral nerve block utilization for inpatients and outpatients
– Customized pain pathways for special populations
– The use of intraoperative tissue infiltration with medications as a primary pain management strategy in joint replacement surgery
About The Speaker:
Nina Whalen, RN, APN-C, has over 30 years of experience as a nurse practitioner in orthopedic medicine. She has been involved in every phase of patient care at both the clinic and tertiary care levels. In the 1990’s she created and worked in a nurse practitioner hospital program at Presbyterian St Luke’s hospital that provided 24 hour coverage for the needs of hospitalized orthopedic surgery patients. She has worked in research and has co-authored publications in the areas of sports medicine and total joint. She is currently the manager of clinical outcomes at OrthoIndy Hospital (formerly Indiana Orthopaedic Hospital) which is a 38 bed, physician owned, orthopedic specialty hospital in Indianapolis.
Regional Anesthesia and Bundled Payments – Opioid-sparing Pain Management for...Wellbe
Speaker: Sonia Szlyk, MD, Director of Regional Anesthesia, Mid-Atlantic Division, North American Partners in Anesthesia
This webinar will:
-Discuss Enhanced Recovery After Surgery (ERAS) protocols for joint replacement
-Review the positive impact of regional anesthesia throughout the episode of care
-Spotlight the key components of successful value-based orthopedic care – length of stay, discharge to home, patient and surgeon satisfaction
About the Speaker:
Sonia Szlyk, MD, is the Director of Regional Anesthesia for North American Partners in Anesthesia’s Mid-Atlantic division. Dr. Szlyk orchestrates an outcomes-based regional anesthesia service focused on patient and surgeon satisfaction, safety, and efficiency. She oversees regional anesthesia quality metrics, billing compliance, strategic growth, and education. Dr. Szlyk specializes in opioid-sparing ERAS protocols for joint replacement, sports medicine, colorectal, general, and cosmetic surgery. Her initiatives highlight the value of regional anesthesia in the evolving era of bundled payments.
Dr. Szlyk served as the Director of Regional Anesthesia at the Ambulatory Surgery Center of Bethesda, MD where she oversaw the design and implementation of anesthesia services as well as AAAHC accreditation. The center’s comprehensive pain management program included ultrasound-guided peripheral nerve blocks and catheters for outpatient knee and hip replacements, and sports medicine procedures.
Dr. Szlyk is a board-certified anesthesiologist. She completed medical school and anesthesia residency at the George Washington University School of Medicine and was a Clinical Instructor in regional anesthesia at Stanford University Hospital.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
MANAGEMENT OF ATRIOVENTRICULAR CONDUCTION BLOCK.pdfJim Jacob Roy
Cardiac conduction defects can occur due to various causes.
Atrioventricular conduction blocks ( AV blocks ) are classified into 3 types.
This document describes the acute management of AV block.
Couples presenting to the infertility clinic- Do they really have infertility...Sujoy Dasgupta
Dr Sujoy Dasgupta presented the study on "Couples presenting to the infertility clinic- Do they really have infertility? – The unexplored stories of non-consummation" in the 13th Congress of the Asia Pacific Initiative on Reproduction (ASPIRE 2024) at Manila on 24 May, 2024.
Tom Selleck Health: A Comprehensive Look at the Iconic Actor’s Wellness Journeygreendigital
Tom Selleck, an enduring figure in Hollywood. has captivated audiences for decades with his rugged charm, iconic moustache. and memorable roles in television and film. From his breakout role as Thomas Magnum in Magnum P.I. to his current portrayal of Frank Reagan in Blue Bloods. Selleck's career has spanned over 50 years. But beyond his professional achievements. fans have often been curious about Tom Selleck Health. especially as he has aged in the public eye.
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Introduction
Many have been interested in Tom Selleck health. not only because of his enduring presence on screen but also because of the challenges. and lifestyle choices he has faced and made over the years. This article delves into the various aspects of Tom Selleck health. exploring his fitness regimen, diet, mental health. and the challenges he has encountered as he ages. We'll look at how he maintains his well-being. the health issues he has faced, and his approach to ageing .
