Objective:Conduct a scoping review to identify radiographic measures of patellofemoral joint (PFJ) alignment and bony morphology reported in literature published during a representative period (2014-2018), and describe their reported measurement properties. Design:Eight electronic databases were searched using keywords relating to "patellofemoral" and "radiograph". Identified records were screened for eligibility by two independent assessors. English-language studies published in the years 2014-2018 were included if they reported: (i) acquiring PFJ radiographs; (ii) method of radiograph acquisition; and (iii) descriptions of radiographic PFJ alignment and bony morphology measures. Non-human and cadaveric studies, single-case studies, and studies with mean participant age <10 years were excluded. For studies that reported measurement properties (reliability, validity, responsiveness), quality appraisal was performed by two independent assessors using the COSMIN Risk of Bias tool. Descriptive data were reported. Results:Of 18,678 records identified, 336 articles met our criteria . Ninety-one unique radiographic alignment and morphology measures were described. Most prevalent were measures of patellar height (222, 66.1 %), patellar alignment (142, 42.3 %), and patellar inclination (121, 36 %). Reliability data were reported by 83 (24.7 %) of the studies. Conclusions:During the selected period, 91 different radiographic measures of PFJ alignment and morphology were reported, with multiple methods used to obtain similar measures, and limited data on reliability and validity. These findings make it difficult to recommend specific measures for clinical and research use. Further studies are needed to determine the measurement properties of radiographic PFJ alignment and morphology measures, and to establish consensus-based recommendations for priority measures and acquisition methods for specific PFJ conditions.

OBJECTIVE:The authors' goal was to perform a retrospective audit of all emergency cranial neurosurgery performed at the Royal Darwin Hospital in the first 5 years of the unit and to compile their data in a similar fashion to an earlier study titled "Emergency Neurosurgery in Darwin: Still the Generalist Surgeons' Responsibility," which was published in 2015. METHODS:All emergency cranial neurosurgery performed by a neurosurgeon between 2017 and 2021 was identified. Data were extracted from the National Critical Care and Trauma Response Centre database. Statistical analyses were descriptive logistic regression performed using Stata version 15.1 software to examine factors associated with death. RESULTS:A total of 320 patients (42% Indigenous) underwent 427 emergency neurosurgeries. There were 35 emergency neurosurgeries in 2017 and 82 in 2021. The most common procedure performed was insertion of an external ventricular drain, followed by craniotomy and removal of intracranial hematoma. Mortality was 7.5% overall and 8.4% among patients with trauma. Only age proved to be a statistically significant independent risk factor for death (t = -2.95, p < 0.0041; OR 1.06, p = 0.02). Location, sex, injury severity, and presenting Glasgow Coma Scale score were not associated with death. Indigenous and non-Indigenous patients had similar outcomes. CONCLUSIONS:The data illustrate the importance of developing small but sustainable neurosurgical units in rural and remote areas. A dedicated neurosurgical unit at the Royal Darwin Hospital has led to an increase in the amount and variety of emergency neurosurgery performed in Darwin. Interstate transfers have reduced. This has tangible lifesaving and economic advantages.

Background: Literature reporting positive outcomes from the Good Life with osteoArthritis in Denmark (GLA:D (R)) program in Australia mainly involves patients attending private physiotherapy services. Objective: Evaluate the feasibility of implementing GLA:D (R) in Australian public hospitals. Design: Implementation study in three metropolitan tertiary public hospitals over six months. Method: Patients aged >= 18 years with knee or hip joint -related problems deemed appropriate for non -surgical care were invited to participate in GLA:D (R). Feasibility was evaluated using RE -AIM framework components (Implementation, Effectiveness, Maintenance) using service -level metrics, patient -level data, and program fidelity assessment. Findings of qualitative interviews with service providers are presented in Part 2. Results: Implementation : 70 patients (69 with knee osteoarthritis) participated (13 cohorts). 55 (79%) patients attended both education sessions, and 49 patients (70%) attended 10 -12 exercises sessions. Fidelity was met based on environmental, therapist, participant- and program -related criteria. Effectiveness: At 3 months, patients reported lower average pain (visual analogue scale [0 -100 mm]: effect size -0.56, 95% CI -0.88 to -0.23) and disability (HOOS/KOOS-12 [100-0]: 0.67, 0.28 to 1.05), and improved quality of life (EQ-5D overall score: 0.46, 0.11 to 0.80). No adverse events were reported. All patients who completed 3 -month assessment (n = 52) would recommend GLA:D (R). Maintenance: All participating services elected to continue delivering GLA:D (R) beyond the study. Conclusions: Implementing GLA:D (R) in Australian public hospitals is feasible, safe, and acceptable to patients with knee osteoarthritis. Public hospital patients with knee osteoarthritis reported improvements in pain, disability, and quality of life similar to previous GLA:D (R) cohorts.

