Matthew D. Gardiner

Orthosis compliance monitoring provides insights into effective orthosis design and user wear time. Frequently, patient reports of orthosis use are subjective and often result in overestimation of compliance. Therefore, a tool to objectively observe whether patients wear their orthoses as instructed is vital. This study assessed the real-world practicality of using an objective compliance monitoring device with a hand orthosis. A device consisting of a pressure sensor and accelerometer was tested by ten healthy volunteers who wore a hand orthosis daily and completed a diary of their wear time and activities for a week. Sensor data obtained from the compliance monitoring device were analysed to discern each user’s orthosis wear time. Differences between estimated wear time and actual wear time were insignificant. Pressure-based wear time estimations had a specificity of 99.3 ± 0.7% and a sensitivity of 80.3 ± 19.2%, whilst acceleration-derived estimations had a specificity of 94.5 ± 6.4% and a sensitivity of 73.2 ± 15.8%. This study demonstrated that orthosis compliance can be monitored outside the laboratory, and, furthermore, this device offers insights into the intensity and frequency of a user’s activities and has the future potential to monitor orthosis fit and forces applied to affected joints using pressure.

Purpose: Long‐term data indicate that postmastectomy radiotherapy (PMRT) is associated with improved overall survival in node‐positive breast cancer patients. Immediate breast reconstruction (IBR) remains controversial in the context of planned PMRT, but rates of IBR are increasing. The aim of this study was to examine patterns of PMRT in patients undergoing mastectomy with or without IBR. Methods: Data were collected from 2526 patients enrolled in the iBRA‐2 prospective cohort study undergoing 2606 mastectomies with and without IBR between 1 July 2016 and 31 December 2016. Patients were recruited consecutively at 71 centres across the United Kingdom (UK) and Ireland and at five international centres. Univariable and multivariable logistic regression models were used to explore associations between recommendation for PMRT and patient‐ and procedure‐related factors. Results: Of 2590 breast procedures included in the analysis, 696 were implant‐based, 105 pedicled‐flap and 230 free‐flap reconstructions, and 32.5% of implant‐based, 34.3% of pedicled‐flap and 35.7% of free‐flap reconstructions were recommended for PMRT. PMRT recommendation by cancer stage was 21% for T1‐2 N0, 65% for T1‐2 N1 and 89% for T _any N2 and T3 N _any . In multivariable analyses, patients with invasive disease undergoing implant‐only reconstruction, but not pedicled‐flap or free‐flap reconstruction, were less likely to be recommended for PMRT than those undergoing mastectomy alone. The likelihood of being recommended for PMRT differed by region. Conclusion: Although IBR was more likely to be performed for lower‐stage cancers and in younger patients with fewer comorbidities, a third of patients undergoing IBR were recommended for PMRT. This adds to a growing body of evidence that IBR is becoming an acceptable option for women requiring PMRT. The study also highlighted regional variation in PMRT practice within the UK and Ireland, which merits further investigation.

Background Flexor tendon injuries are common and lead to over 3200 admissions for specialist surgical repair annually in England and Wales. Surgery to repair complete division of both flexor tendons in zone 2 of the hand is technically challenging. There is variation in surgical repair techniques with no high-quality evidence to support decisionmaking. In particular, the decision to repair both tendons or just one is contested. Surgery is followed by specialist rehabilitation, which takes at least 12 weeks. The resulting hand function can impact the patient's income, life satisfaction, well-being, self-worth, and mental health. The FLARE trial aims to determine the clinical and cost-effectiveness of repairing the flexor digitorum profundus (FDP) alone (intervention) versus the repair of both FDP and flexor digitorum superficialis (FDS) (control) for the treatment of complete zone 2, single-digit flexor tendon injuries in adults. Methods A multi-centre, two-arm, blinded, non-inferiority, parallel group, randomised controlled trial with an internal pilot, economic evaluation, and nested qualitative study. Participants will be randomised 1:1 to receive either repair of FDP alone or repair of both FDP and FDS. A total of 310 adults will be recruited from NHS Trusts within the UK, randomised at surgery, and followed up within 7 days, 6 weeks, 3 months, and 6 months post-randomisation. The primary outcome measure is the patient evaluation measure (PEM) administered 6 months post-randomisation. Secondary outcomes include the PEM at other timepoints, Patient Related Wrist/Hand Evaluation (PRWHE), EuroQol 5 Dimensions Score (EQ-5D-5L), complications, total range of motion, grip strength, adherence to splint and therapy regimens, work outcomes, treatment and outcome satisfaction, and healthcare resource use.