Early Life and Career
Childhood and Athletic Beginnings
Tom Selleck was born on January 29, 1945, in Detroit, Michigan, and grew up in Sherman Oaks, California. From an early age, he was involved in sports, particularly basketball. which played a significant role in his physical development. His athletic pursuits continued into college. where he attended the University of Southern California (USC) on a basketball scholarship. This early involvement in sports laid a strong foundation for his physical health and disciplined lifestyle.
Transition to Acting
Selleck's transition from an athlete to an actor came with its physical demands. His first significant role in "Magnum P.I." required him to perform various stunts and maintain a fit appearance. This role, which he played from 1980 to 1988. necessitated a rigorous fitness routine to meet the show's demands. setting the stage for his long-term commitment to health and wellness.
Fitness Regimen
Workout Routine
Tom Selleck health and fitness regimen has evolved. adapting to his changing roles and age. During his "Magnum, P.I." days. Selleck's workouts were intense and focused on building and maintaining muscle mass. His routine included weightlifting, cardiovascular exercises. and specific training for the stunts he performed on the show.
Selleck adjusted his fitness routine as he aged to suit his body's needs. Today, his workouts focus on maintaining flexibility, strength, and cardiovascular health. He incorporates low-impact exercises such as swimming, walking, and light weightlifting. This balanced approach helps him stay fit without putting undue strain on his joints and muscles.
Importance of Flexibility and Mobility
In recent years, Selleck has emphasized the importance of flexibility and mobility in his fitness regimen. Understanding the natural decline in muscle mass and joint flexibility with age. he includes stretching and yoga in his routine. These practices help prevent injuries, improve posture, and maintain mobilit
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Ve...kevinkariuki227
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
TEST BANK for Operations Management, 14th Edition by William J. Stevenson, Verified Chapters 1 - 19, Complete Newest Version.pdf
Title: Sense of Taste
Presenter: Dr. Faiza, Assistant Professor of Physiology
Qualifications:
MBBS (Best Graduate, AIMC Lahore)
FCPS Physiology
ICMT, CHPE, DHPE (STMU)
MPH (GC University, Faisalabad)
MBA (Virtual University of Pakistan)
Learning Objectives:
Describe the structure and function of taste buds.
Describe the relationship between the taste threshold and taste index of common substances.
Explain the chemical basis and signal transduction of taste perception for each type of primary taste sensation.
Recognize different abnormalities of taste perception and their causes.
Key Topics:
Significance of Taste Sensation:
Differentiation between pleasant and harmful food
Influence on behavior
Selection of food based on metabolic needs
Receptors of Taste:
Taste buds on the tongue
Influence of sense of smell, texture of food, and pain stimulation (e.g., by pepper)
Primary and Secondary Taste Sensations:
Primary taste sensations: Sweet, Sour, Salty, Bitter, Umami
Chemical basis and signal transduction mechanisms for each taste
Taste Threshold and Index:
Taste threshold values for Sweet (sucrose), Salty (NaCl), Sour (HCl), and Bitter (Quinine)
Taste index relationship: Inversely proportional to taste threshold
Taste Blindness:
Inability to taste certain substances, particularly thiourea compounds
Example: Phenylthiocarbamide
Structure and Function of Taste Buds:
Composition: Epithelial cells, Sustentacular/Supporting cells, Taste cells, Basal cells
Features: Taste pores, Taste hairs/microvilli, and Taste nerve fibers
Location of Taste Buds:
Found in papillae of the tongue (Fungiform, Circumvallate, Foliate)
Also present on the palate, tonsillar pillars, epiglottis, and proximal esophagus
Mechanism of Taste Stimulation:
Interaction of taste substances with receptors on microvilli
Signal transduction pathways for Umami, Sweet, Bitter, Sour, and Salty tastes
Taste Sensitivity and Adaptation:
Decrease in sensitivity with age
Rapid adaptation of taste sensation
Role of Saliva in Taste:
Dissolution of tastants to reach receptors
Washing away the stimulus
Taste Preferences and Aversions:
Mechanisms behind taste preference and aversion
Influence of receptors and neural pathways
Impact of Sensory Nerve Damage:
Degeneration of taste buds if the sensory nerve fiber is cut
Abnormalities of Taste Detection:
Conditions: Ageusia, Hypogeusia, Dysgeusia (parageusia)
Causes: Nerve damage, neurological disorders, infections, poor oral hygiene, adverse drug effects, deficiencies, aging, tobacco use, altered neurotransmitter levels
Neurotransmitters and Taste Threshold:
Effects of serotonin (5-HT) and norepinephrine (NE) on taste sensitivity
Supertasters:
25% of the population with heightened sensitivity to taste, especially bitterness
Increased number of fungiform papillae
micro teaching on communication m.sc nursing.pdfAnurag Sharma
Microteaching is a unique model of practice teaching. It is a viable instrument for the. desired change in the teaching behavior or the behavior potential which, in specified types of real. classroom situations, tends to facilitate the achievement of specified types of objectives.