Background: Previous literature has reported the successful implementation of the Good Life with osteoArthritis in Denmark (GLA:D (R)) program into predominantly private practice settings. There may be unique challenges present within the public hospital setting that influence GLA:D (R) implementation in public health. Objective: Explore the attitudes and experiences of service providers directly involved in implementing GLA:D (R) in Australian public tertiary hospitals. Design: Qualitative descriptive study design. Method: Service providers (n = 14) from three participating hospitals took part in semi-structured focus groups at the completion of the 6-month implementation period. Inductive thematic analysis was employed to identify primary domains across all facilities. Results: Four broad domains were identified. Factors that influenced uptake included GLA:D (R) being a recognisable, evidence-based product requiring minimal development or adaptation. The fidelity of the GLA:D (R) Australia program was challenged by referral of patients with multiple/complex medical comorbidities, and patient preference to complete registry data via paper rather than online. Several operational considerations are required when delivering GLA:D (R) in a public hospital setting, including adequate numbers of GLA:D (R)-trained staff, additional screening requirements, obtaining appropriate clinical space, and persisting patient barriers to attending the service. GLA:D (R) provided benefits beyond improvement in pain and function, including social interactivity, high attendance and promotion of long-term self-management, while also maximising service efficiencies. Conclusions: Implementing GLA:D (R) in Australian public hospitals was supported by service providers. Specific operational and administrative factors, including staff training, patient complexity, and registry requirements should be considered when attempting to embed and sustain GLA:D (R) in large Australian public tertiary hospitals.

Purpose Ventriculoperitoneal shunts (VPS) are a life-saving intervention for hydrocephalus. Device failure is extremely common, and carries great morbidity for patients, their families, and the healthcare system. Predicting shunt failure remains a substantial challenge. Clinically, cerebrospinal fluid protein (CSFp) is suspected to contribute to VPS obstruction, this is widely debated, and definitive evidence is lacking. We assess the value of CSFp in predicting VPS failure due to non-infective causes. Methods: A retrospective review of VPS procedures at the Queensland Children’s Hospital between 2014-2019 was conducted. The relationship between CSFp level and outcome were explored. Outcome variables were early VPS failure (< 90-days), and late VPS failure (<1-year). A CNS infection was reason for exclusion. A logarithmic correction was applied to CSFp (Log-CSFp) for statistical modelling. Results 552 procedures were assessed in 243 patients. 87 (15.8%) VP shunts failed within 90-days, 129 (23.4%) within 1-year. 77 patients (31.7%) experienced an episode of <1-year VPS failure. Multivariate analysis found Log-CSFp was predictive for early VPS failure (OR 1.19, 1.05-1.35, p=0.005), and late VPS failure (OR 1.15, 1.01-1.32, p=0.042) independent to hydrocephalus aetiology, patient age, and CSF red blood cell count. Older patient age was a significant protective factor for early (OR 0.94, 0.89-0.99, p=0.023) and late VPS failure (OR 0.89, 0.84-0.95, p<0.0001) respectively. Conclusion CSFp holds prognostic value for VPS failure in pediatric patients, a relentlessly unpredictable complication of VPS devices, informing procedure timing, patient follow-up and risk-stratification.

