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Tuesday 1pm - 6pm Wednesday 9am - 6pm Thursday 1pm - 6pm Friday 1pm - 6pm

https://your-health-medical-and-rehab-of-london.business.site/

Your Health Medical and Rehab of London, 267 Fanshawe Park Road West, London, ON (2026)

04/02/2023

We are hiring!!

Join our team as a rehab/medical office assistant 👍🏻👍🏻

Reliable, self directed professional rehab/medical office assistant needed that is able to work collaboratively on a busy interdisciplinary healthcare team. Job duties include, but not limited to, supporting patient flow, assist practitioners with booking appointments and referrals, receive faxes and mail,process payments for daily visits, billing, establish and maintain patient files

Full time position starting end of April.

Job Type: Full-time ; monday to Friday

Salary: $30,000.00-$35,000.00 per year

Preference to have some medical office assistant training and experience.

Please send resumes to Dr Robin Meisner at meisner.fanshawe@gmail.com or drop resume to the clinic at 267 Fanshawe park road west London Ontario.

12/12/2022

Conservative care first for BPPV! "Vestibular suppressants for benign paroxysmal positional vertigo: A systematic review and meta-analysis of randomized controlled trials" (Academic Emergency Medicine 2022)

Not a lot of data to analyze, but at this point conservative care remains a viable first option for BPPV...in my experience with patients the Rx options don't work very well.

Results: Five RCTs, enrolling 296 patients, were included in the quantitative analysis. We found that vestibular suppressants may have no effect on symptom resolution at the point of longest follow-up (14–31 days in four studies) when evaluated as a continuous outcome (standardized mean difference –0.03 points, 95% confidence interval [CI] −0.53 to 0.47). Conversely, CRMs (canalith repositioning maneuvers) may improve symptom resolution at the point of longest follow-up as a dichotomous outcome when compared to vestibular suppressants (relative risk [RR] 0.63, 95% CI 0.52 to 0.78). Vestibular suppressants had an uncertain effect on symptom resolution within 24 h (mean difference [MD] 5 points, 95% CI −16.92 to 26.94), repeat emergency department (ED)/clinic visits (RR 0.37, 95% CI 0.12 to 1.15), patient satisfaction (MD 0 points, 95% CI −1.02 to 1.02), and quality of life (MD −1.2 points, 95% CI −2.96 to 0.56). Vestibular suppressants had an uncertain effect on adverse events.

Conclusions: In patients with BPPV, vestibular suppressants may have no effect on symptom resolution at the point of longest follow-up; however, there is evidence toward the superiority of CRM over these medications. Vestibular suppressants have an uncertain effect on symptom resolution within 24 h, repeat ED/clinic visits, patient satisfaction, quality of life, and adverse events. These data suggest that a CRM, and not vestibular suppressants, should be the primary treatment for BPPV.

Read more: https://onlinelibrary.wiley.com/doi/10.1111/acem.14608

10/27/2022

NEW RESEARCH REVIEW POSTED TODAY: “Iliotibial Band – Clinical Overview” (Sports Medicine 2022)

The iliotibial band (ITB) is made up of tough, fibrous fascial tissues and spans from the iliac crest to the lateral proximal tibia. The ITB's various functional roles appear to depend on the posture and activity performed. This is likely a result of the in-series muscular contributions of the gluteus maximus and tensor fascia latae (TFL), and the anatomical path of the ITB crossing the hip and knee joints. During walking, the ITB affects the hip and knee, activating as a hip and knee stabilizer, as well as storing elastic energy.

The current clinical understanding of ITB syndrome is lacking, and the purpose of this review is to summarize the literature surrounding the anatomy and biomechanics of the ITB, to better understand the etiology, clinical examination and treatment of ITB syndrome. n syndrome or impingement model.

The current clinical understanding of ITB syndrome is lacking, and the purpose of this review is to summarize the current body of literature surrounding the anatomy and biomechanics of the ITB, in order to better understand the etiology, clinical examination and treatment of ITB syndrome.

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https://www.rrseducation.com/research-reviews

10/26/2022

"MRI grading of spinal stenosis is not associated with the severity of low back pain in patients with lumbar spinal stenosis" (BMC Musculoskeletal Disorders 2022 - open access)

Although lumbar spinal stenosis (LSS) often coexists with other degenerative conditions, few studies have fully assessed possible contributing factors for low back pain (LBP) in patients with LSS. The purpose of this study was to identify factors associated with the severity of LBP in patients with LSS.

Results:
A total of 293 patients (135 male and 158 female, average age 72.6 years) were analyzed. LBP was moderately correlated with buttock and leg pain, and buttock and leg numbness. Significant but weak correlations were observed between LBP and body mass index, appendicular and trunk muscle mass, all domains of SF-36, pelvic tilt, total number of endplate defects and Modic endplate changes, and summary score of disc degeneration grading, but not severity or number of spinal stenoses. In the multivariate regression analysis, age, female s*x, trunk muscle mass, diabetes, NRS buttock and leg pain, NRS buttock and leg numbness, SF-36 vitality, pelvic tilt, and total number of endplate defects were associated with the severity of LBP.