Flu Vaccine Alert in Bangalore Karnatakaaddon Scans
As flu season approaches, health officials in Bangalore, Karnataka, are urging residents to get their flu vaccinations. The seasonal flu, while common, can lead to severe health complications, particularly for vulnerable populations such as young children, the elderly, and those with underlying health conditions.
Dr. Vidisha Kumari, a leading epidemiologist in Bangalore, emphasizes the importance of getting vaccinated. "The flu vaccine is our best defense against the influenza virus. It not only protects individuals but also helps prevent the spread of the virus in our communities," he says.
This year, the flu season is expected to coincide with a potential increase in other respiratory illnesses. The Karnataka Health Department has launched an awareness campaign highlighting the significance of flu vaccinations. They have set up multiple vaccination centers across Bangalore, making it convenient for residents to receive their shots.
To encourage widespread vaccination, the government is also collaborating with local schools, workplaces, and community centers to facilitate vaccination drives. Special attention is being given to ensuring that the vaccine is accessible to all, including marginalized communities who may have limited access to healthcare.
Residents are reminded that the flu vaccine is safe and effective. Common side effects are mild and may include soreness at the injection site, mild fever, or muscle aches. These side effects are generally short-lived and far less severe than the flu itself.
Healthcare providers are also stressing the importance of continuing COVID-19 precautions. Wearing masks, practicing good hand hygiene, and maintaining social distancing are still crucial, especially in crowded places.
Protect yourself and your loved ones by getting vaccinated. Together, we can help keep Bangalore healthy and safe this flu season. For more information on vaccination centers and schedules, residents can visit the Karnataka Health Department’s official website or follow their social media pages.
Stay informed, stay safe, and get your flu shot today!
Anti ulcer drugs and their Advance pharmacology ||
Anti-ulcer drugs are medications used to prevent and treat ulcers in the stomach and upper part of the small intestine (duodenal ulcers). These ulcers are often caused by an imbalance between stomach acid and the mucosal lining, which protects the stomach lining.
||Scope: Overview of various classes of anti-ulcer drugs, their mechanisms of action, indications, side effects, and clinical considerations.
- Video recording of this lecture in English language: https://youtu.be/lK81BzxMqdo
- Video recording of this lecture in Arabic language: https://youtu.be/Ve4P0COk9OI
- Link to download the book free: https://nephrotube.blogspot.com/p/nephrotube-nephrology-books.html
- Link to NephroTube website: www.NephroTube.com
- Link to NephroTube social media accounts: https://nephrotube.blogspot.com/p/join-nephrotube-on-social-media.html
Prix Galien International 2024 Forum ProgramLevi Shapiro
June 20, 2024, Prix Galien International and Jerusalem Ethics Forum in ROME. Detailed agenda including panels:
- ADVANCES IN CARDIOLOGY: A NEW PARADIGM IS COMING
- WOMEN’S HEALTH: FERTILITY PRESERVATION
- WHAT’S NEW IN THE TREATMENT OF INFECTIOUS,
ONCOLOGICAL AND INFLAMMATORY SKIN DISEASES?
