Objective: To investigate the impact, quality and acceptability of a musculoskeletal screening clinic provided by physiotherapists for patients referred to the outpatient orthopaedic department at a major metropolitan hospital. Design, setting and participants: Prospective observational trial undertaken between 29 November 2005 and 6 June 2006 at the Northern Hospital (a tertiary teaching hospital in outer Melbourne) of 52 patients with non‐urgent musculoskeletal conditions who were assessed by one of two physiotherapists with postgraduate qualifications and subsequently by an orthopaedic surgeon. Main outcome measures: Proportion of new patients referred who could have been managed without needing to see a surgeon; level of agreement between physiotherapists and orthopaedic surgeon on diagnoses and management decisions; and levels of satisfaction of patients, referring general practitioners and the orthopaedic surgeon with the physiotherapist‐led screening initiative. Results: 45 of 52 selected patients (31 women and 21 men; mean age, 53.3 years) attended their appointment with the physiotherapist; of these, 38 also attended a later appointment with the orthopaedic surgeon. Seven of the 38 patients were listed for surgery, and seven others needed management by the surgeon (injection for three, imaging for four). Almost two‐thirds (63%) were appropriate for non‐surgical management. The physiotherapists identified the same patient management plans as the surgeon for 74% of the group. Patients and doctors reported high levels of satisfaction with the physiotherapist‐led service. Conclusions: Nearly two‐thirds of patients with non‐urgent musculoskeletal conditions referred by their GPs to one public outpatient orthopaedic department did not need to see a surgeon at the time of referral, and were appropriately assessed and managed by experienced, qualified physiotherapists.

Standardized mean differences (SMDs; Hedges' g) were calculated from means and standard deviations (mean difference/pooled SD) of muscle strength data using Review Manager software (Version 5.2; The Cochrane Collaboration, London, UK). The SMDs of 0.2, 0.5, and 0.8 were considered small, moderate, and large, respectively. 9 The percentage difference in strength was also calculated to provide a further indication of the relative difference in strength between OA and control participants [(OA strength -control strength)/control strength × 100]. Results were grouped according to the type of strength measurement (eg, isometric or isokinetic) or hip action performed (eg, hip flexion or extension). Data were pooled for multiple studies in a meta-analysis within each group using a random-effects model. When studies reported on multiple grades of OA classification (eg, Kellgren-Lawrence grade 2 or 3) without reporting on muscle strength of the whole sample combined, only the more established OA grading was used in the meta-analysis, to avoid repeated assessment of control-group data. When studies measured isokinetic strength at multiple speeds, the slower speed was used, as slower speeds are considered more reliable.35,41 When a study reported results of left and right knees of participants with bilateral knee OA, only the side with the most conservative SMD was presented, to avoid repeated inclusion of control-group data.10 Statistical heterogeneity across pooled studies was assessed using the I 2 statistic, in which a value of 25%, 50%, or 75% was considered a low, moderate, or high level of heterogeneity, respectively. 23 Assessment of Quality of Body of EvidenceA modified version of the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach was used to evaluate the quality of evidence in each meta-analysis. 20,35,43 The GRADE tool has been modified to apply to observational, nonexperimental data. 35,43 Each meta-analysis was graded using the following predefined criteria: (1) inconsistency (downgraded if I 2 was 50% or greater), (2) Screened by title and abstract, n = 1737Screened by title and abstract, n = 1737Full-text articles assessed for eligibility, n = 102Full-text articles assessed for eligibility, n = 102Hip strength in knee OA compared to control, n = 5Hip strength in knee OA compared to control, n = 5Hip strength as a risk factor for knee OA development, n = 0Hip strength as a risk factor for knee OA development, n = 0

Background There is controversy surrounding the early use of open-kinetic-chain (OKC) quadriceps-strengthening exercises following anterior cruciate ligament reconstruction (ACLR) due to the belief that increased strain on the graft could cause damage. Objectives To determine whether OKC quadriceps exercises result in differences in anterior tibial laxity, strength, function, quality of life, or adverse events in the ACLR population, when compared to closed-kinetic-chain (CKC) quadriceps exercises. Methods Seven electronic databases (MEDLINE, Embase, AMED, CINAHL, SPORTDiscus, PEDro, and the Cochrane Central Register of Controlled Trials) were searched through April 2017. A systematic review with meta-analysis was conducted on randomized controlled trials comparing OKC versus CKC exercises following ACLR. Outcomes of interest were tibial laxity, strength, and function. A methodological quality assessment of the included studies was completed, and the results were synthesized using meta-analysis and the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results Ten studies were included in the review. The meta-analysis demonstrated low- to moderate-quality evidence of no between-group differences in anterior tibial laxity, strength, or patient-reported function at any time point. Meta-analysis was unable to be performed for functional outcomes. Conclusion There was limited to moderate-quality evidence of no difference in anterior tibial laxity, strength, patient-reported function, or physical function with early or late introduction of OKC exercises in the ACLR population, when compared to CKC exercises, at all follow-up time points. Level of Evidence Therapy, level 1a. J Orthop Sports Phys Ther 2018;48(7):552-566. Epub 23 Apr 2018. doi:10.2519/jospt.2018.7656.

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