BMI not a reason to deny knee replacements

Patients should not be denied a knee replacement based on their BMI alone, a registry study spanning a decade concludes.

The researchers from the Musculoskeletal Research Unit at Bristol Medical School in the UK assessed almost 500,000 knee replacements recorded in the national joint registry over a 10 year period. Patients with raised BMI, as defined by WHO categories, were then compared to patients with a BMI within “normal” ranges.

While patients with raised BMI were more likely to need revision surgery after 10 years, a cumulative revision estimate across all groups met the 5% benchmark generally considered to be acceptable.

Patients with higher BMI also did not score as well as other groups on the postoperative Oxford Knee Score at 6 months but the difference was below the threshold considered to be clinically meaningful.

“These findings do not support restriction of referral for knee replacement based on BMI alone,” the researchers conclude in their paper published in PLOS Medicine. 

“It appears that even if some patients with raised BMI are at risk of poorer outcomes, the outcomes remain acceptable by contemporary standards, and the selection process of orthopaedic surgeons is effective at identifying the correct patients to operate on at a population level,” they added.

Physicians urged to avoid stigmatising language in medical records

When writing in a patient’s medical record, physicians should be conscious of the use of language that reinforces negative and stigmatising attitudes toward patients that may influence the decisions of other clinicians subsequently caring for that patient, according to the authors of a US study.

An analysis of 600 medical records written by 138 physicians at a major hospital identified five types of negative and judgmental language used to describe patient encounters that encompassed racial and class stereotyping, personal disapproval of their actions, questioning a patient’s credibility and portraying them as a difficult or non-compliant. The stigmatising attitudes found in medical notes also included the use of authoritative and paternalistic language by physicians in which they recorded themselves as ‘instructing’ patients, according to researchers from Johns Hopkins University.

In their article, published in JAMA Network Open, they offered six examples of how physicians could use positive and collaborative language in medical records including compliments, approval of positive behaviours and noting of humanising personal details, in addition to acknowledgement of the physician’s own negative attitude and explaining non-adherence in a non-judgmental way.

“Just as we have developed a greater understanding about microaggressions and micro-inequities, this study’s findings suggest that we must raise consciousness about how we write and read medical records,” they said.

“Language has a powerful role in influencing subsequent clinician attitudes and behaviour. Attention to this language could have a large influence on the promotion of respect and reduction of disparities for disadvantaged groups.”

Telehealth helps chronic pain patients access treatment

For people living with chronic pain, the pandemic shift for telehealth has provided better access to health practitioners and pain relief, according to a survey carried out by Chronic Pain Australia.

Responses from more than 2000 people with chronic pain across Australia showed that 76% of had used telehealth to meet with a GP, specialist, or other health practitioner such as physiotherapist during the first year of the pandemic.

Of these, 67% reported experiencing a benefit from using telehealth. Respondents mentioned benefits such as being able to see health practitioners on days when they were experiencing pain, as there was no need to travel, and being able to rest instead of leaving the house for appointments on days off.

However, while more than 80% of respondent felt they have all the technology required to engage with a practitioner through telehealth, many believed it a barrier or unsuitable for accessing some kinds of care such as physical therapy

Nevertheless more than half (55%) said they would consider continuing to use telehealth options with their health practitioner in an ongoing capacity, if they were available.

President of Chronic Pain Australia Alexandra Hordern said, “It is wonderful to see an unexpected silver lining emerge from the COVID-19 pandemic. 3.4 million Australians live with some form of chronic pain and this simple change could help them better access the medical treatment they need to manage their pain. We urge governments to consider making bulk-billed telehealth appointments available long-term.”