Conclusions:
Trunk muscle mass, lumbopelvic alignment, and endplate defects, but not severity of stenosis are partly associated with severity of LBP, but buttock and leg pain and buttock and leg numbness have strongest relationships with LBP in patients with LSS.

Read more: https://bmcmusculoskeletdisord.biomedcentral.com/articles/10.1186/s12891-022-05810-y

10/20/2022

Diagnostic accuracy of the Ottawa ankle rule to exclude fractures in acute ankle injuries in adults: a systematic review and meta-analysis (BMC MSK Disorders 2022)

Ankle traumas are common presenting injuries to emergency departments in Australia and worldwide. The Ottawa Ankle Rules (OAR) are a clinical decision tool to exclude ankle fractures, thereby precluding the need for radiographic imaging in patients with acute ankle injury. Previous studies support the OAR as an accurate means of excluding ankle and midfoot fractures, but have included a paediatric population, report both the ankle and mid-foot, or are greater than 5 years old. This systematic review and meta-analysis aimed to update and assess the existing evidence of the diagnostic accuracy of the Ottawa Ankle Rule (OAR) acute ankle injuries in adults.

Results: From 254 unique studies identified in the screening process, 15 were included, involving 8560 patients from 13 countries. Sensitivity, specificity, negative likelihood ratio, positive likelihood ratio and diagnostic odds ratio were 0.91 (95% CI, 0.89 to 0.92), 0.25 (95% CI, 0.24 to 0.26), 1.47 (95% CI, 1.11 to 1.93), 0.15 (95% CI, 0.72 to 0.29) and 10.95 (95% CI, 5.14 to 23.35) respectively, with high between-study heterogeneity observed (sensitivity: I2 = 94.3%, p < 0.01; specificity: I2 = 99.2%, p < 0.01). Most studies presented with low risk of bias and concern regarding applicability following assessment against QUADAS-2 criteria.

Conclusions: Application of the OAR is highly sensitive and can correctly predict the likelihood of ankle fractures when present, however, lower specificity rates increase the likelihood of false positives. Overall, the use of the OAR tool is supported as a cost-effective method of reducing unnecessary radiographic referral, that should improve efficiency, lower medical costs and reduce waiting times.

Read more: http://ow.ly/fowU50Lcw95

10/15/2022

Statin Use for the Primary Prevention of Cardiovascular Disease in Adults: US Preventive Services Task Force Recommendation Statement (JAMA 2022)

Awareness for your patients (MSK pain = common side-effect!), or yourself...

Recommendation: The USPSTF recommends that clinicians prescribe a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more CVD risk factors (ie, dyslipidemia, diabetes, hypertension, or smoking) and an estimated 10-year CVD risk of 10% or greater. (B recommendation) The USPSTF recommends that clinicians selectively offer a statin for the primary prevention of CVD for adults aged 40 to 75 years who have 1 or more of these CVD risk factors and an estimated 10-year CVD risk of 7.5% to less than 10%. The likelihood of benefit is smaller in this group than in persons with a 10-year risk of 10% or greater. (C recommendation) The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of initiating a statin for the primary prevention of CVD events and mortality in adults 76 years or older. (I statement)

Read more: http://ow.ly/fJGj50L3pRb

10/13/2022

The Concerns and Experiences of Patients With Lumbar Spinal Stenosis Regarding Prehabilitation and Recovery After Spine Surgery: A Qualitative Study (Archives of Physical Medicine & Rehabilitation 2022)

Highlights:

Patients desired more information from their surgeons before their spinal surgery.

Good patient-physician rapports can facilitate surgical decision-making.

Prehabilitation may be useful, but patients’ poor mobility deter them from joining.

Post-surgical therapeutic exercises help patients regain physical function.

COVID-19 pandemic affects patients’ post-operative recovery.

Conclusions: Our study highlights the need for better preoperative LSS education. Because face-to-face prehabilitation or postoperative rehabilitation may not be feasible for all patients, future studies should explore whether online-based prehabilitation or postoperative rehabilitation may benefit certain patient subgroups.

Read more: https://www.sciencedirect.com/science/article/pii/S2590109522000556

10/11/2022

Effect of ischemic compression on myofascial pain syndrome: a systematic review and meta-analysis (BMC MSK Disorders 2022 - open access)

IC is one treatment option for MPS - not surprised to see the mixed results here...

Results: Seventeen studies were included in the systematic review, and 15 studies were included in the meta-analysis. For the pressure pain threshold (PPT) index, 11 studies and 427 subjects demonstrated statistically significant differences compared with the control at posttreatment (SMD = 0.67, 95% CI [0.35, 0.98], P < 0.0001, I2 = 59%). For visual analog scale (VAS) or numeric rating scale (NRS) indices, 7 studies and 251 subjects demonstrated that there was no significant difference between ischemic compression and controls posttreatment (SMD = − 0.22, 95% CI [− 0.53, 0.09], P = 0.16, I2 = 33%).

