ORCID Profile
0000-0002-8884-8596
Current Organisation
Bond University
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Publisher: Public Library of Science (PLoS)
Date: 15-09-2016
Publisher: Informa UK Limited
Date: 2023
DOI: 10.2147/PPA.S390123
Publisher: Wiley
Date: 06-2023
Publisher: CSIRO Publishing
Date: 15-10-2019
DOI: 10.1071/AH17242
Abstract: Objective The aim of this study was to calculate the societal economic burden of shoulder pain in patients on the orthopaedic waiting list at an Australian public hospital and calculate the cost (from the government’s perspective) of care delivered by the hospital for those patients. Methods A cost-of-illness analysis was undertaken in a cohort of 277 orthopaedic patients on the Gold Coast in Australia. Outcomes included a health care costs and impacts questionnaire, work absenteeism, presenteeism questionnaires (Work Limitations Questionnaire (WLQ) and Work Productivity and Activity Impairment Questionnaire (WPAI)) and hospital care provision over a 2-year period. Results The mean societal cost of healthcare and domestic support was AU$20.72 per day (AU$7563 annually) per patient on the orthopaedic waiting list. When absenteeism and presenteeism were included, the cost per patient who was employed was AU$38.04 per day (AU$13 885 annually) calculated with the WLQ and AU$61.31 per day (AU$22 378 annually) calculated with the WPAI. The mean per-patient cost to government of public hospital care was AU$2622 in Year 1 and AU$3835.78 (s.d. 4961.28) over 2 years. The surgical conversion rate was 22%, and 51% of hospital care cost was attributable to outpatient services. Conclusions Public orthopaedic shoulder waiting lists create a large economic burden for society few referrals require surgery and just over half the hospital care costs are for out-patient services. New models of care that better manage shoulder pain and identify surgical candidates before orthopaedic referral could reduce this burden. What is known about the topic? Little is known about the cost of shoulder pain in Australia, or the cost of patients referred for public orthopaedic care. What does this paper add? This article quantifies the costs of shoulder pain and the value of lost production from shoulder pain. The time spent waiting for public hospital orthopaedic appointments and the costs associated with waiting demonstrate that the time spent on a waiting list is a key driver of the economic burden. What are the implications for practitioners? Greater resourcing to reduce public orthopaedic shoulder waiting lists may be helpful, but system change is also required. Earlier and more accurate identification of surgical cases could reduce inefficient referrals and improve hospital productivity. Collaboration between clinicians and policy makers is needed to design more economically efficient shoulder care.
Publisher: Elsevier BV
Date: 09-2016
Publisher: Wiley
Date: 04-05-2023
DOI: 10.1002/MSC.1770
Abstract: Musculoskeletal shoulder pain is a common problem and its symptoms often become persistent. The experience of pain is multidimensional, and therefore, a range of patient characteristics may influence treatment response. An altered sensory processing has been associated with persistent musculoskeletal pain states and may contribute to outcomes in patients with musculoskeletal shoulder pain. The presence and potential impact of altered sensory processing in this patient cohort is not currently known. The aim of this prospective longitudinal cohort study is to investigate if baseline sensory characteristics are associated with clinical outcomes in patients presenting to a tertiary hospital with persistent musculoskeletal shoulder pain. If found, a relationship between sensory characteristics and outcome may lead to the creation of more effective treatment strategies and improvements in risk adjustment and prognosis. This is a single‐centre prospective cohort study with 6‐, 12‐ and 24‐month follow‐up. A total of 120 participants aged ≥18 years with persistent musculoskeletal shoulder pain (≥3 months) will be recruited from an Australian public tertiary hospital orthopaedic department. Baseline assessments, including quantitative sensory tests and a standardised physical examination, will be performed. In addition, information will be obtained from patient interviews, self‐report questionnaires and medical records. Follow‐up outcome measures will comprise information from the Shoulder Pain and Disability Index and a six‐point Global Rating of Change scale. Descriptive statistics will be used to report baseline characteristics and outcome measures over time. Change in outcome measures at the primary endpoint of six months from baseline will be calculated using paired t ‐tests. Associations between baseline characteristics and outcomes at a 6‐month follow‐up will be reported using multivariable linear and logistic regression models. Understanding the relationship between sensory profile and the variable response to treatment in people with persistent musculoskeletal shoulder pain may enhance our understanding of the mechanisms contributing to the presentation. In addition, through better understanding of the contributing factors, the results of this study may contribute to the development of an in idualised, patient‐centred approach to treatment for people with this highly prevalent and debilitating condition.
