Agreement between a physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain

Marks, Darryn; Comans, Tracy; Thomas, Michael; Ng, Shu‐Kay; O’Leary, Shaun; Conaghan, Philip G.; Scuffham, Paul Anthony; Bisset, Leanne

doi:10.1016/j.math.2016.10.001

Cited by 14 publications

(21 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Participant numbers varied from 30 to 383 (age range 15-85 years, mean age (where available) ranging from 46.2 to 67 years). The majority of studies included patients with one or two problem areas; knee [70,73], hip and knee [20,68,71], shoulder [67,69,72], shoulder or knee [66], shoulder, knee or spinal [19], with two studies having a broader inclusion of musculoskeletal or orthopaedic conditions [24,57,58,67].…”

Section: Search Resultsmentioning

confidence: 99%

See 1 more Smart Citation

Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

Samsson

Grimmer

Larsson

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background Physiotherapist-led (PT-led) orthopaedic triage is an evolving model of care for patients with musculoskeletal disorders. Objectives for this study were to establish the current evidence body on the impact of PT-led orthopaedic triage on health, quality, and service outcomes for patients referred for orthopaedic consultation, compared with standard (orthopaedic surgeon) care. Methods Medline, EMBASE, Scopus and CINAHL were searched from inception until 7 May 2018; search updated 24 April 2020. Search terms (including derivatives) included physiotherapy, advanced/extended scope, musculoskeletal/orthopaedic, triage. The search was framed as Population = patients referred for orthopaedic consultation; Intervention = PT-led orthopaedic triage; Comparison = standard care; Outcomes = health, quality and process outcomes. Only randomised controlled trials (RCTs) and prospective comparative cohort studies were eligible for inclusion. Screening, study selection, data extraction, and assessment of methodological quality were performed independently by reviewer pairs. Quality was scored with the Downs and Black checklist. Certainty of evidence was determined using GRADE. PROSPERO registration number CRD42017070950. Results We included two RCTs and eleven cohort studies (n = 1357 participants) of variable methodological quality (range 14–23 of possible 28). Certainty of evidence was low to moderate. There was no difference between PT-led orthopaedic triage and standard care for patient-reported outcomes (two RCTs). Perceived quality of care with PT-led orthopaedic triage was higher (two RCTs, four cohort studies) or equal (one cohort study) compared with standard care. PT-led orthopaedic triage had higher surgery conversion rates (one RCT, three cohort studies) (55–91% vs 22–38%), lower (two RCTs) or equal rate (two cohort studies) of referral for investigations, shorter waiting times (one RCT, one cohort study), and lower costs (one RCT). Furthermore, there was high agreement between physiotherapists’ and orthopaedic surgeons’ treatment approach (eight cohort studies), referral for investigation (five cohort studies), and diagnosis (nine cohort studies). Study limitations were the low number of RCTs, and variable methodological quality. Conclusions Evidence of low to moderate certainty suggests that PT-led orthopaedic triage leads to similar diagnostic decisions as standard care, has a higher conversion-to-surgery rate, reduces waiting times, is cost effective and valued by patients, and that health outcomes are equivalent.

show abstract

Section: Search Resultsmentioning

confidence: 99%

“…Certainty of evidence was largely constrained. Two RCTs and three cohort studies had low to unclear risk of bias [23,24,57,58,[67][68][69], and seven cohort studies had unclear risk of bias [19,20,66,[70][71][72][73]. One study [19] provided inadequate information and reported incomplete data.…”

Section: Quality Appraisalmentioning

confidence: 99%

Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

Samsson

Grimmer

Larsson

et al. 2020

BMC Musculoskelet Disord

View full text Add to dashboard Cite

show abstract

“…Gwet [24] and Shankar and Bangdiwala [28] compared some measures and showed that AC 1 has better properties than other kappa-type measures. In addition, AC 1 has been utilized in the field of medical research over the past decade [29][30][31][32][33][34][35]. However statistical inference procedures of AC 1 have not been discussed sufficiently.…”

Section: Discussionmentioning

confidence: 99%

“…Shanker and Bangdiwala compared Cohen's κ, Scott's π, Prevalence Adjusted Bias Adjusted Kappa (PABAK) [26], AC 1 and B-statistic [27], which is not a kappa-type chance-corrected measure, in the case of two raters and binary outcomes and showed that AC 1 has better properties than other kappa-type measures [28]. In addition, AC 1 has been utilized in the field of medical research over the past decade [29][30][31][32][33][34][35]. Therefore, in this study we have limited our discussion to AC 1 in the case of two raters with binary outcomes.…”

Section: Introductionmentioning

confidence: 99%

Homogeneity score test of AC1 statistics and estimation of common AC1 in multiple or stratified inter-rater agreement studies

Honda

Ohyama

2020

BMC Med Res Methodol

View full text Add to dashboard Cite

Background: Cohen's κ coefficient is often used as an index to measure the agreement of inter-rater determinations. However, κ varies greatly depending on the marginal distribution of the target population and overestimates the probability of agreement occurring by chance. To overcome these limitations, an alternative and more stable agreement coefficient was proposed, referred to as Gwet's AC 1. When it is desired to combine results from multiple agreement studies, such as in a meta-analysis, or to perform stratified analysis with subject covariates that affect agreement, it is of interest to compare several agreement coefficients and present a common agreement index. A homogeneity test of κ was developed; however, there are no reports on homogeneity tests for AC 1 or on an estimator of common AC 1. In this article, a homogeneity score test for AC 1 is therefore derived, in the case of two raters with binary outcomes from K independent strata and its performance is investigated. An estimation of the common AC 1 between strata and its confidence intervals is also discussed. Methods: Two homogeneity tests are provided: a score test and a goodness-of-fit test. In this study, the confidence intervals are derived by asymptotic, Fisher's Z transformation and profile variance methods. Monte Carlo simulation studies were conducted to examine the validity of the proposed methods. An example using clinical data is also provided. Results: Type I error rates of the proposed score test were close to the nominal level when conducting simulations with small and moderate sample sizes. The confidence intervals based on Fisher's Z transformation and the profile variance method provided coverage levels close to nominal over a wide range of parameter combination. Conclusions: The method proposed in this study is considered to be useful for summarizing evaluations of consistency performed in multiple or stratified inter-rater agreement studies, for meta-analysis of reports from multiple groups and for stratified analysis.

show abstract

“…In addition, it provided some early suggestion that SSNBs delivered by PTs might be as effective as those provided by medical doctors. A recent study comparing the efficacy of PTs providing steroid injections (in this case, to the subacromial region of the shoulder) with that of medical doctors reported equivocal outcomes (Marks et al, ). Research that tests the effectiveness of adding SSNBs to PT‐led exercise for persistent shoulder pain is needed.…”

Section: Discussionmentioning

confidence: 99%

Physiotherapist‐led suprascapular nerve blocks for persistent shoulder pain: Evaluation of a new service in the UK

Salt

Windt

Chesterton

et al. 2017

Musculoskeletal Care

View full text Add to dashboard Cite

show abstract

Agreement between a physiotherapist and an orthopaedic surgeon regarding management and prescription of corticosteroid injection for patients with shoulder pain

Abstract: Background:

Cited by 14 publications

References 34 publications

Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

Effects on health and process outcomes of physiotherapist-led orthopaedic triage for patients with musculoskeletal disorders: a systematic review of comparative studies

Homogeneity score test of AC1 statistics and estimation of common AC1 in multiple or stratified inter-rater agreement studies

Physiotherapist‐led suprascapular nerve blocks for persistent shoulder pain: Evaluation of a new service in the UK

Contact Info

Product

Resources

About