Objective:Conduct a scoping review to describe the use and application of different radiographic classification approaches to grade patellofemoral osteoarthritis (PFOA) in literature published during a representative period (2014-2018), and describe reported measurement properties of these grading criteria. Design:The scoping review was conducted in accordance with PRISMA-ScR guidelines. Eight electronic databases were searched using keywords relating to "patellofemoral" and "radiograph". Two independent assessors screened each record for eligibility. English-language studies published in the years 2014 to 2018 were included if they acquired patellofemoral joint (PFJ) radiographs, described the method of radiograph acquisition, and reported grading PFOA. We excluded non-human and cadaveric studies, single-case studies, and studies with mean participant age <10 years. Studies that reported measurement properties underwent quality appraisal using the COSMIN Risk of Bias Tool. Descriptive statistics were reported. Results:Of 18,678 records identified, 177 articles were selected. Twenty-six classification approaches to grade radiographic PFOA were reported, with Kellgren-Lawrence (KL) (n = 70, 40 %), OsteoArthritis Research Society International (OARSI) (n = 26, 15 %), and Iwano (n = 25, 14 %) most prevalent. Axial projections (n = 81, 46 %) were most commonly used to grade PFOA, followed by lateral (n = 31, 18 %) and frontal (n = 16, 9 %) projections. KL was most frequently used across settings, disciplines, and regions. Reliability data was reported by 32 (18 %) studies. Conclusions:Multiple radiographic OA classification approaches were used to grade PFOA during the representative period, although few are specific to the PFJ. We recommend that a reliable and valid PFOA radiographic grading approach be developed using standardized PFJ radiograph acquisition techniques.

OBJECTIVE:Spine surgery addresses a wide range of spinal pathologies. Potential applications of 3-dimensional (3D) printed in spine surgery are broad, encompassing education, planning, and simulation. The objective of this study was to explore how 3D-printed spine models are implemented in spine surgery and their clinical applications.METHODS:Methods were combined to create a scoping review with meta-analyses. PubMed, EMBASE, the Cochrane Library, and Scopus databases were searched from 2011 to 7 September 2021. Results were screened independently by 2 reviewers. Studies utilizing 3D-printed spine models in spine surgery were included. Articles describing drill guides, implants, or nonoriginal research were excluded. Data were extracted according to reporting guidelines in relation to study information, use of model, 3D printer and printing material, design features of the model, and clinical use/patient-related outcomes. Meta-analyses were performed using random-effects models.RESULTS:Forty articles were included in the review, 3 of which were included in the meta-analysis. Primary use of the spine models included preoperative planning, education, and simulation. Six printing technologies were utilized. A range of substrates were used to recreate the spine and regional pathology. Models used for preoperative and intraoperative planning showed reductions in key surgical performance indicators. Generally, feedback for the tactility, utility, and education use of models was favorable.CONCLUSIONS:Replicating realistic spine models for operative planning, education, and training is invaluable in a subspeciality where mistakes can have devastating repercussions. Future study should evaluate the cost-effectiveness and the impact spine models have of spine surgery outcomes.

OBJECTIVE: 3D printing is increasingly used to fabricate three-dimensional neurosurgical simulation models, mak-ing training more accessible and economical. 3D printing includes various technologies with different capabilities for reproducing human anatomy. This study evaluated different materials across a broad range of 3D printing technologies to identify the combination that most pre-cisely represents the parietal region of the skull for burr hole simulation.METHODS: Eight different materials (polyethylene tere-phthalate glycol, Tough PLA, FibreTuff, White Resin, BoneSTN, SkullSTN, polymide [PA12], glass-filled polyamide [PA12-GF]) across 4 different 3D printing processes (fused filament fabrication, stereolithography, material jetting, selective laser sintering) were produced as skull samples that fit into a larger head model derived from computed tomography imaging. Five neurosurgeons conducted burr holes on each sample while blinded to the details of manufacturing method and cost. Qualities of mechanical drilling, visual appearance, skull exterior, and skull interior (i.e., diploe) and overall opinion were documented, and a final ranking activity was performed along with a semi -structured interview. RESULTS: The study found that 3D printed polyethylene terephthalate glycol (using fused filament fabrication) and White Resin (using stereolithography) were the best models to replicate the skull, surpassing advanced multi -material samples from a Stratasys J750 Digital Anatomy Printer. The interior (e.g., infill) and exterior structures strongly influenced the overall ranking of samples. All neurosurgeons agreed that practical simulation with 3D printed models can play a vital role in neurosurgical training.CONCLUSIONS: The study findings reveal that widely accessible desktop 3D printers and materials can play a valuable role in neurosurgical training.