Publisher: University Library System, University of Pittsburgh
Date: 13-12-2022
Abstract: Introduction: While the efficacy of telehealth in musculoskeletal physiotherapy has been supported, its cost effectiveness has not been established. Therefore, the objective of this review was to ascertain the health economic impact of outpatient musculoskeletal physiotherapy delivered by telehealth and describe methodology utilized to date. Methods: Electronic searching of PubMed, CINHAL, PEDro, and Web of Science databases was undertaken alongside handsearching for publications comprising: population: adults with musculoskeletal disorders managed in any type of outpatient ambulatory setting intervention: physiotherapy delivered by telehealth comparison: traditional in-person physiotherapy and, outcomes: economic analyses reporting costs and consequences. Appraisal was undertaken with the Downs and Black Questionnaire and the Consolidated Health Economic Evaluation Reporting Standards Checklist. Results: Eleven studies of mixed methodological quality were included. Most were conducted in the public sector, from the economic perspective of the health service funder. Telehealth consistently produced health outcomes akin to in-person care. In all but one, telehealth was less costly, with savings achieved by reducing in-person consultations and travel costs. Conclusion: Telehealth is as effective and cheaper than in-person physiotherapy for musculoskeletal disorders in public hospital outpatients. Further health economic research is needed to clarify the economic impact of telehealth upon non-government providers of musculoskeletal physiotherapy.
Publisher: Elsevier BV
Date: 12-2017
DOI: 10.1016/J.PHYSIO.2016.11.006
Abstract: There is large variation in models-of-care involving the professional substitution of doctors with physiotherapists. To establish the impact upon patients and health services, of substituting doctors with physiotherapists in the management of common musculoskeletal disorders. Medline, CINAHL and ABI Complete databases, and hand-searching of related studies. Randomised and non-randomised clinical trials, inter-rater reliability and comparative studies comparing the outcomes of usual care from doctors, with outcomes when the doctor was substituted with a physiotherapist. Two reviewers evaluated all studies using the Downs and Black Instrument. Meta-analysis was not possible due to study heterogeneity. A descriptive review was undertaken. 14 studies of moderate to low quality met the inclusion criteria. Professional substitution with a physiotherapist causes no significant change to health outcomes and inconsistent variation in the use of healthcare resources. There is insufficient health economic data to determine overall efficiency. In the selected presentations studied, physiotherapists made similar diagnostic and management decisions to orthopaedic surgeons and patients are as, or more satisfied with a physiotherapist. Further high quality health and economic research is needed, in less selective patient populations, to determine the optimal role for physiotherapists. Physiotherapists provide a professional alternative to doctors for musculoskeletal disorders but the health economic implications of this model are presently unclear. Systematic Review Registration Number PROSPERO (Registration number CRD42015027671).
Publisher: Elsevier BV
Date: 04-2023
Publisher: Springer Science and Business Media LLC
Date: 12-2014
Publisher: Elsevier BV
Date: 06-2005
DOI: 10.1016/J.JMPT.2005.04.009
Abstract: The purpose of this study is to quantitatively compare outcomes for trials when treating clinicians did, or did not, have the discretion to decide on treatment technique. CINAHL, EMBASE, MEDLINE, the Physiotherapy Evidence Database, the Cochrane Controlled Trials register, reference list searching, and citation tracking were investigated. Ten randomized controlled trials (RCTs) of mobilization and manipulation for nonspecific low back pain (NSLBP) met the inclusion criteria. The effectiveness of manual therapy with and without clinician technique choice was assessed using descriptive statistics and metaanalysis for the outcomes of pain and activity limitation. In approximately two thirds of the included RCTs, clinicians had choice of treatment technique. There were no systematic differences favoring results for RCTs that did allow clinician choice of treatment technique. Few quality studies are available, and conclusions on the basis of these data need to be interpreted with caution. However, allowing clinicians to choose from a number of treatment techniques does not appear to have improved the outcomes of these RCTs that have investigated the effect of manual therapy for NSLBP. If tailoring manual therapy treatment to NSLBP patients does positively impact on patient outcomes, this is not yet systematically apparent.