The high-quality management of hand osteoarthritis (OA) is crucial for improving the daily lives of people with the condition. The 2022 National Institute for Health and Care Excellence (NICE) guidelines for OA management emphasize education, weight advice and physical activity as foundational management strategies, although hand OA requires specific, tailored approaches. While there can be a focus on pharmacological treatments, non-drug interventions such as education, hand exercises, splinting, joint protection and ‘offloading’ should be prioritized. Pharmacological options including topical NSAIDs are recommended before considering oral medications or intra-articular steroid injections. Although no disease-modifying therapies exist, many symptom management strategies are available. In cases where conservative treatments fail, surgical interventions such as joint fusion, trapeziectomy or arthroplasty are options. The latest insights into OA management based on collective clinical expertise as well as research are outlined. This is underpinned by a current view of pathogenesis, with the hope of enabling a positive consultation incorporating current, accurate information about hand OA. Addressing concerns, myth-busting and using non-negative language are important for activation and empowerment.

Monitoring orthosis compliance using patient diaries is subjective, as patients can overestimate their levels of device use. An objective way to monitor compliance is required because if an orthotic prescription is not followed, the orthosis will not work as intended. This study aimed to develop and validate a device that monitors orthosis compliance objectively using pressure and acceleration. Fifteen participants were recruited to test the device’s ability to estimate wear time during the performance of several grip patterns and whilst completing selected activities of daily living. Sensor threshold values were used to discern whether users were wearing their orthosis or not. No differences between pressure sensor and accelerometer-based wear time estimations were found. The device’s pressure-based wear time estimations were found to have a specificity of 92.7 ± 16.4% and sensitivity of 74.0 ± 41.3%, whilst accelerometer-based wear time estimates had a specificity of 66.1 ± 34.7% and sensitivity of 86.2 ± 8.0%. This study successfully demonstrated the feasibility of monitoring hand orthosis compliance using pressure or acceleration. This device has the potential to provide insight into the effectiveness of both existing and novel orthotics, benefitting both clinical practice and research.

Background: This review aimed to examine in-depth the extent and content of guidance related to the delivery of surgical procedures outside of the operating theatre. Methods: Documents concerning the delivery of surgical procedures in non-operating theatre settings were eligible for inclusion. Guidance documents were identified from three sources: electronic databases (MEDLINE and Embase), professional organization websites and expert knowledge. No time limits were imposed. Endoscopic, interventional radiology/cardiology, dental and obstetric procedures were excluded. Eligible documents were included if specifications on the setting and descriptions of procedures were provided. Study titles, abstracts and full texts were screened for relevance. A standardized data extraction form was developed, focusing on: document type, surgical specialty, rationale for developing the guidance, setting specifications, staffing requirements, patient information and safety; descriptive statistics summarized data where appropriate. Verbatim text extracted was summarized descriptively. Results: Of 375 documents identified, 173 full manuscripts were reviewed and 17 were included in the scoping review, published between 1992 and 2022. Guidance provided by documents was limited. They typically included information about general procedures, setting specifications and equipment that may be required to deliver appropriate procedures in the non-operating theatre setting. There was significant heterogeneity in the terminology used to describe the non-operating theatre setting. Appropriate procedures were commonly minor procedures performed under local or topical anaesthesia. The non-theatre setting was recommended to be of adequate size for all appropriate equipment and personnel, with considerations for lighting, waste disposal, ventilation and emergency equipment. Documents also described appropriate training for staff and requirements for personal protective equipment, surgical record keeping, and occupational health and safety guidelines. Conclusions: This scoping review has demonstrated there is significant heterogeneity in guidance documents concerning the delivery of surgical procedures in the non-theatre setting. Standardization of terminology and definitions is required to help inform stakeholders about the development of non-theatre setting practices.

Trauma is a leading cause of mortality and morbidity in the paediatric population¹. Available epidemiological data on paediatric lower limb trauma are scarce^2,3. The International Lower Limb Collaborative (INTELLECT) study aimed to describe the treatment and outcomes of these injuries from a global perspective. The authors present an analysis of the paediatric population included in the INTELLECT study, representing the largest global study on paediatric open lower limb trauma.