BACKGROUND New-onset adult foot drop is commonly encountered in neurosurgical practice and has a broad differential, including radiculopathy, peroneal nerve palsy, demyelinating diseases, and central causes. Etiology is commonly identified with comprehensive history, examination, imaging, and investigations. Despite familiarity with the management of lumbar spondylosis and peroneal nerve compression causes, rare or uncommon presentations of nonsurgical causes are important to consider in order to avoid nonbeneficial surgery. OBSERVATIONS The authors report a very uncommon cause of foot drop: new-onset isolated L5 mononeuritis in a 61-year-old nondiabetic male. They provide a review of the etiology and diagnosis of foot drop in neurosurgical practice and detail pitfalls during workup and the strategy for its nonsurgical management. LESSONS Uncommon, nonsurgical causes for foot drop, even in the setting of degenerative lumbar spondylosis, should be considered during workup to reduce the likelihood of unnecessary surgical intervention. The authors review strategies for investigation of new-onset adult foot drop and relate these to an uncommon cause, an isolated L5 mononeuritis, and detail its clinical course and response to treatment.

Purpose: Blood-brain barrier (BBB) dysregulation and pro-inflammatory signalling molecules are secondary factors that have been associated with injury severity and long-term clinical outcome following traumatic brain injury (TBI). However, the association between BBB permeability and inflammation is unknown in human TBI patients. In this study, we investigated whether BBI integrity as measured by Dynamic Contrast-Enhanced (DCE) Magnetic Resonance Imaging (MRI) correlates with plasma levels of immunological markers following TBI.Methods: Thirty-two TBI patients recruited from a neurosurgical unit were included in the study. Structural threedimensional T1-weighted and DCE-MRI images were acquired on a 3T MRI at the earliest opportunity once the participant was sufficiently stable after patient admission to hospital. Blood sampling was performed on the same day as the MRI. The location and extents of the haemorrhagic and contusional lesions were identified. Immunological biomarkers were quantified from the participants' plasma using a multiplex immunoassay. Demographic and clinical information, including age and Glasgow Coma Scale (GCS) were also collected and the immunological biomarker profiles were compared across controls and the TBI severity sub-groups. Contrast agent leakiness through blood-brain barriers (BBB) in the contusional lesions were assessed by fitting DCE-MRI using Patlak model and BBB leakiness characteristics of the participants were correlated with the immunological biomarker profiles.Results: TBI patients showed reduced plasma levels of interleukin (IL)-1 & beta;, IFN-& gamma;, IL-13, and chemokine (C-C motif) ligands (CCL)2 compared to controls and significantly higher levels of platelet-derived growth factor (PDGF-BB), IL-6, and IL-8. BBB leakiness of the contusional lesions did not significantly differ across different TBI severity sub-groups. IL-1ra levels significantly and positively correlated with the contusional lesion's BBB integrity as measured with DCE-MRI via an exponential curve relationship. Discussion: This is the first study to combine DCE-MRI with plasma markers of inflammation in acute TBI patients.Our finding that plasma levels of the anti-inflammatory cytokine IL-1ra correlated negatively with increased leakiness of the BBB.

ABSTRACT:Reduced conditioned pain modulation (CPM) and psychological distress co-occur frequently in many pain conditions. This study explored whether common negative pain cognitions and emotional factors were related to lower CPM in individuals across the spectrum from acute to chronic pain. Previously collected data on the CPM effect, pain-related cognitions (fear of movement, pain catastrophizing), and emotional distress (depression, anxiety) through questionnaires from 1142 individuals with acute, subacute, or chronic pain were used. The presence of negative psychological factors was dichotomized according to cutoff values for questionnaires. Associations between the presence of each negative psychological factor and the amplitude of pain reduction in the CPM paradigm was explored with Generalized Linear Models adjusted for sex, age, body mass index, and pain duration. A secondary analysis explored the cumulative effect of psychological factors on CPM. When dichotomized according to cutoff scores, 20% of participants were classified with anxiety, 19% with depression, 36% with pain catastrophizing, and 48% with fear of movement. The presence of any negative psychological factor or the cumulative sum of negative psychological factors was associated with lower CPM (individual factor: β between -0.15 and 0.11, P ≥ 0.08; total: β between -0.27 and -0.12, P ≥ 0.06). Despite the common observation of psychological factors and reduced CPM in musculoskeletal pain, these data challenge the assumption of a linear relationship between these variables across individuals with acute, subacute, and chronic pain. Arguably, there was a nonsignificant tendency for associations in nonexpected directions, which should be studied in a more homogenous population.