- ARTIFICIAL INTELLIGENCE AND ETHICS
- GENE THERAPY
- BEYOND BORDERS: GLOBAL INITIATIVES FOR DEMOCRATIZING LIFE SCIENCE TECHNOLOGIES AND PROMOTING ACCESS TO HEALTHCARE
- ETHICAL CHALLENGES IN LIFE SCIENCES
- Prix Galien International Awards Ceremony
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stockrebeccabio
Factory Supply Best Quality Pmk Oil CAS 28578–16–7 PMK Powder in Stock
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Some WorkCover fusions work
1. Some WorkCover
fusions work:
Presence of leg pain
influences outcome
Emma Johnston
Dr Ben Goss
Taylor Major
Adj Prof Paul Licina
Brisbane Private Hospital Research Group
2. Some WorkCover fusions work: Presence of leg pain influences outcome
We declare that in relation to this talk there are no conflicts of interest to disclose.
In relation to all other possible conflicts of interest:
• Institutional support from Brisbane Private Hospital Research Group has been
received and used to employ a research assistant.
• Dr Ben Goss is an employee of NuVasive.
Paul Licina (principal author)
Emma Johnston
Ben Goss
Taylor Major
Disclaimer
3. Compensation and Fusion
Some WorkCover fusions work: Presence of leg pain influences outcome
• Compensation patients have low return to work rates after
surgery (50%)
• A large number still required some form of ongoing
treatment two years postoperatively (77%)
4. Compensation and Fusion
Some WorkCover fusions work: Presence of leg pain influences outcome
• Compensation patients have higher rates of surgery but
poorer outcomes
• Little or no improvement seen in function and disability
scores, with some worsening
5. ? Our WorkCover patients weren’t as bad as papers suggested
• Location of preoperative pain
Some WorkCover fusions work: Presence of leg pain influences outcome
Observations
6. Some WorkCover fusions work: Presence of leg pain influences outcome
Aims
1. To quantify the outcomes of WorkCover fusion patients
2. To determine if preoperative location of pain influences outcome
7. Method
Prospectively collected data
Retrospectively reviewed
10 year period (2006-2015)
Single surgeon
Single level primary interbody lumbar fusions
Degenerative conditions
Some WorkCover fusions work: Presence of leg pain influences outcome
8. Some WorkCover fusions work: Presence of leg pain influences outcome
Patient Reported Outcomes
Pre-operative 6/52 postop 6/12 postop
9. Private WorkCover Total
465 42 507
nt back 103 12 115
g equal 269 17 286
nt leg 93 13 106
WorkCover
Some WorkCover fusions work: Presence of leg pain influences outcome
Results
10. Pre-operative 6 weeks 6 months
0
20
40
60
80
100
Time
ODI%
Private (n=465)
WorkCover (n= 42)
Some WorkCover fusions work: Presence of leg pain influences outcome
ODI
11. Pre-operative 6 weeks 6 months
0
2
4
6
8
10
Time
BackVAS WorkCover (n=42)
Private (n=465)
Some WorkCover fusions work: Presence of leg pain influences outcome
Back VAS
12. Pre-operative 6 weeks 6 months
0
2
4
6
8
10
Time
LegVAS WorkCover (n=42)
Private (n=465)
Some WorkCover fusions work: Presence of leg pain influences outcome
Leg VAS
13. Some WorkCover fusions work: Presence of leg pain influences outcome
ODI improvement - Private
-50
-25
0
25
50
75
100
DODI
n = 465
71.83% MCID better
9.89% Subjectively better
1.29% No change
4.52% Subjectively worse
0.65% MCID worse
Private change in ODI
81%
improved
1%
worse
18%
no clinically
relevant change
15. Some WorkCover fusions work: Presence of leg pain influences outcome
Back VAS improvement - Private
-10
-5
0
5
10
DBackVAS
n = 465
67.53% MCID better
6.88% Subjectively better
