BESS/BOA Patient Care Pathways

Brownson, Peter; Donaldson, Oliver; Fox, Michael A.; Rees, Jonathan; Rangan, Amar; Jaggi, Anju; Tytherleigh-Strong, Graham; McBernie, Julie; Thomas, Michael; Kulkarni, Rohit

doi:10.1177/1758573215585656

Cited by 46 publications

(34 citation statements)

References 78 publications

(153 reference statements)

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“…The shoulder is the most frequently dislocated joint; occurring in 8.2-23.9 per 100 000 people per year. 1 Traumatic anterior shoulder dislocations (TASDs) occur when excessive forces during a traumatic event displace the humeral head frontwards, out of the shoulder socket, resulting in the joint surfaces completely losing contact. [1][2][3] They predominantly occur in men under 25 years during high-impact events and women over 80 years during low-impact events.…”

Section: Introductionmentioning

confidence: 99%

“…1 Traumatic anterior shoulder dislocations (TASDs) occur when excessive forces during a traumatic event displace the humeral head frontwards, out of the shoulder socket, resulting in the joint surfaces completely losing contact. [1][2][3] They predominantly occur in men under 25 years during high-impact events and women over 80 years during low-impact events. 1 People sustaining TASD often have ongoing pain, disability and morbidity linked to redislocation and subsequent need for repeated management.…”

Section: Introductionmentioning

confidence: 99%

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Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial

et al. 2020

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IntroductionFirst-time traumatic anterior shoulder dislocation (TASD) is predominantly managed non-operatively. People sustaining TASD have ongoing pain, disability and future risk of redislocation. There are no published randomised controlled trials (RCTs) comparing different non-operative rehabilitation strategies to ascertain the optimum clinically effective approach after TASD.Methods and analysisIn this multicentre adaptive RCT, with internal pilot, adults with a radiologically confirmed first time TASD treated non-surgically will be screened at a minimum of 30 sites. People with neurovascular complications, bilateral dislocations or are unable to attend physiotherapy will be excluded.Randomisation will be on a 1:1 treatment allocation, stratified by age, hand dominance and site. Participants will receive a single session of advice; or a single session of advice plus offer of further physiotherapy (maximum 4 months). The primary analysis will be the difference in Oxford Shoulder Instability Score at 6 months. A sample size of a minimum of 478 participants will allow us to show a four point difference with 90% power.An embedded qualitative study will explore the participants’ experiences of the trial interventions.Ethics, registration and disseminationFunded by NIHR HTA (16/167/56), 1 June 2018; National Research Ethic Committee approved (18/WA/0236), 26 July 2018. First site opened 5 November 2018 and final results will be updated on trial registries and submitted to a peer-reviewed journal and will inform rehabilitation strategies after a TASD. Study Within A Trial (SWAT) funded by MRC (MR/R013748/1), 1 May 2019; registered on the MRC-HTMR All-Ireland Hub (reference number SWAT 121).Trial registration numberISRCTN63184243. (Trial stage: Pre-results)

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial

et al. 2020

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“…Further advances in diagnostic imaging have led to a better understanding of the pathology involved. Different treatment pathways have been postulated for acute and recurrent anterior instability depending on the incidence, age, sex, size and location of the soft tissue/bony lesion (Bankart/ Hill- Sachs lesion) [ 7 ]. The mainstay of surgical management for recurrent anterior shoulder instability with a Bankart lesion is arthroscopic Bankart repair with proven excellent results [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Arthroscopic knotless anterior labral stabilization using labral tape and wide awake anaesthesia-short term results

Edwin¹,

Morris²,

Ahmed

et al. 2018

BMC Musculoskelet Disord

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BackgroundThe shoulder is the least constrained of all joints of the body and is more susceptible to injury including dislocation. The rate of recurrent instability following primary stabilization procedure at 10 years of follow-up ranged from 3.4 to 20%. There is a lack of evidence in the literature regarding use of labral tape and anchors for anterior stabilization despite the growing market for this product. We describe the outcomes of 67 patients who underwent knotless arthroscopic anterior stabilisation under awake anaesthesia using 1.5 mm LabralTape with 2.9 mm Pushlock anchors for primary anterior instability by a single surgeon.MethodsThis was a retrospective analysis of prospectively collected outcome data for adult patients undergoing anterior stabilisation for primary traumatic anterior shoulder instability between 2013 and 2016 at two centres. Patients with > 25% glenoid bone loss, engaging Hill Sach’s, and multidirectional instability were excluded. All cases underwent surgery using awake anaesthetic technique. The surgical technique and post-operative physiotherapy was standardized. Outcomes were measured at 6 months and 12 months.ResultsOf the 74 patients in our study, 7 were lost to follow up. Outcomes were measured using the Oxford Instability Shoulder Score (OISS) and clinical assessment including the range of motion. The OISS showed statistically significant improvement from a mean score and standard deviation (SD) of 24.72 ± 2.8 pre-surgery to 43.09 ± 3.5 after the procedure at 12 months with good to excellent outcomes in 66 cases (98.5%). The mean abduction was 134.2 ± 6.32 and external rotation was 72.55 ± 5.42 at 60–90 position at 12 months. We report no failures due to knot slippage or anchor pull-out.ConclusionOur case series using the above technique has distinct advantages of combining a small non-absorbable implant with flat, braided, and high-strength polyethylene tape. This technique demonstrates superior medium term results to conventional suture knot techniques for labral stabilization thereby validating its use.

