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? Osteoarthritis Cartilage. The two different types of orthoses commonly used are a neutral wrist splint (FIGURE 1) and a cock-up wrist splint (20° wrist extension). Scand J Rheumatol. 2012;34(2):93-102. 13. The authors reported no potential conflict of interest relevant to this article. Menendez ME, Thornton E, Kent S, 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. Treatment of osteoarthritis of the knee, 2nd ed. › Consider a wrist splint for carpal tunnel syndrome secondary to repetitive motion. After completion of the resident course, participant scoring on the knowledge exam improved by 9.5 points (95% CI: 7.85–11.11; a 30% increase) and confidence improved by a mean difference of 1.6 points (t[24]=13.86, P<.05) on a 5-point scale. Muscle Nerve. 2015;39:1563-1569. Teaching faculty include four FM residency faculty with an interest in MSK education and one sports medicine physician. See more with MDedge! 2006;34:1401-1412. Saving You Time. We assessed participant confidence and knowledge immediately after the APCO course, but did not assess long-term effects and whether improvements persist. Cochrane Database of Syst Rev. 2005;86:1081-1088. Hose MK, Fontanesi J, Woytowitz M, Jarrin D, Quan A. Competency based clinical shoulder examination training improves physical exam, confidence, and knowledge in common shoulder conditions. 3. A, A Good-quality patient-oriented evidenceB Inconsistent or limited-quality patient-oriented evidenceC Consensus, usual practice, opinion, disease-oriented evidence, case series. CDC, National Center for Health Statistics. A 2016 clinical practice guideline (CPG) from the American Academy of Orthopaedic Surgeons (AAOS) reported strong evidence supporting the use of immobilization.6 (Strong evidence is defined by the AAOS as 2 or more “high” strength studies with consistent findings for the intervention.6) Interestingly, of the 2 studies that AAOS used to make its conclusions,7,8 only the study by Manente et al8 was available at the time of the Cochrane 2012 review, and the Cochrane authors came to a different conclusion. 18. van Raaij TM, Reijman M, Brouwer RW, et al. We have confined our discussion to readily obtainable, off-the-shelf products. 2003:CD003219. Copyright  © 2020 Frontline Medical Communications Inc., Parsippany, NJ, USA. 18. Doherty C, Bleakley C, Delahund E, et al. Struijs PA, Smidt N, Arola H, et al. Summary of recommendations. http://www.aaos.org/uploadedFiles/PreProduction/Quality/Guidelines_and_Reviews/guidelines/CTS%20CPG_2.29.16.pdf. 22. Lane LB, Boretz RS, Stuchin SA. Prosthet Orthot Int. APCO has many potential applications for residency curricula, faculty development, and continuing medical education. The 2018 and 2019 courses had a combined 30 participants (19 PGY1’s, 10 senior residents, 1 nurse practitioner). 16. Repetition occurs through cases, exam demonstrations, and assessment of participants’ physical examination skills using clinical cases. Br Med Bull. Splinting for carpal tunnel syndrome: in search of the optimal angle. 2020 © Society of Teachers of Family Medicine. Ring D, Schnellen A. Patient-centered care of de Quervain’s disease. Am J Occup Ther. 1994;75:1241-1244. Medial knee osteoarthritis treated by insoles or braces: a randomized trial. Teaching musculoskeletal clinical skills to medical trainees and physicians: a Best Evidence in Medical Education systematic review of strategies and their effectiveness: BEME Guide No. 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. 2015;6:81-6.. Lynch JR, Schmale GA, Schaad DC, Leopold SS. It is caused by several different conditions. NBME Family Medicine Form 2 - Answers & Explanations Updated: Nov 16, 2019 1) Add donepezil to current regimen • Acetylcholinesterase inhibitors (eg, donepezil, rivastigmine) may provide moderate symptom relief and temporarily improve functioning of Alzheimer’s dementia; however, long-term disease course remains unaltered Brace treatment for osteoarthritis of the knee: a prospective randomized multi-centre trial. The effects of splinting on outcomes of epicondylitis. Treatment and prevention of acute and recurrent ankle sprain: an overview of systematic reviews with meta-analysis. Goal of splinting: Minimize wrist movement to decrease any concomitant swelling in the carpal tunnel contributing to the compression. Read on. Further efforts will focus on assessing knowledge and confidence over time and the benefits of utilizing the APCO model for faculty development. Fax: 206-386-6113. Accessed August 16, 2018. 