The aim of this study was to prepare industrial design students for emerging roles in design and health through a 13-week, neurosurgery-centric design challenge. The study gathered survey data on their before and after perceptions on biomedical design, as well as their understanding of the role additive manufacturing plays in healthcare. At the conclusion of the project, nearly two-thirds of students had an interest in pursuing biomedical design after graduation. Prosthetics, implants and surgical planning aids were seen as the top applications of additive manufacturing in healthcare, while working with 3D models of human anatomy was seen as the biggest practical challenge. 3D printed prototypes exhibited at a major hospital showed a broad range of novel, modular, haptic and multi-material solutions that evidenced the value of biomedical design within healthcare, as well as the role advanced technology like additive manufacturing plays in solving real-world neurosurgical training challenges.

Objectives: Explore individuals' lived experience with ankle osteoarthritis and to identify health-related domains for ankle osteoarthritis based on the perspectives of people living with the condition, as an initial step to address the International Foot and Ankle Osteoarthritis Consortium's recommendation to develop a core domain set for ankle osteoarthritis. Methods: A qualitative study using semi-structured interviews was conducted. Interviews were undertaken with individuals with symptomatic ankle osteoarthritis who were aged & GE;35 years. Interviews were recorded, transcribed verbatim and thematically analysed. Results: Twenty-three individuals (16 females; mean (range) age 62 (42-80) years) were interviewed. Five themes were identified: pain, often severe, is a central feature of living with ankle osteoarthritis; stiffness and swelling are key symptoms; ankle osteoarthritis induced mobility impairments compromise enjoyment in life; ankle osteoarthritis instability and balance impairments lead to concerns about falling; there are financial implications of living with ankle osteoarthritis. We propose 17 domains based on individuals' experiences. Conclusion: Study findings indicate that individuals with ankle osteoarthritis live with chronic ankle pain, stiffness and swelling which affect their ability to participate in physical, and social activities, maintain an active lifestyle, and work in physical occupations. From the data, we propose 17 domains that are important to people with ankle osteoarthritis. These domains require further evaluation to ascertain their inclusion in a core domain set for ankle osteoarthritis.

Purpose: We aim to identify specific parameters that will allow identification of those patients at greater risk of vision loss, specifically variables such as geometry, volume and size of the pituitary tumour.Methodology: Volume measurements were made with both manual (using the formula width x height x length x 0.5) and video size, sub-voxel interpolation using Brainlab software. The shape of the tumour was divided into four categories, ovoid, dumbbell, pyramidal and other. Chiasmal compression was divided into central and lateral compression and the chiasm location was classified based on pre/post and normal fixed chiasm in relation to the tuberculum sella. We used a visual impairment score ranging from (0-100), which was then further subdivided in to four grades: Grade I - 0-25 (mild); Grade II - 26-50 (moderate); Grade III - 51-75 (severe); Grade IV - 76-100 (subtotal or complete).Results: Univariate analysis of variables related to vision loss found tumour volume, suprasellar growth and lateral chiasmal compression related to pre-operative vision loss. On multivariate regression analysis tumour volume and lateral chiasmal compression remained significant (p < 0.008). In relation to post-operative vision, univariate analysis indicated that variables such as giant macroadenoma, pre-operative visual impairment score and suprasellar growth were significant. Multivariate analysis showed pre-operative visual impairment and suprasellar growth as the only statistically significant variables.Conclusion: Our ROC analysis suggests tumours with suprasellar extension 16 mm (sensitivity 85 %, specificity 67 %) in sagittal plane are more likely to result in moderate to severe grade vision loss (VIS grade >= 2).

Computational fluid dynamics (CFD) simulations are increasingly utilised to evaluate intracranial aneurysm (IA) haemodynamics to aid in the prediction of morphological changes and rupture risk. However, these models vary and differences in published results warrant the investigation of IA-CFD reproducibility. This study aims to explore sources of intra-team variability and determine its impact on the aneurysm morphology and CFD parameters. A team of four operators were given six sets of magnetic resonance angiography data spanning a decade from one patient with a middle cerebral aneurysm. All operators were given the same protocol and software for model reconstruction and numerical analysis. The morphology and haemodynamics of the operator models were then compared. The segmentation, smoothing factor, inlet and outflow branch lengths were found to cause intra-team variability. There was 80% reproducibility in the time-averaged wall shear stress distribution among operators with the major difference attributed to the level of smoothing. Based on these findings, it was concluded that the clinical applicability of CFD simulations may be feasible if a standardised segmentation protocol is developed. Moreover, when analysing the aneurysm shape change over a decade, it was noted that the co-existence of positive and negative values of the wall shear stress divergence (WSSD) contributed to the growth of a daughter sac.