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“… 27 Common function measures include the Western Ontario Osteoarthritis of the Shoulder index, 30 American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES) score, 25 the Single-Assessment Numerical Evaluation (SANE), 24 and more recently, the Patient-Reported Outcome Measurement Information System (PROMIS) Upper Extremity (UE) and Physical Function instruments. 14 Instruments used to evaluate HRQoL outcomes in those with GHOA include the the 12-Item Short Form Survey 6 and EuroQol 5 Dimensions. 6 , 14 The wide array of instruments available, each with its own unique psychometric properties, has created variability in the PROMs used to report outcomes after treatment for GHOA.…”

mentioning

confidence: 99%

“… 14 Instruments used to evaluate HRQoL outcomes in those with GHOA include the the 12-Item Short Form Survey 6 and EuroQol 5 Dimensions. 6 , 14 The wide array of instruments available, each with its own unique psychometric properties, has created variability in the PROMs used to report outcomes after treatment for GHOA. 32 , 48 , 49 , 59 Considered in the context of financial, administrative, and instrument-based limitations aforementioned, there is a specific need across orthopedic disciplines to adopt efficient, easily understandable instruments that display acceptable psychometric properties and may be administered in a variety of avenues (ie, paper, computer, cell phone messaging).…”

mentioning

confidence: 99%

Preoperative psychometric properties of visual analog scale asessments for function, pain, and strength compared with legacy upper extremity outcome measures in glenohumeral osteoarthritis

Beletsky

Nwachukwu

et al. 2020

JSES International

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Background Patient-reported outcome measures (PROMs) are increasingly being used in orthopedic surgery; however, there is significant variability and burden associated with their administration. The visual analog scale (VAS) may represent an efficient, single-question method to establish functional baselines in a domain-specific manner for glenohumeral arthritis. Methods Single-question VAS measures assessing function, strength, and pain as a percentage of normal were administered alongside legacy PROMs in patients with primary glenohumeral arthritis in a preoperative setting between October 2015 and March 2017. PROM performance was assessed using Spearman correlation coefficients. Both absolute and relative floor and ceiling effects were examined. Results A total of 70 patients (age 66.09 ± 9.84 years, body mass index 28.8 ± 9.77, 57.1% male, 54.2% right-sided) were included. The VAS Pain instrument ( r = 0.45-0.64) outperformed the VAS Function ( r = 0.23-0.62) and VAS Strength ( r = 0.21-0.65) in correlation to preoperative PROMs. The performance of VAS Pain was comparable to American Shoulder and Elbow Surgeons Standardized Shoulder Assessment Form (ASES; r = 0.47-0.84). None of the VAS instruments in our study demonstrated preoperative floor effects (7.1%-8.6%) or ceiling effects (0.0%-4.3%). The most efficient instruments were Single-Assessment Numerical Evaluation (SANE; 0.87 ± 0.41 minutes), Patient-Reported Outcome Measurement Information System Upper Extremity Computer Adaptive Test (PROMIS UE CAT; 1.27 ± 1.30 minutes), and the triad of VAS measures (1.51 ± 1.61 minutes). Conclusion VAS Pain outperformed VAS Strength and Function relative to legacy PROMs, while performing comparable to ASES. None of the VAS measures were susceptible to significant floor or ceiling effects preoperatively. The VAS instruments along with SANE and PROMIS UE were the most time-efficient measures. VAS instruments may have a role in establishing preoperative baselines in those with glenohumeral arthritis in a simple, efficient, and adoptable manner.

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BESS/BOA Patient Care Pathways

Cited by 46 publications

References 78 publications

Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial

Acute Rehabilitation following Traumatic anterior shoulder dISlocAtioN (ARTISAN): protocol for a multicentre randomised controlled trial

Arthroscopic knotless anterior labral stabilization using labral tape and wide awake anaesthesia-short term results

Preoperative psychometric properties of visual analog scale asessments for function, pain, and strength compared with legacy upper extremity outcome measures in glenohumeral osteoarthritis

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