Elsevier

Journal of Surgical Education

Volume 74, Issue 4, July–August 2017, Pages 748-753
Journal of Surgical Education

Original Reports
How Knowledge Relates to Confidence in Orthopedics and Emergency Medicine Regarding Return to Sport and Rehabilitation in Foot and Ankle Trauma

https://doi.org/10.1016/j.jsurg.2016.11.019Get rights and content

Objective

The aim of this study was to survey the knowledge of registrars in emergency medicine and orthopedics on 5 common injuries to the foot and ankle and compare this knowledge, and self-reported confidence in giving it, with that of consultants and physiotherapists of various levels of experience.

Design

An online survey was used to gather the information using scenario-based open and closed questions.

Participants

A total of 102 health care professionals, who regularly deal with sports injuries, were recruited. These included consultant orthopedic surgeons with a subspecialty interest in foot and ankle surgery, orthopedic surgeons in other specialties, extended scope physiotherapy practitioners (ESPs) in foot and ankle and general musculoskeletal practice, emergency medicine consultants, emergency medicine registrars, orthopedic registrars, senior physiotherapists, and junior physiotherapists.

Setting

The participants were drawn from various health care institutions in the North East of England.

Results

Consultant foot and ankle surgeons and extended scope practitioners in foot and ankle both scored significantly on knowledge of rehabilitation program design than either set of registrars. For 2 of the case scenarios, there was a significant difference in scores between either orthopedic consultants or ESPs and registrars (p < 0.05). For total score, there was a trend for extended scope practitioners to score higher than both sets of registrars, but this did not reach significance.

Correlation coefficients for knowledge and self-reported confidence ranged between 0.009 and 0.33, demonstrating only weak positive linear correlation between scenario score and reported confidence in advice given.

Conclusions

The most significant area of gaps in knowledge among the 2 groups of registrars was in the specifics of rehabilitation programs. There was markedly higher confidence with greater seniority. Registrars in emergency medicine and orthopedics are likely to benefit from case-based teaching in sports injury rehabilitation.

Introduction

Patients who have sustained foot and ankle trauma are usually managed by consultants and trainees in emergency medicine and orthopedics, with their rehabilitation managed by physiotherapists. Many patients are involved in sports at a variety of levels and are often keen to be given guidance on the likely course and timescale of their rehabilitation back to their preinjury level of participation. Previous work on physician perceptions of sports injury and rehabilitation knowledge found, in a survey of emergency medicine consultants and specialty trainees, that 100% of them felt that they should know and understand the prognosis of common sporting injuries, and 95% agreed that they should understand the principles of rehabilitation after injury.1 A study by Murphy et al.2 found that emergency department staff would benefit from increased training in sports injury management. Despite this, there is very little time afforded to sports injury or rehabilitation in either the emergency medicine or orthopedic curricula.

The aim of this study was to survey knowledge of rehabilitation in several groups of health care professionals and compare this to self-reported confidence. We reviewed the current state of knowledge regarding rehabilitation following lateral ankle ligament injury, bimalleolar ankle fracture, fifth metatarsal fracture, navicular stress fracture, and tendoachilles rupture, and created 5 clinical scenarios covering these common conditions and used an online survey to gather information on health care professionalsʼ knowledge and confidence in providing guidance on these areas.

Section snippets

Questionnaire Design

The questionnaire was created in conjunction with a consultant foot and ankle surgeon with input from extended scope practitioners (ESPs) in foot and ankle, using the current orthopedic and sports medicine literature, to produce a combination of open and closed questions based on clinical scenarios, on return to sport, and rehabilitation principles. The 5 scenarios used were related to (1) bimalleolar ankle fracture, (2) fifth metatarsal fracture, (3) lateral ankle ligament injury, (4)

Results

There were 102 survey participants including 11 emergency medicine registrars (two year-1, four year-2, two year-3, one year-4, and two year-6), 11 trauma and orthopedics registrars (three year-1, two year-2, three year-3, two year-4, and one year-6), 13 senior physiotherapists, 9 junior physiotherapists, 10 emergency medicine consultants, 16 orthopedics consultants (from specialties other than foot and ankle), 13 consultant foot and ankle surgeons, 9 ESPs in foot and ankle, and 10 ESPs in

Discussion

There is very little information currently available in the literature regarding patient expectations following foot and ankle trauma. A Canadian study demonstrated good overall patient satisfaction with physician discharge information but does not address how physician knowledge influences this and does not specifically address advice on rehabilitation.6 There are several validated patient expectation scales currently in use in orthopedics; however, these were designed and validated for use in

Conclusions

A trend for greater knowledge of rehabilitation from sports injuries to the foot and ankle was found among consultants in orthopedics and extended scope physiotherapy practitioners in comparison to orthopedic and emergency medicine registrars as well as more junior physiotherapists. The most significant area of gaps in knowledge among the 2 groups of registrars was in the specifics of rehabilitation programs. There was a markedly higher confidence with greater seniority that correlated poorly

References (10)

  • D.E. Wilson et al.

    Evaluation of patient satisfaction and outcomes after assessment for acute ankle injuries

    Am J Emerg Med

    (2002)
  • L. Abernethy et al.

    Sports medicine and the accident and emergency medicine specialist

    Emerg Med J

    (2002)
  • A.W. Murphy et al.

    Sports injuries and the accident and emergency department

    Ir Med J

    (1992)
  • D.D. Nulty

    The adequacy of response rates to online and paper surveys: what can be done?

    Assess Eval Higher Educ

    (2008)
  • K.A. Egol et al.

    Lower-extremity function for driving an automobile after operative treatment of ankle fracture

    J Bone Joint Surg Am

    (2003)
There are more references available in the full text version of this article.

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