Patellofemoral joint (PFJ) pathology is prevalent and associated with significant morbidity. Although protocols for PFJ radiograph acquisition exist, standardized methods to acquire radiographs of the PFJ have yet to be universally adopted, resulting in variances in patient positioning, weight-bearing status, knee flexion angle, and beam direction, leading to inconsistent joint assessment. We conducted a scoping review of the literature to determine commonly described methods of acquiring PFJ radiographs, and evaluate the methods used in specific settings, disciplines, regions, and for different pathologies. Adhering to PRISMA-ScR guidelines, we searched common databases using keywords related to the concepts of ‘patellofemoral’ and ‘radiograph’. Two independent assessors screened each record for eligibility. Studies published between 2014-2018 describing radiographic acquisition methods of the PFJ were included. Studies of non-human subjects, pediatric populations under 10 years, cadaver studies, and single-subject studies were excluded. Qualitative synthesis of radiographic methods was performed. From 15,053 unique records, 549 articles were included. Four radiographic projections were reported (lateral (84.3% of articles), axial (68.5%), anteroposterior/posteroanterior (66.3%), and lower-limb alignment (21.1%)). We found marked variability for each projection in relation to views acquired (e.g., 13 described axial plane views) and techniques used (e.g., patient positioning, radiograph beam direction). Acquisition techniques varied across disciplines, settings, regions, and pathologies without clear patterns emerging. Our findings highlight considerable variability in PFJ radiograph acquisition methods in contemporary literature. The lack of standardization of PFJ radiograph acquisition may make it difficult to accurately assess and estimate true population prevalence for PFJ pathology.

3D printing is increasingly used to fabricate medical devices and educational models, yet most studies to-date focus on a particular case study or training scenario. This study instead seeks to understand the relative importance of different qualities for 3D printed anatomical training models, including haptics, accuracy and costs. Clinicians at a major Australian hospital were presented with 24 3D printed prototypes for neurosurgical education in an interactive exhibition. These were produced by undergraduate industrial design students. A post-exhibition survey found that the top quality required in a 3D printed educational model was to feel realistic (33%), followed by accuracy to real anatomy (27%). A separate survey of other health professionals working within health-related disciplines and research also supported these two qualities as most important after attending the exhibition. 60% of clinicians left the exhibition believing that 3D printing plays a moderate or significant role in the hospital/health system, while 100% of other health professionals shared this same opinion. With a range of materials, 3D print and other technologies employed in the production of the models, this unique study helps clarify the core considerations when designing and 3D printing educational models for neurosurgery and other medical disciplines, and highlights some of the differences between clinicians and other health professionals in relation to the technology.

