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The purpose of this paper is to examine the outcomes of chiropractic manipulative and manual therapy (MMT) provided to residents experiencing spinal pain in a substance misuse therapeutic community (TC).

Clinical audit to explore the potential benefits of the interventions offered to residents experiencing spinal pain in a TC. Residents seeking care underwent an assessment by either general practitioner or chiropractic intern. Eligible participants could choose one of the four interventions: usual care without any additional treatment (Group 1), usual care with simple analgesics (Group 2), usual care plus MMT without simple analgesics (Group 3), or usual care plus MMT with simple analgesics (Group 4). Outcome measures were the RAND-36-item short form health-related quality-of-life survey and the patient satisfaction questionnaire (PSQ). Data were collected at baseline and after six weeks for each participant, with those participants choosing MMT receiving up to six treatments over the study period. Two cycles of six weeks of data collection was used. Data were analysed for statistically significant (repeated measures ANOVA with Bonferroni correction) and clinically meaningful changes in scores.

Of 71 self-presenting residents seeking care, 68 were eligible to participate. Of these, 32 chose usual care with simple analgesics (Group 2) and 36 chose usual care plus the package of MMT but without simple analgesics (Group 3). None chose usual care without additional treatment or usual care plus the package of MMT with analgesics, thus offering only the data from two groups for analysis. Group allocation was non-random and based on patient choice. Between-group analysis of the cumulative and component RAND-36 data indicated a significant difference between the two groups (p=0.034), particularly in the physical outcomes (p=0.012), indicating that Group 3 had improved scores over Group 2. Group 3 showed a significant change in RAND-36 scores (p<0.01) when compared with Group 2 (p=0.23) over the six-week treatment period. The PSQ scores of the two groups showed a statistically significant difference (p=0.0093), suggesting that Group 3 had greater patient satisfaction with care. The outcomes suggest that the package of MMT in Group 3, delivered by an appropriately trained clinician may have added to therapeutic effect that extended beyond physical outcomes but also influenced psychological outcomes.

The results of this clinical outcome-based audit suggest that the addition of a package of chiropractic MMT to usual care may be of benefit over usual care with simple analgesics for residents of a TC with spinal pain. The results intimate that benefits may extend across both the physical and psychological components of the pain experience, although a confirmatory study is recommended to substantiate these insights.

As far as the authors are aware, this trial is the first of this type in a TC, with the insights and experience gained supporting a definitive trial.

Proposes that, in large measure, chronic low back pain is a result of inappropriate information given to acute low back pain patients. This information leads patients into an avoidance pattern of behaviour which has psychological and physiological consequences. Suggests that chronic low back pain can be in part prevented if correct information is provided, maybe in the workplace, at the acute stage.

Clinical specialist physiotherapy (CSP)-led musculoskeletal triage clinics have been established in the UK as a means of managing patients referred for outpatient orthopaedic consultation. The purpose of this paper is to determine if a CSP could allocate patients into distinct diagnostic triage categories in line with national and international guidelines. A second aim was to describe the CSPs clinical decision making.

A review of 100 spinal patients, consecutively referred between February and April 2013 to a CSP spinal triage clinic was undertaken. Patient demographics (age, gender, employment status), clinical diagnosis and diagnostic triage categories selected for each patient were recorded. Subsequently, if clinical triage led to further investigation or a consultant opinion then the onward management pathway was followed to calculate conversion to consultant surgical intervention.

In total, 69 per cent of patients were independently managed by the CSP and discharged back to the General Practitioner or on to therapy. In total, 30 per cent of patients (n=30) were referred for consultant opinion, of these 12 underwent intervention. This represents a conversion rate to consultant intervention of 40 per cent.

Findings suggest that a significant number of spinal patients referred for an orthopaedic consultation may be managed independently by a CSP. Referral for consultant review was deemed appropriate in terms of conversion to intervention, advice on further imaging, referral to other medical disciplines and patient counselling. This study suggests that CSPs can manage a significant number of patients with spinal conditions whilst providing high-quality referrals to surgical colleagues. This audit provides a novel insight into practitioner behaviour that supports the development of advanced practice for non-medical clinicians.

Work-related low back disorders (LBDs) are prevalent among rebar workers although their causes remain uncertain. The purpose of this study is to examine the self-reported discomfort and spinal biomechanics (muscle activity and spinal kinematics) experienced by rebar workers.