Publisher: Wiley
Date: 15-11-2023
DOI: 10.1002/MSC.1705
Abstract: The burden of Musculoskeletal disorders (MSD) is large. Surgery is an important management option but the factors that shape patients' surgical decisions are not well understood. As prior reviews have explored only single data types or conditions, a mixed methods appraisal across the musculoskeletal spectrum was undertaken. A mixed‐methods systematic, convergent segregated approach was used, with PubMed, Cumulated Index to Nursing and Allied Health Literature (CINHAL), Embase and PsycINFO searched to identify studies of adult patients' decisions about whether to undergo surgery. A narrative synthesis was conducted, with identified themes integrated across quantitative, qualitative and mixed‐methods studies. Forty‐six studies were included (24 quantitative, 19 qualitative and three mixed methods), with four decision‐making themes identified (symptoms, sociodemographic and health factors, information and perceptions). Decision‐making involves a complex interaction of in idual sociodemographic, health and symptom information, integrated with in idual perceptions of candidacy and surgical expectations. While most studies investigated hip and knee surgery, across all included conditions, patients are more likely to favour surgery if symptoms and/or dysfunction are higher, and if perceptions of surgical candidacy and processes (outcomes, inconvenience, and risk) are favourable. Other factors including age, general health, race, financial context, professional and non‐professional communication, and information sources also impact decision‐making but exert a less consistent impact upon the propensity to prefer surgery. Patients are more likely to choose surgery for MSD when they have higher levels of symptoms or dysfunction and positive perceptions of surgical suitability and expectations. Other factors important to in iduals, have a less consistent impact upon the propensity to prefer surgery. These findings have potential to aid the efficient referral of patients to orthopaedics. More research is needed to validate these findings across the spectrum of MSD.
Publisher: Springer Science and Business Media LLC
Date: 12-2020
DOI: 10.1186/S12891-020-03839-5
Abstract: Non-surgical multidisciplinary management is often the first pathway of care for patients with chronic low back pain (LBP). This study explores if patient characteristics recorded at the initial service examination have an association with a poor response to this pathway of care in an advanced practice physiotherapist-led tertiary service. Two hundred and forty nine patients undergoing non-surgical multidisciplinary management for their LBP across 8 tertiary public hospitals in Queensland, Australia participated in this prospective longitudinal study. Generalised linear models (logistic family) examined the relationship between patient characteristics and a poor response at 6 months follow-up using a Global Rating of Change measure. Overall 79 of the 178 (44%) patients completing the Global Rating of Change measure (28.5% loss to follow-up) reported a poor outcome. Patient characteristics retained in the final model associated with a poor response included lower Formal Education Level (ie did not complete school) (Odds Ratio (OR (95% confidence interval)) (2.67 (1.17–6.09), p = 0.02) and higher self-reported back disability (measured with the Oswestry Disability Index) (OR 1.33 (1.01–1.77) per 10/100 point score increase, p = 0.046). A low level of formal education and high level of self-reported back disability may be associated with a poor response to non-surgical multidisciplinary management of LBP in tertiary care. Patients with these characteristics may need greater assistance with regard to their comprehension of health information, and judicious monitoring of their response to facilitate timely alternative care if no benefits are attained.
Publisher: Wiley
Date: 05-10-2023
DOI: 10.1111/AJAG.13240
Publisher: Informa UK Limited
Date: 09-2021
DOI: 10.2147/PPA.S323766
No related grants have been discovered for Darryn Marks.