BACKGROUND:Osteoarthritis (OA) is a major problem globally. First-line management comprises education and self-management strategies. Online support groups may be a low-cost method of facilitating self-management. OBJECTIVE:The aim of this randomized controlled pilot study is to evaluate the feasibility of the study design and implementation of an evidence-informed, expert-moderated, peer-to-peer online support group (My Knee Community) for people with knee OA. The impacts on psychological determinants of self-management, selected self-management behaviors, and health outcomes were secondary investigations. METHODS:This mixed methods study evaluated study feasibility (participant recruitment, retention, and costs), experimental intervention feasibility (acceptability and fidelity to the proposed design, including perceived benefit, satisfaction, and member engagement), psychological determinants (eg, self-efficacy and social support), behavioral measures, health outcomes, and harms. Of a total of 186, 63 (33.9%) participants (41/63, 65% experimental and 22/63, 35% control) with self-reported knee OA were recruited from 186 volunteers. Experimental group participants were provided membership to My Knee Community, which already had existing nonstudy members, and were recommended a web-based education resource (My Joint Pain). The control group received the My Joint Pain website recommendation only. Participants were not blinded to their group allocation or the study interventions. Participant-reported data were collected remotely using web-based questionnaires. A total of 10 experimental group participants also participated in semistructured interviews. The transcribed interview data and all forum posts by the study participants were thematically analyzed. RESULTS:Study feasibility was supported by acceptable levels of retention; however, there were low levels of engagement with the support group by participants: 15% (6/41) of participants did not log in at all; the median number of times visited was 4 times per participant; only 29% (12/41) of participants posted, and there were relatively low levels of activity overall on the forum. This affected the results for satisfaction (overall mean 5.9/10, SD 2.7) and perceived benefit (17/31, 55%: yes). There were no differences among groups for quantitative outcomes. The themes discussed in the interviews were connections and support, information and advice, and barriers and facilitators. Qualitative data suggest that there is potential for people to derive benefit from connecting with others with knee OA by receiving support and assisting with unmet informational needs. CONCLUSIONS:Although a large-scale study is feasible, the intervention implementation was considered unsatisfactory because of low levels of activity and engagement by members. We recommend that expectations about the support group need to be made clear from the outset. Additionally, the platform design needs to be more engaging and rewarding, and membership should only be offered to people willing to share their personal stories and who are interested in learning from the experiences of others. TRIAL REGISTRATION:Australian New Zealand Clinical Trials Registry ACTRN12619001230145; http://anzctr.org.au/Trial/Registration/TrialReview.aspx?id=377958.

Objective: To identify challenges confronting patients and physiotherapists in managing patellofemoral pain by seeking their perspectives via generative activities involving critique, ideation and formulating shared visions for future treatments. Design: Two Future Workshops, Reflexive Thematic Analysis. Methods: We recruited 8 patients (median age 36 yrs, 4 women) who were experiencing patellofemoral pain and 10 physiotherapists (54 yrs, 8 women) who treated patients with the condition. Several vignette cases and design cards were constructed and included as tools for facilitating dialogue, throughout all three phases (each ~40 min duration) of the workshops (i.e., critique, fantasy, implementation). Participants' discussions were audio recorded, transcribed and thematically analyzed independently by four investigators until no additional themes emerged. Results/findings: Four themes were identified; (i) challenges confronting patients, (ii) learning to manage patellofemoral pain (knowledge), (iii) stakeholder accountability and (iv) development/use of portable applications (apps). Some challenges and strategies were related to family and social networks, financial costs, and psychological factors. Knowledge related to the condition, mental and physical impact of pain, exercises and physical activity. The physiotherapist's role in moderating accurate information was raised, as was that of the GP and personal trainer. Visions of future treatments centered about the inclusion of flexible modes of communication and cultivating mutual accountability. Social determinants and the invisible work of patients in managing their condition was apparent. Conclusion: Enacting patient centered care was sought/recommended - requiring consideration of social contexts and flexible delivery. The physiotherapist was seen as a source of accurate information and a point of accountability.

ObjectivesResults Delayed inter-hospital transfers of deteriorating neurotrauma patients from rural and regional hospitals to tertiary centres have seen the need for non-neurosurgeons to undertake emergency intracranial haematoma evacuation surgery locally. In the present study, the authors contributed to the paucity in the literature regarding the widespread availability of cranial access equipment in non-tertiary centres and patient outcomes in Queensland. Methods We surveyed delegates (senior theatre nurses or surgical service directors) from rural and regional Queensland hospitals if they were located outside the local catchment of a tertiary centre and had a CT scanner. Questions regarded availability, location and storage conditions of mechanical cranial access kits, as well as last usage, and associated patient outcomes. Twenty-six delegates from eligible hospitals responded. Eighteen hospitals offered surgical services. Eleven hospitals housed complete mechanical cranial access kits. Five hospitals housed incomplete kits. Thirteen hospitals housed their equipment sterile in the operating theatre or ED. Eleven hospitals reported using the equipment, with last usage ranging from 4 months to over 30 years. Two hospitals reported using the equipment within 12 months while a further five reported using it within 10 years. Two hospitals reported 'good' outcomes, two 'ok' and one 'poor'. Conclusions The availability of cranial access equipment outside Queensland tertiary centres has been limited. Inter-hospital transfers are likely to persist in Queensland and haematoma evacuation surgery has been a life-saving endeavour, so improving access to cranial access equipment in hospitals where it is currently lacking is highly warranted.