Splinting for carpal tunnel syndrome: in search of the optimal angle. In the 2019 resident course, 12 of 13 participants (92%) completed the knowledge assessments and 13 of 13 participants completed the confidence assessments. Rui P, Okeyode T. National Ambulatory Medical Care Survey: 2015 State and National Summary Tables. https://www.aaos.org/research/guidelines/OAKSummaryofRecommendations.pdf. Musculoskeletal Medicine: Common Orthopedic Problems in Family Medicine. All Rights Reserved. Burke DT, Burke MM, Stewart GW, et al. Further, our experience suggests that APCO can also be applied to teach FM faculty and improves faculty confidence in their own exam skills. Saving You Time. About 25% of all outpatient visits to family physicians include musculoskeletal (MSK) complaints.1 Splinting, bracing, or wrapping are used in 25% of these visits.2 The goals of splinting/bracing are multifold: accommodate a correct movement pattern, restrict poor movement patterns, and decrease the use of an injured area to allow for healing. 2. 206-386-6056. Musculoskeletal (MSK) problems account for 10%-20% of primary care visits,1,2 and 124 million American adults reported a MSK condition in 2015.3 However, studies have shown that family medicine (FM) residents and attendings lack MSK knowledge and confidence.4-6 This may be due to divergent approaches to MSK problems and lack of faculty confidence in teaching the exam.7,8. APCO is a unique solution to improving MSK education that provides a standardized approach to the MSK physical exam and helps participants confidently diagnose their patients’ MSK conditions. 4-6 This may be due to divergent approaches to MSK problems and lack of faculty confidence in teaching the exam. Derebery VJ, Devenport JN, Giang GM, et al. In the 2018 resident course, 11 of 17 participants (65%) completed pre- and postcourse knowledge assessments and 12 of 17 participants (71%) completed pre- and postcourse assessments of MSK exam confidence. Various … J Gen Intern Med. 7,8. See our Other Publications. 2013;48:528-545. 2010;62:161-169. 15. 10. Investigating the effectiveness of full-time wrist splinting and education in the treatment of carpal tunnel syndrome: a randomized controlled trial. We compared pre- and postcourse knowledge and confidence assessment results using mean differences and paired t-test statistics using Stata. Br J Sports Med. We plan to repeat annual knowledge assessments as residents progress through training to better assess long-term knowledge retention. The devices can be adjusted for swelling and are more comfortable than casts, but have the potential for poor patient adherence, may require frequent adjustment, and can allow for excessive motion. In the 2018 preconference workshop, 23 of 36 participants (64%) completed the confidence assessment. A prospective randomized clinical trial of prescription of full-time versus as-directed splint wear for de Quervain tendinopathy. 2013;7:448-459. Presentations: This study was presented as a workshop at both the Society of Teachers of Family Medicine 2017 Annual Spring Conference in San Diego, California, and at the Society of Teachers of Family Medicine 2018 Annual Spring Conference in Washington, DC. Confidence increased from 2.17 to 3.61 (P<.05) after course completion. Treatment of osteoarthritis of the knee, 2nd ed. Musculoskeletal examination for medical students: the need to agree what we teach. Manente G, Torrieri F, di Blasio F, et al. 18. In the 2018 and 2019 resident courses, participant knowledge was assessed before and after the course through a written knowledge assessment comprised of 32 multiple-choice questions. https://www.cdc.gov/nchs/data/ahcd/nhamcs_outpatient/2010_opd_web_tables.pdf, http://www.aaos.org/uploadedFiles/PreProduction/Quality/Guidelines_and_Reviews/guidelines/CTS%20CPG_2.29.16.pdf, https://www.aaos.org/research/guidelines/OAKSummaryofRecommendations.pdf, Palliative care update highlights role of nonspecialists, Subscribe To The Journal Of Family Practice, Clinical Guidelines for Family Physicians, A team approach for their senior patients and their physicians, Nurse Practitioners / Physician Assistants. Which devices do—and don’t—have evidence to support their use when it comes to injuries like carpal tunnel syndrome, “tennis elbow,” or an ankle sprain? Affiliations: Swedish First Hill Family Medicine Residency, Seattle, WA, Elizabeth Hutchinson, MD Cochrane Database Syst Rev. 2012;34(2):93-102. 13. Read on. Am J Occup Ther. J Grad Med Educ. J Bone Joint Surg Am. 5. Further, an orthopedic surgeon has participated as course advisor and reviewed the material for accuracy. This improved to 100% after APCO (Table 2). Resuscitation. Advanced cardiac life support training improves long-term survival from in-hospital cardiac arrest. APCO has been taught annually as a 1.5-day course to residents at our urban community hospital-based FM residency program since 2012. Conclusions: Participation in the APCO course increased short-term musculoskeletal knowledge and confidence. 2006;88(7):1589-1595. Combination therapy—medication, occupational therapy, and splinting—is better for carpal tunnel syndrome than splinting alone. Orthotic devices for the treatment of tennis elbow. 2013;48:528-545. J Athl Train. Am J Sports Med. Prior to the course, 39% respondents reported a confidence score of 3 (somewhat confident) or higher with the MSK exam, which improved to 100% after APCO (Table 2). CDC, National Center for Health Statistics. Clin Orthop Relat Res. Our approach builds on existing literature that demonstrates the value of mixed educational methods and small group learning,9-11 and is innovative in its condensed length, integration of multiple joint exams and intentional repetition of material. (MSK) 1) Bony tenderness of the posterior edge or tip of the medial or lateral malleolus 2) Tenderness of the midfoot with point tenderness over the base of the fifth metatarsal or navicular 3) If the patient is unable to bear weight The effect of bracing on varus gonarthrosis. MacKay C, Canizares M, Davis AM, et al. Evidence: A 2003 Cochrane review concluded that short-term symptom relief was achievable with bracing; however, better outcomes were seen with combination therapies (eg, medications, occupational therapy) vs splinting alone.3 A more recent Cochrane review in 2012 found poor or limited evidence that splint use at night was better than no treatment or any other nonsurgical treatment.4 There was also insufficient evidence to recommend one type of splint over another, although several poor-quality studies found neutral splinting to be more beneficial.5. These products come in a variety of sizes and are easily kept on hand, or ordered through a durable medical equipment provider. Fax: 206-386-6113. Participants in the preconference workshop were asked to assess their confidence only. Unauthorized use prohibited. We developed Advanced Primary Care Orthopedics (APCO) as an innovative method of teaching the MSK exam in a concentrated session combining small group interactive learning and direct observation with the proven pedagogical principle of intentional repetition. Confidence in the musculoskeletal exam, as assessed on a 5-point Likert scale (1–not confident at all; 5–very confident), improved from 2.2 to 3.8 after the course (P<.05). After internal work to refine APCO, two sports medicine fellowship-trained physician educators comprehensively reviewed course material in 2018. Cite indications for immediate imaging of the lumbar spine. 18. van Raaij TM, Reijman M, Brouwer RW, et al. Rheumatology (Oxford). Am J Sports Med. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. 14. van de Streek MD, van der Schans CP, de Greef MH, et al.