3.87% No change
3.66% Subjectively worse
3.44% MCID worse
Private change in Back VAS
17%
no clinically
relevant change
77%
improved
4%
worse
16. Some WorkCover fusions work: Presence of leg pain influences outcome
Back VAS improvement
79% 61%
improved
4% 11%
worse
17% 28%
no clinically
relevant change
17. Some WorkCover fusions work: Presence of leg pain influences outcome
Leg VAS improvement - Private
-10
-5
0
5
10
DLegVAS
n = 465
65.38% MCID better
7.31% Subjectively better
7.53% No change
3.23% Subjectively worse
1.94% MCID worse
Private change in Leg VAS
19%
no clinically
relevant change
77%
improved
4%
worse
18. Some WorkCover fusions work: Presence of leg pain influences outcome
Leg VAS improvement
77% 61%
improved
4% 8%
worse
19% 31%
no clinically
relevant change
19. Some WorkCover fusions work: Presence of leg pain influences outcome
Aims
1. To quantify the outcomes of WorkCover fusion patients
Postoperative improvement in both groups
WorkCover did not improve as much
20. Some WorkCover fusions work: Presence of leg pain influences outcome
Aims
1. To quantify the outcomes of WorkCover fusion patients
2. To determine if preoperative location of pain influences outcome
21. Results
Private
Some WorkCover fusions work: Presence of leg pain influences outcome
Equal
Leg
Back
Back
Equal
WorkCover
Leg
Back
Equal
58%
22%
31%20%
40%
29%
22. Pre-operative 6 weeks 6 months
0
20
40
60
Time
ODI%
LPD WorkCoverLPD Private
BPD WorkCoverBPD Private
BLE WorkCoverBLE Private
Some WorkCover fusions work: Presence of leg pain influences outcome
ODI
Back VAS
Leg VAS
23. Some WorkCover fusions work: Presence of leg pain influences outcome
ODI
Pre-operative 6 weeks 6 months
0
20
40
60
Time
ODI%
LPD Private
BPD Private
BLE Private
24. Pre-operative 6 weeks 6 months
0
20
40
60
Time
ODI%
LPD WorkCoverLPD Private
BPD WorkCoverBPD Private
BLE WorkCoverBLE Private
Some WorkCover fusions work: Presence of leg pain influences outcome
ODI
25. Some WorkCover fusions work: Presence of leg pain influences outcome
Pre-operative 6 weeks 6 months
0
2
4
6
8
10
Time
BackVAS
BPD WorkCoverBPD Private
BLE WorkCoverBLE Private
Back VAS
26. Some WorkCover fusions work: Presence of leg pain influences outcome
Leg VAS
Pre-operative 6 weeks 6 months
0
2
4
6
8
10
Time
LegVAS
LPD WorkCoverLPD Private
27. Pre-operative 6 weeks 6 months
0
2
4
6
8
10
Time
LegVAS
LPD WorkCoverLPD Private
BLE WorkCoverBLE Private
Some WorkCover fusions work: Presence of leg pain influences outcome
Leg VAS
28. Some WorkCover fusions work: Presence of leg pain influences outcome
Aims
1. To quantify the outcomes of WorkCover fusion patients
2. To determine if preoperative location of pain influences outcome
WorkCover patients with leg pain do well
29. • WorkCover patients have less improvement in ODI and VAS
• Especially with significant preoperative back pain
• Very few are worse (5-10%)
• WorkCover patients with dominant leg pain do better
Some WorkCover fusions work: Presence of leg pain influences outcome
Conclusions
30. • Study limited by small numbers
• If a patient has predominant leg pain, their WorkCover status
should not exclude them from surgery
• Research into back pain treatment should focus on identifying
subgroups that respond to treatment
Some WorkCover fusions work: Presence of leg pain influences outcome
Impressions
Editor's Notes
Good morning my name is Emma Johnston and I am a second year medical student at the University of Melbourne. Prior to this I was our groups research assistant for nearly 5 years.
Thank you for allowing me to present today.
These are our disclosures.