In all, 20 healthy male participants performed simulated repetitive rebar lifting tasks with three different lifting weights, using either a stoop (n = 10) or a squat (n = 10) lifting posture, until subjective fatigue was reached. During these tasks, trunk muscle activity and spinal kinematics were recorded using surface electromyography and motion sensors, respectively.

A mixed-model, repeated measures analysis of variance revealed that an increase in lifting weight significantly increased lower back muscle activity at L3 level but decreased fatigue and time to fatigue (endurance time) (p < 0.05). Lifting postures had no significant effect on spinal biomechanics (p < 0.05). Test results revealed that lifting different weights causes disproportional loading upon muscles, which shortens the time to reach working endurance and increases the risk of developing LBDs among rebar workers.

Future research is required to: broaden the research scope to include other trades; investigate the effects of using assistive lifting devices to reduce manual handling risks posed; and develop automated human condition-based solutions to monitor trunk muscle activity and spinal kinematics.

This study fulfils an identified need to study laboratory-based simulated task conducted to investigate the risk of developing LBDs among rebar workers primarily caused by repetitive rebar lifting.

Acute and chronic pain affects more Americans than heart disease, diabetes, and cancer combined. Conservative estimates suggest the total economic cost of pain in the United States is $600 billion, and more than half of this cost is due to lost productivity, such as absenteeism, presenteeism, and turnover. In addition, an escalating opioid epidemic in the United States and abroad spurred by a lack of safe and effective pain management has magnified challenges to address pain in the workforce, particularly the military. Thus, it is imperative to investigate the organizational antecedents and consequences of pain and prescription opioid misuse (POM). This chapter provides a brief introduction to pain processing and the biopsychosocial model of pain, emphasizing the relationship between stress, emotional well-being, and pain in the military workforce. We review personal and organizational risk and protective factors for pain, such as post-traumatic stress disorder, optimism, perceived organizational support, and job strain. Further, we discuss the potential adverse impact of pain on organizational outcomes, the rise of POM in military personnel, and risk factors for POM in civilian and military populations. Lastly, we propose potential organizational interventions to mitigate pain and provide the future directions for work, stress, and pain research.

Orthopaedics, rheumatology, pain management, specialist radiology and therapy services were brought under one umbrella to form Northwest Surrey integrated musculoskeletal (IMSK) services and introduced advance clinical practice, a multi-disciplinary team triage with a formalised straight to test (STT) process defined in 2018. Historically, prior to these services' integration, there were a primary and second care triage systems within individual specialities. The aim of this service evaluation is to assess the impact of a single IMSK multidisciplinary triage (MDT) system and the efficacy of STT from triage, which allows patients to be sent for diagnostics based on the cluster of symptoms and past medical history in order to achieve early identification of serious pathologies. This is a complex adaptive system with pathways spanning into the core areas of orthopaedics, rheumatology, therapies, pain management services, radiology and some less frequent specialities such as neurology, oncology, vascular and gynaecology. One of the objectives of this study was to identify how many referrals were triaged to consultants, Advance practice and therapies. In addition, the authors wanted to highlight the proportion of referrals that were sent straight to test from triage and the percentage of these that had sinister pathology identified. This information would then be compared against existing red flag literature to identify common themes. This study aims to discuss the aforementioned objectives.

Data were extracted retrospectively from a hospital database from January to December 2019 for all the adult musculoskeletal service referrals. The data collected were analysed on a Microsoft Excel sheet with information including date of triage, hospital number, ordering clinician, body part, type of diagnostic, indications for scanning, outcome for STT, serious pathology findings (named code 5 within our trust) and outcome of appointment.

A total of 47,039 referrals were received into the IMSK service. Of these referrals 19,967 were directly referred to therapies, with 27,072 referrals received into the IMSK service MDT process. Within triage, 718 patients were directed to STT to rule out serious pathology. A total of 28 patients (3.9%) had sinister pathology identified on their investigation. A total of 46% of patients were discharged from their first consultation following STT. Overall, 50% of the total number of referrals into the IMSK service was seen by advanced practitioners with 16% of patients directed to consultants with pre-consultation diagnostic work up.

This service evaluation highlights that STT allows early access to diagnostics, resulting in quicker access to identification of sinister pathology. A one stop MDT system has been shown to be effective in guiding the referral to the right place with increased referrals into allied health advance practice clinics and access to therapies directly. It has resulted in a reduction of unwarranted referrals to consultant care, duplication of investigations and identified patients on multiple pathways.