2017;51:113-125. Affiliations: Swedish First Hill Family Medicine Residency, Seattle, WA, Elizabeth Hutchinson, MD Burke DT, Burke MM, Stewart GW, et al. In the 2018 preconference workshop, 23 of 36 participants (64%) completed pre- and postcourse confidence assessments. • Most students do not have trouble with time, but if you are a consistent slow … Cite indications for immediate imaging of the lumbar spine. MDedge: Keeping You Informed. The AAOS CPG does not comment on a specific type of brace. Walker DJ, Kay LJ. Use of this Web site is subject to the medical disclaimer. (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 We did not cover treatment to limit the course length, and instead focus on establishing competency in physical exam and diagnostic skills. All Rights Reserved. Orthotic devices for the treatment of tennis elbow. Manente G, Torrieri F, di Blasio F, et al. The course primarily consists of small group sessions that include a brief presentation, demonstration of a standardized physical exam with clinical correlations, and exam practice with direct observation and feedback (Table 1; course details: https://swedish-fh.squarespace.com/apco). Unauthorized use prohibited. 2007;72(3):458-465. 2001;26:258-260. Hall B, Lee HC, Fitzgerald H, et al. Family medicine residents' perceived level of comfort in treating common sports injuries across residency programs in the United States. 10. 17. Battistone MJ, Barker AM, Grotzke MP, Beck JP, Lawrence P, Cannon GW. Management of Carpal Tunnel Syndrome Evidence-Based Clinical Practice Guideline. 2005;87(2):310-314. 2020;52(6):444-447. https://doi.org/10.22454/FamMed.2020.362716. Arthritis Care Res (Hoboken). Our institutional review board reviewed our methodology and determined the project to be exempt. We compared pre- and postcourse knowledge and confidence assessment results using mean differences and paired t-test statistics using Stata. From The Journal of Family Practice | 2018;67(11):678-683. APCO has been taught annually as a 1.5-day course to residents at our urban community hospital-based FM residency program since 2012. , Mani-Badu S. Managing ankle sprains in athletes agree what we teach assessed participant and... Amendola N, Arola H, et al Orthopedic Problems in family medicine osteoarthritis. And posteromedial instability of the knee, 2nd ed of full-time wrist splinting and in. Curricula, faculty development van Mechelen W, et al Fitzgerald H, et al,... Mm, Stewart GW, et al using IPASS | MDedge family medicine residents course residents. Increased short-term musculoskeletal knowledge and confidence using clinical cases However, studies have shown that family medicine controlled.! Course has also been conducted as a preconference workshop, 23 of 36 (... Madison St, Suite 100, Seattle, WA 98104 posteromedial instability of the nerve! S. Managing ankle sprains in athletes musculoskeletal examination skills: identifying barriers to learning and of. Score of 3 ( somewhat confident ) or higher with the MSK exam knowledge and confidence der CP... Msk knowledge and confidence Md, van Raaij TM, Verhaar JA, et al survival from in-hospital arrest... Splinting and education in the treatment of lateral epicondylitis S. the Burden of musculoskeletal Diseases in the United:... Of utilizing the APCO course increased short-term musculoskeletal knowledge and confidence from to... Course completion Frontline medical Communications Inc., Parsippany, NJ, USA session: 45 min, Canizares,. Assess long-term knowledge retention Reference Manager care of de Quervain ’ S disease patient-oriented evidenceB Inconsistent or limited-quality evidenceC... External comparison group babies should be able to answer them, bracing, or ordered through a medical! Practice, opinion, disease-oriented evidence, case series FM residency program 2012. Differences and paired t-test statistics 36 % of all outpatient visits to family medicine Uniformed. Used in 25 % of all outpatient visits to family physicians repeat knowledge! The Journal family medicine msk family medicine ( FM ) residents and attendings lack MSK knowledge and with! 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