As we are all well aware, the perception of spinal fusion for compensation patients is negative
This paper was published by professor Ian Harris in 2012 showing poor outcomes in workers compensation patients after surgery.
A more recent study had similar conclusions.
However, anecdotally, our outcomes weren’t as bad as some of these papers indicated
WorkCover being the QLD Workers Compensation scheme
We thought that the type of pre-operative pain may be important
So we conducted this study to quantify the outcomes we were seeing for WorkCover patients
And to also look at whether the location of preoperative pain influences postoperative outcome
We retrospectively reviewed data that was prospectively collected.
All primary single level interbody fusions performed over a 10 year period for degenerative conditions by a single surgeon were included.
PRO were collected pre-operatively and at 6 wks, 6 months postoperatively.
Standard protocol for patient review meant that all patient data was available
Oswestry Disability Index and back and leg Visual Analogue Score were collected
507 patients were included in the study
WC patients represented less than 10% of the cohort
As expected, we found that the average ODI improved for both groups but that the improvement was greater in the private patient group.
The same trend was seen for back pain
And for leg pain.
To look at this data more closely we analysed the amount of change in each of the patient reported outcomes from preop to 6 months postop.
Most patients improved. But taking into account the
Minimum Clinically Important Difference or MCID of 12.8 for ODI, some patients fell into the grey zone of no clinically meaningful improvement.
More than 80% of private patients achieved this MCID.
However, just over half of WorkCover patients improved above the MCID. More WorkCover than private patients fell into the group of no clinically meaningful improvement. Importantly, however, very few were worse.
For back VAS the MCID is 1.2.
Again, nearly 80% of private patients improved above this level.
However, only 60% of WorkCover patients had a meaningful improvement.
We saw a similar trend for leg pain with almost 80% of private patients
And just over 60% of WorkCover patients achieving MCID.
So for our first aim, we found that there was postoperative improvement in both groups but that the WorkCover group did not improve as much.
We also felt the WorkCover results were not as dismal as some people think.
Now to our second aim which is to determine whether the location of preoperative pain has any influence on outcome
To assess this the private and WorkCover groups were further subdivided based on the dominant preoperative pain location. ____
The 3 groups were patients who had predominantly leg pain, predominately back pain or equal amounts of back and leg pain. Patients were considered equal if their back and leg VAS were within 2 points of each other.
There was some difference in the proportion of each group between private and WorkCover patients.
Next I am going to show you a series of graphs focusing on pain location.
The LPD patients are in the darkest shade (of blue for private and red for WC)
We will look at the PROMS being ODI and back and leg VAS.
First ODI
We saw that private patients did equally well, regardless of their dominant preoperative pain location.
Whereas in the WC group leg pain patients did better, nearly as well as private patients.
For Back VAS we saw that patients were very different, depending on whether they were private or WC
In contrast, for leg VAS, the patients with predominatley leg pain had very similar improvements, regardless of their WC status.
As soon as there is a significant element of back pain the numbers are very different.
So for our second aim, we have isolated a group where WC status does not seem to influence outcome. These are patients where preoperative leg pain exceeds back pain.
Another way of looking at that is if back pain is equal or greater than leg pain, WC patients do poorly.
In conclusion, WC patients undergoing spinal fusion do not do as well as private patients.
Especially if they have significant preoperative back pain.
Fortunately, very few are subjectively worse.
A sub-group of WC patients, those with mainly leg pain preoperatively, do well.
This study and its results are significantly limited by the small numbers.
But maybe we can draw from this that WC patients with leg pain should not necessarily be excluded from surgery.
As we have heard at this meeting from Dr McCombe and others, as clinicians we know many interventions are effective even if unable to be proven in RCTs.
We recognise patients with back pain are heterogenous and combining them into one big group may mask possible benefits in subgroups.
Perhaps this type of study is where the focus should be.
It may be fruitless to undertake more and more large RCTs to prove a treatment works or doesn’t work. We need to look at treatments where outcome varies and further define the factors which are associated with a good clinical outcome.