Repetitive lifting tasks have detrimental effects upon balance control and may contribute toward fall injuries, yet despite this causal linkage, risk factors involved remain elusive. The purpose of this paper is to evaluate the effects of different weights and lifting postures on balance control using simulated repetitive lifting tasks.

In total, 20 healthy male participants underwent balance control assessments before and immediately after a fatiguing repetitive lifting tasks using three different weights in a stoop (ten participants) or a squat (ten participants) lifting posture. Balance control assessments required participants to stand still on a force plate with or without a foam (which simulated an unstable surface) while center of pressure (CoP) displacement parameters on the force plate was measured.

Results reveal that: increased weight (but not lifting posture) significantly increases CoP parameters; stoop and squat lifting postures performed until subjective fatigue induce a similar increase in CoP parameters; and fatigue adversely effected the participant’s balance control on an unstable surface vis-à-vis a stable surface. Findings suggest that repetitive lifting of heavier weights would significantly jeopardize individuals’ balance control on unstable supporting surfaces, which may heighten the risk of falls.

This research offers an entirely new and novel approach to measuring the impact that different lifting weights and postures may have upon worker stability and consequential fall incidents that may arise.

This study aimed to develop a method to calculate the mattress indentation for further estimating spinal alignment.

A universal indentation calculation model is derived based on the system theory, and the deformation characteristics of each component are analyzed by the finite element (FE) model of a partial air-spring mattress under the initial air pressure of 0.01–0.025 MPa. Finally, the calculation error of the model is verified.

The results indicate that the indentation calculation model could describe the stain of a mattress given the load and the constitutive model of each element. In addition, the FE model of a partial air-spring mattress can be used for further simulation analysis with an error of 1.47–3.42 mm. Furthermore, the deformation of the series system is mainly contributed by the air spring and the components directly in contact with it, while the top component is mainly deflection deformation. In addition, the error of the calculation model is 2.17–5.59 mm on the condition of 0.01–0.025 MPa, satisfying the engineering application. Finally, the supine spinal alignment is successfully extracted from the mattress indentation.

The limitation of this study is that it needs to verify the practicality of the indentation calculation model for the Bonnier spiral spring mattress. The main feature of the Bonnier spring mattress is that all springs are connected, so the mattress deflection and neighborhood effect are more significant than those of the air-spring mattress. Therefore, the applicability of the model needs to be tested. Moreover, it is worth further research to reduce the deformation error of each component.

As part of the series of studies on the intelligent air-spring mattress, the indentation-based evaluation method of spinal alignment in sleep postures will be studied for hardness and intelligent regulation based on this study.

The results of this research are ultimately used for the intelligent adjustment of air-spring mattresses, which automatically adjusts the hardness according to the user's sleep postures and spinal alignment, thus maintaining optimal spinal biomechanics. The successful application of this result could improve the sleep health of the general public.

Based on the series system theory, an indentation calculation model for mattresses with arbitrary structure is proposed, overcoming the dependence of parameters on materials and their combinations when fitting the Burgers model. Further, the spinal alignment in supine posture is extracted from the indentation, laying a theoretical foundation for further recognition and adjustment of the spinal alignment of the intelligent mattress.

The orthopaedic consultants at East Kent Hospitals NHS Trust had questioned whether the Extended Scope Practitioners (ESPs) and consultants were forming a comparable diagnosis and treatment plan. This audit aims to identify what percentage of patients received a comparable diagnosis from the ESPs and the orthopaedic consultant and to find out what percentage of patients referred from the ESP to the orthopaedic consultant for a surgical opinion underwent surgery.

The medical notes of a sample of patients from the ESP clinic who had been referred to the orthopaedic consultant were reviewed retrospectively and the following information was documented in a table: the ESP's diagnosis, the consultant's diagnosis and whether the patient underwent surgery.

The audit found a 31 per cent partially and 65 per cent fully comparable diagnosis rate between the consultant and the ESPs, and the ESPs predicted which patient would undergo surgery in 86 per cent of cases. The results of this audit compared favourably with the benchmarks set.

Audits such as this will hopefully help improve consultant, ESP, manager and patient confidence that the ESP is a valuable and effective member of the orthopaedic team.

A search for papers relating to ESP services on the healthcare databases AMED, BNI, CINAHL and MEDLINE found a number of articles which have reported on audits of ESP services but to date not with regard to shoulder problems. The paper may encourage other clinicians to do similar audits, supporting the expansion of ESP services within the NHS and ultimately improving patient care.