Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2018 Sep 27;19(1):348.
doi: 10.1186/s12891-018-2265-6.

General health factors may be a barrier to effective non-surgical multidisciplinary rehabilitation of common orthopaedic conditions in tertiary care settings

Shaun O'Leary  1   2 , Michelle Cottrell  3   4 , Maree Raymer  5 , David Smith  4 , Asaduzzaman Khan  3
Affiliations

General health factors may be a barrier to effective non-surgical multidisciplinary rehabilitation of common orthopaedic conditions in tertiary care settings

Shaun O'Leary et al. BMC Musculoskelet Disord. .

Abstract

Background: To explore patient characteristics predictive of a poor response to multidisciplinary non-surgical rehabilitation of three common orthopaedic conditions within a tertiary care service.

Methods: A retrospective audit of medical records of patients who had undergone multidisciplinary non-surgical management of their knee osteoarthritis (KOA, n = 190), shoulder impingement syndrome (SIS, n = 199), or low back pain (LBP, n = 242) within a multisite tertiary care service was undertaken. Standardised clinical measures recorded by the service at the initial consultation were examined using a base binary logistic regression model to determine their relationship with a poor response to management (ie. not achieving a minimal clinically important improvement in the condition disability measure pre-post management).

Results: Factors predictive of a poor response following non-surgical management included;; higher levels of anxiety (OR 1.11, P < 0.02) and lower functional score (OR 0.76, P < 0.04) for KOA, higher number of comorbidities (OR 1.16, P < 0.03) for SIS, and coexisting cervical or thorax pain (OR 2.1, P = 0.04) and lower pain self-efficacy (OR 0.98, P = 0.02) for LBP.

Conclusions: General health issues may present a barrier to achieving favourable outcomes in response to multidisciplinary non-surgical rehabilitation for the management of common orthopaedic conditions in a tertiary care setting. Clinicians may need to consider these broader patient issues when designing management strategies for patients with these conditions.

Keywords: Knee osteoarthritis; Low back pain; Musculoskeletal; Non-surgical management; Predictors; Shoulder impingement.

PubMed Disclaimer

Conflict of interest statement

Ethics approval and consent to participate

This project received multisite ethical approval from the Royal Brisbane and Women’s Hospital Medical Research Ethics Committee (HREC/10/QRBW/455). Public Health Act approval was obtained from each hospital (Royal Brisbane and Women’s Hospital, Ipswich Hospital, Princess Alexandra Hospital, Logan Hospital, Gold Coast Hospital, Townsville Hospital, and Redcliffe Hospital) permitting access to medical records without the need for informed consent.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow diagram of the audit process
See this image and copyright information in PMC

References

    1. Vos T, Flaxman AD, Naghavi M, Lozano R, Michaud C, Ezzati M, et al. Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the global burden of disease study 2010. Lancet. 2012;380:2163–2196. doi: 10.1016/S0140-6736(12)61729-2. - DOI - PMC - PubMed
    1. Bennell KL, Hunter DJ, Hinman RS. Management of osteoarthritis of the knee. Br Med J. 2012;345:e4934. doi: 10.1136/bmj.e4934. - DOI - PubMed
    1. Cummins CA, Sasso LM, Nicholson D. Impingement syndrome: temporal outcomes of nonoperative treatment. J Shoulder Elb Surg. 2009;18:172–177. doi: 10.1016/j.jse.2008.09.005. - DOI - PubMed
    1. Airaksinen O, Brox JI, Cedraschi C, Hildebrandt J, Klaber-Moffett J, Kovacs F, et al. Chapter 4. European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(Suppl 2):S192–S300. doi: 10.1007/s00586-006-1072-1. - DOI - PMC - PubMed
    1. Franklin PD, Li W, Ayers DC. The Chitranjan Ranawat award: functional outcome after total knee replacement varies with patient attributes. Clin Orthop Relat Res. 2008;466:2597–2604. doi: 10.1007/s11999-008-0428-8. - DOI - PMC - PubMed

MeSH terms

LinkOut - more resources