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Background: Decision regret (DR) is a recognised patient centered outcome measure following a therapeutic intervention. This study aimed to measure DR following primary total hip and knee arthroplasty (THA/TKA), to assess for differences between these patients and explore possible contributory factors., Method: DR was measured using the DR scale in a group of THA and TKA patients, between February 2017 and December 2018, who had made a decision to have joint replacement surgery within the previous year and were able to reflect on their outcomes., Results: On analysis a significantly greater proportion of TKA patients reported moderate or severe (Mod/Sev) DR [17.1% (56/328)] compared to THA patients [4.8% (18/376)]. Conversely, a significantly reduced proportion of TKA patients reported having No DR [42.1% (138/328)] compared to THA patients [66.7% (251/376)]. On multivariate logistic regression analysis joint replacement type (TKA/THA) and change in Oxford score were significant predictors of DR with gender, age, BMI and ASA grade not significantly associated. TKA patients were more than twice as likely to have Mod/Sev DR compared THA patients (Odds Ratio = 2.33 (95% CI 1.24-4.39)). Patients with poorer improvements in pain and function 1-year post-operatively (measured by Oxford scores) reported greater levels of DR., Conclusion: TKA patients were significantly more likely to report greater levels of DR 1-year following surgery compared to THA patients. For both TKA and THA patients, greater levels of DR were associated with poorer Oxford scores. The use of decision aids to reduce post-operative DR in joint replacement patients should be examined especially for knee replacement patients., Competing Interests: Declaration of competing interest None., (Crown Copyright © 2021. Published by Elsevier B.V. All rights reserved.)

Objectives: To evaluate the £ for lb. Challenge, a novel country-wide, workplace-based, peer-led weight management programme with participants from a range of private and public organisations in Northern Ireland., Study Design: Pre- and post-intervention studies., Methods: The intervention was workplace-based, led by volunteer co-worker champions and based on the NHS Choices 12-week weight loss guide which incorporates dietary advice, physical activity, behaviour change methods and weekly weight monitoring. It operated from January to April in three consecutive years (2014-16). Overweight and obese adult workers were eligible. Training of peer champions involved two half-day workshops delivered by dieticians and physical activity professionals. Employers and/or participants pledged £1 to charity for every pound of weight lost. Weight was reported at enrolment and at either 12 weeks (2014) or at 12 weekly intervals (2015-16). Changes in weight and % weight, and body mass index were determined for all the participants and for gender and deprivation subgroups., Results: There were 734, 1559 and 1513 eligible participants, and 21, 31 and 35 participating companies in 2014, 2015 and 2016, respectively. Engagement rates were 94% and 96% and completion rates were 70% and 71% in 2015 and 2016, respectively. Mean weight loss was 1.9 kg (2.2%; 2014), 2.5 kg (2.8%; 2015) and 2.4 kg (2.7%; 2016). The proportions losing ≥5% initial bodyweight were 21% (2014), 24% (2015) and 26% (2016). Male participants were more than twice as likely as women to complete the programme (odds ratio: 2.5 [2015]; 2.2 [2016]) and to lose ≥5% bodyweight (odds ratio: 2.5 [2015]; 3.7 [2016])., Conclusions: The £ for lb. Challenge was an effective, low-cost health improvement intervention with meaningful weight loss for many participants, particularly male workers. With high levels of engagement and ownership, and successful collaboration between public health, voluntary bodies, private companies and public organisations, it is a novel workplace-based model with potential to expand., (Copyright © 2017 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.)

Purpose: Care of pregnant women with epilepsy (WWE) should be shared between an epilepsy specialist and obstetrician. Joint care is provided by the regional, but not peripheral, maternity units in Northern Ireland (NI). We investigated whether demographic and socio-economic factors influenced access of joint obstetric/neurology services., Method: Data on WWE delivering between 1st January 2012 and 31st December 2014 were collected. Demographic (age, parity, Trust residence) and socio-economic (employment status, deprivation level) factors were compared between three groups: (1) women delivering at the regional unit from its catchment, (2) women delivering at the regional unit from outside its catchment and (3) women delivering at peripheral units., Results: 447 WWE delivered in the 3-year period. 48% (214/447) and 52% (233/447) delivered at regional and peripheral units respectively. 42% delivering at the regional unit were from its catchment and 58% outside. There was no difference in parity, employment status or deprivation of WWE from outside the regional unit catchment who accessed joint services and those who did not. Trust residence was the strongest predictor of delivery location with women from adjacent Trusts over 90% less likely to deliver at peripheral units. Maternal age was also a predictor of delivery location with a woman aged 30 being 50% less likely to deliver at a peripheral unit than one aged 20., Conclusions: 52% of all WWE and 63% outside the regional unit catchment do not access the joint service. Service models which deliver improved access should focus on those in geographically distant locations and of younger age., (Copyright © 2016 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.)

Background: This study investigated the effect of socioeconomic deprivation on preoperative disease and outcome following unicompartmental knee replacement (UKR)., Methods: 307 Oxford UKRs implanted between 2008 and 2013 under the care of one surgeon using the same surgical technique were analysed. Deprivation was quantified using the Northern Ireland Multiple Deprivation Measure. Preoperative disease severity and postoperative outcome were measured using the Oxford Knee Score (OKS)., Results: There was no difference in preoperative OKS between deprivation groups. Preoperative knee range of motion (ROM) was significantly reduced in more deprived patients with 10° less ROM than least deprived patients. Postoperatively there was no difference in OKS improvement between deprivation groups (p=0.46), with improvements of 19.5 and 21.0 units in the most and least deprived groups respectively. There was no significant association between deprivation and OKS improvement on unadjusted or adjusted analysis. Preoperative OKS, Short Form 12 mental component score and length of stay were significant independent predictors of OKS improvement. A significantly lower proportion of the most deprived group (15%) reported being able to walk an unlimited distance compared to the least deprived group (41%) one year postoperatively., Conclusion: More deprived patients can achieve similar improvements in OKS to less deprived patients following UKR., (Copyright © 2015 Elsevier B.V. All rights reserved.)

Increasing knee flexion following total knee arthroplasty (TKA) has become an important outcome measure. Surgical technique is one factor that can influence knee motion. In this study, it was hypothesised that stripping of the posterior knee capsule could improve flexion and range of motion (ROM) following TKA. Patients who were undergoing TKA were prospectively randomised into two groups - one group (62 patients) were allocated stripping of the posterior knee capsule (PCS), the other group (66 patients) no stripping (no-PCS). The primary outcome was change in flexion and ROM compared to pre-operative measurements at three time points; after wound closure, 3 months and 1 year post-operatively. Secondary outcomes were absolute measurements of flexion, extension, ROM and complications. All operations were performed by a single surgeon using the same implant and technique. All patients received identical post-operative rehabilitation. There was a significant gain in flexion after wound closure in the PCS group (p=0.022), however there was no significant difference at 3 months or 1 year post-operatively. Absolute values of extension (p=0.008) and flexion (p=0.001) 3 months post-operatively were significantly reduced for the PCS group. The absolute value of ROM was significantly higher for the no-PCS group at 3 months (p=0.0002) and 1 year (p=0.005).There were no significant difference in the rate of complications. Posterior capsular stripping causes a transient increase in flexion that does not persist post-operatively. We do not recommend routine stripping of the posterior knee capsule in patients undergoing TKA., (Crown Copyright © 2010. Published by Elsevier B.V. All rights reserved.)