Conclusion: Ischemic compression, as a conservative and noninvasive therapy, only enhanced tolerance to pain in MPS subjects compared with inactive control. Furthermore, there was no evidence of benefit for self-reported pain. The number of currently included subjects was relatively small, so the conclusion may be changed by future studies. Big scale RCTs with more subjects will be critical in future.

Read more: https://chiromt.biomedcentral.com/articles/10.1186/s12998-022-00441-5

10/06/2022

NEW RESEARCH REVIEW POSTED TODAY: “Nonoperative vs. Surgical Treatment of Acute Achilles’ Tendon Rupture” (New England Journal of Medicine 2022)

Rupture of the Achilles tendon is a major injury, but what is the best way to manage these patients? This week’s Review looks at a very important randomized trial on nonoperative versus surgical management that was published this year…

Acute Achilles tendon ruptures are one of the most common musculoskeletal injuries and can result in severe disability. This injury is more common in individuals who are male, older, and more active. Randomized clinical trials (RCTs) assessing nonoperative treatment compared to open repair of acute Achilles tendon ruptures have demonstrated similar patient-reported outcomes and physical performance with both approaches. A recent systematic review of 10 RCTs and 19 observational studies demonstrated a higher risk of re-rupture after nonoperative treatment, whereas surgical treatment was associated with increased risks of postoperative complications such as infection and nerve injuries. However, the trials reviewed were relatively small and protocols of treatment varied or were incompletely described. Studies have suggested that accelerated functional rehab protocols that emphasize early mobilization and weight bearing may lessen the risk of re-rupture after nonoperative treatment. To better inform clinical decision-making for acute Achilles tendon rupture, these authors conducted a multicenter randomized trial comparing non-operative treatment, open repair, and minimally invasive surgery.

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09/26/2022

Exercise as effective for depression as...wait for it...anti-depressants! Exercise. For. The. Win!

"Comparative effectiveness of exercise, antidepressants and their combination in treating non-severe depression: a systematic review and network meta-analysis of randomised controlled trials" (BJSM 2022 - open access)

Results Twenty-one randomised controlled trials (n=2551) with 25 comparisons were included in the network. There were no differences in treatment effectiveness among the three main interventions (exercise vs antidepressants: standardised mean differences, SMD, −0.12; 95% CI −0.33 to 0.10, combination versus exercise: SMD, 0.00; 95% CI −0.33 to 0.33, combination vs antidepressants: SMD, −0.12; 95% CI −0.40 to 0.16), although all treatments were more beneficial than controls. Exercise interventions had higher drop-out rates than antidepressant interventions (risk ratio 1.31; 95% CI 1.09 to 1.57). Heterogeneity in the network was moderate (τ2=0.03; I2=46%).

Conclusions The results suggest no difference between exercise and pharmacological interventions in reducing depressive symptoms in adults with non-severe depression. These findings support the adoption of exercise as an alternative or adjuvant treatment for non-severe depression in adults.

Read more: http://ow.ly/9rF050KRBrA

09/19/2022

Fall prevention is an area with HUGE potential to benefit the health of our patients and the public, yet we desperately need more research at this point: "A systematic review of chiropractic care for fall prevention: rationale, state of the evidence, and recommendations for future research" (BMC MSK Disorders 2022 - open access)

Falls in older adults are a significant and growing public health concern. There are multiple risk factors associated with falls that may be addressed within the scope of chiropractic training and licensure. Few attempts have been made to summarize existing evidence on multimodal chiropractic care and fall risk mitigation. Therefore, the broad purpose of this review was to summarize this research to date.

Systematic review was conducted - eligible study designs included randomized controlled trials (RCT), prospective non-randomized controlled, observational, and cross-over studies in which multimodal chiropractic care was the primary intervention and changes in gait, balance and/or falls were outcomes. The original search yielded 889 articles; 21 met final eligibility including 10 RCTs. One study directly measured the frequency of falls (underpowered secondary outcome) while most studies assessed short-term measurements of gait and balance. The overall methodological quality of identified studies and findings were mixed, limiting interpretation regarding the potential impact of chiropractic care on fall risk to qualitative synthesis.

Conclusion: Little high-quality research has been published to inform how multimodal chiropractic care can best address and positively influence fall prevention. We propose strategies for building an evidence base to inform the role of multimodal chiropractic care in fall prevention and outline recommendations for future research to fill current evidence gaps.

Read more: http://ow.ly/77s150KFuCm

09/18/2022

The purpose of this study was to examine the association between receipt of chiropractic services and initiating a prescription for opioids among adul…

Your Health Medical and Rehab of London

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Tuesday	1pm - 6pm
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