ABSTRACT Objective This study evaluated the effectiveness of a standardized shoulder support in reducing shoulder subluxation, alleviating pain, and improving upper limb motor function and functional independence in stroke survivors using ultrasonography as the primary outcome measure for subluxation. Methods In this single‐blind randomized controlled trial, 40 stroke survivors with clinically confirmed shoulder subluxation were randomly allocated to either an intervention group ( n = 20) or a control group ( n = 20). Both groups received conventional rehabilitation consisting of 45‐min sessions, 5 days per week, over a seven‐week period. Participants in the intervention group additionally wore a standardized shoulder support during waking hours. Outcome evaluations were performed at baseline (before the intervention), week 3 (mid‐intervention), and week 7 (end of the intervention) by independent assessors (physicians and rehabilitation therapists) who were blinded to group allocation. The primary and secondary endpoints included ultrasonographic measurement of the Acromion‐Greater Tuberosity (AGT) distance, pain intensity assessed by the visual analog scale (VAS), upper extremity motor performance measured with the Fugl‐Meyer Assessment (FMA), and functional independence evaluated using the Functional Independence Measure (FIM). Results Within‐group analyses revealed statistically significant changes in shoulder subluxation ( p = 0.02), pain reduction ( p < 0.001), upper limb function ( p < 0.05), and functional independence ( p = 0.001) in both groups over time. However, between‐group comparisons showed no significant differences in any of the outcome measures ( p > 0.05). Conclusion Adding a standardized shoulder support to conventional rehabilitation did not produce a statistically significant additional benefit over 7 weeks in reducing shoulder subluxation, pain, or improving upper‐limb motor function and functional independence. The observed changes over time should be interpreted in the context of rehabilitation received by both groups, spontaneous recovery, and other time‐related factors cannot be distinguished.
ABSTRACT Background The efficacy and acceptability of remote care have now been demonstrated for many musculoskeletal disorders (MSKDs). However, the acceptability and potential uses of an initial remote evaluation for MSKDs have been scarcely studied and may be lower because of the loss of physical contact during the physical examination. Objective To explore the use of telehealth for the initial evaluation of MSKDs in France and to provide an in‐depth understanding of its application, benefits and barriers. Methods Twenty‐nine semi‐structured interviews were conducted in France with patients, healthcare providers (family physicians, musculoskeletal medical specialists and physiotherapists), professional body representatives and telehealth software specialists. Five tailored interview guides adapted from a previous qualitative study were used. All interviews were transcribed verbatim and a reflexive thematic analysis was performed. Results Participants found initial remote evaluations innovative for improving access but disagreed on the optimal scope and use. Four key themes were identified: (1) remote evaluation as a continuum from triage to diagnosis, conditioned by the perceived validity and feasibility of the adapted physical examination; (2) telehealth can complicate the patient–provider relationship; (3) videoconferencing is common, but its use in medical consultations may increase workload and burden; and (4) unlocking the full potential of telehealth requires coordinated planning and action as well as system‐level support. Conclusions Participants consistently identified remote triage as an acceptable initial stage in implementing remote evaluations for patients with MSKDs. Successful implementation will likely require targeted support for both patients and healthcare providers in conducting remote evaluations.
ABSTRACT Introduction Hip and knee osteoarthritis can cause difficulty with daily activities and are particularly common in people experiencing socioeconomic disadvantage. Supported self‐management programmes, such as peer mentorship, can be a valuable way to support people to actively participate in managing their condition. The aim of this study was to develop, deliver and evaluate a remote peer mentorship programme to support self‐management of hip and/or knee osteoarthritis among people experiencing socioeconomic disadvantage. Methods The current study is a process evaluation of a complex intervention involving participants with diagnosed osteoarthritis and self‐reported socioeconomic disadvantage. Prior to participating in the remote self‐management programme, mentees completed a baseline questionnaire. Following programme completion, mentees and peer mentors were invited to take part in a semi‐structured interview, with mentees also invited to a follow‐up interview. Quantitative data from baseline questionnaires were analysed using descriptive statistics, and an inductive‐deductive approach was undertaken to analyse qualitative data. Data were integrated through narrative using a contiguous approach. Results Thirty mentees participated in the remote peer mentorship programme, delivered by 13 trained peer mentors. Twenty‐two mentees participated in an initial interview, 17 participated in a follow‐up interview, and 12 peer mentors were interviewed. Four inter‐related themes were developed that explored engagement, remote delivery, acceptability and self‐management progress. The process evaluation identified factors that influenced engagement with the programme such as competing priorities, the role of the peer mentor, and motivation. Conclusions Remote peer mentorship for people with osteoarthritis experiencing socioeconomic disadvantage is largely acceptable, with the potential for meaningful impact.
ABSTRACT Background Direct‐access physiotherapy requires physiotherapists to make accurate clinical decisions whilst ensuring patient safety through appropriate triage and referral. Evidence regarding these competencies among Greek physiotherapists is lacking. Objective To evaluate the diagnostic accuracy and clinical management decision‐making abilities of Greek physiotherapists using clinical vignettes representative of direct‐access practice. Methods A cross‐sectional online survey was conducted among 253 licenced physiotherapists in Greece. Participants completed 12 clinical vignettes classified according to the original instrument as musculoskeletal, non‐critical medical and critical medical presentations. Diagnostic and management responses were scored dichotomously and summarised as accuracy scores and percentages. Descriptive statistics were used to summarise performance, a paired‐samples t ‐test was used to examine within‐participant differences between diagnostic and management scores and repeated‐measures ANOVA was used to compare diagnostic accuracy across the three clinical categories. Spearman correlation and general linear model analyses explored associations of diagnostic and management accuracy with clinical experience and screening behaviours, whereas group differences according to specialisation were examined separately. Results Mean diagnostic accuracy was 5.57 ± 2.49/12, whereas responses classified as correct were more frequent for management decisions (8.51 ± 1.45/12; p < 0.001). However, the diagnostic and management components differed in their response and scoring structures, limiting direct interpretation of this comparison. Diagnostic accuracy differed significantly across clinical categories ( p < 0.001), with the highest accuracy for musculoskeletal presentations (56.60 ± 27.01%), followed by non‐critical medical (50.89 ± 25.52%) and critical medical presentations (23.32 ± 25.30%). Diagnostic accuracy ranged from 13.8% to 96.8% across vignettes. Several clinical scenarios showed low diagnostic accuracy but comparatively higher management accuracy, suggesting that an acceptable management decision may sometimes be selected despite diagnostic uncertainty. No statistically significant associations were identified in the categorical‐factor general linear models, and no statistically significant differences in diagnostic or management accuracy were observed across physiotherapy specialisation groups. Conclusions Greek physiotherapists demonstrated variable diagnostic accuracy across clinical presentations and more frequently selected responses classified as appropriate for management; however, this difference should be interpreted cautiously because of the differing response and scoring structures of the two components. Diagnostic accuracy varied substantially across clinical categories and was particularly low for critical medical presentations. The vignette‐level findings suggest that appropriate management decisions may sometimes occur despite diagnostic uncertainty. Targeted education in differential diagnosis and red‐flag screening may improve clinical preparedness for first‐contact practice.
BACKGROUND Traditionally, patients who undergo total knee arthroplasty (TKA) are scheduled for an in-person routine follow-up (RFU) regimen. Increasing pressure on orthopaedic services and growing acceptance of digital health technologies urge clinics to adopt more efficient RFU strategies. However, limited insight exists into how RFU after TKA is organised in clinical practice and under which conditions digital follow-up is acceptable to orthopaedic surgeons. This study explored current RFU practices after TKA and examined surgeons' perspectives on digital follow-up. METHODS A qualitative study using semi-structured interviews was conducted with 21 orthopaedic surgeons from different healthcare institutions. Interviews were conducted digitally, transcribed verbatim, and analysed using qualitative analysis software. Two researchers independently coded the transcripts, after which the codes were compared, refined, and grouped into overarching themes. RESULTS Four main themes emerged. (1) RFU after TKA was highly fragmented across institutions, with variation in timing, contact modality, responsible healthcare provider, and use of radiographic assessment. (2) Follow-up visits were primarily perceived as a means to confirm uncomplicated recovery and detect complications early. (3) Digital follow-up was viewed not as a replacement for in-person visits but as an additional triage strategy to support decisions on physical consultation. (4) Acceptance of digital follow-up depended on clear patient selection, predefined clinical recovery indicators, and preservation of professional and patient autonomy. CONCLUSION RFU after TKA is poorly standardized and institution dependent. Digital follow-up is considered acceptable mainly as a triage mechanism if patient safety, professional autonomy, and the surgeon-patient relationship are maintained.
