Dr Rinesh Chetty & associates- orthopaedic surgeons

Why knee osteoarthritis patients avoid restorative activity – Australian study

June 19, 2024

Although physical activity is known to ease the painful symptoms of knee osteoarthritis (OA) – a common cause of pain and joint stiffness – only one in 10 people regularly exercise, says scientists, whose recent study dissects what contributes to patients’ inactivity.

Researchers from the University of South Australia found that people with knee OA unconsciously believe that activity may be dangerous to their condition, despite medical advice telling them otherwise, and that of those they surveyed, 69% with knee pain had stronger implicit (unconscious) beliefs that exercise was dangerous than the average person without pain.

Their finding – published in the journal Pain – not only highlights the conflicted nature of pain and exercise, but also that what people say and what people think, deep down, may be entirely different things, the team said.

Brian Pulling, lead researcher and UniSA PhD candidate based at South Australian Health and Medical Research Institute (SAHMRI), said the findings provide valuable insights for clinicians treating people with knee OA.

“Research shows that physical activity is good for people with knee OA, but most people with this condition do not move enough to support joint or general health,” he said.

“To understand why, research studies typically use questionnaires to assess fear of moving. But unfortunately, questionnaires are limited – what we feel deep down (and how our system naturally reacts to something that is threatening) may be different to what we report. And we still know that many people are avoiding exercise, so we wanted to know why.”

To assess this, the researchers developed a tool that can detect and evaluate people’s implicit beliefs about exercise; that is, whether they unconsciously think activity is dangerous for their condition.

“We found that that even among those who said they were not fearful about exercise, they held unconscious beliefs that movement was dangerous,” he said.

“Our research shows that people have complicated beliefs about exercise, and that they sometimes say one thing if asked directly yet hold a completely different implicit belief.

“People are not aware that what they say doesn’t match what they choose on the new task; they are not misrepresenting their beliefs.

“This research suggests that to fully understand how someone feels about an activity, we must go beyond just asking directly, because their implicit beliefs can sometimes be a better predictor of actual behaviour than what people report. That’s where our tool is useful.”

The online implicit association test presents a series of words and images to which a participant must quickly associate with being either safe or dangerous. The tool intentionally promotes instant responses to avoid deliberation and other influencing factors (such as responding how they think they should respond).

Associate Professor Tasha Stanton said the new tool has the potential to identify a group of people who may have challenges increasing their activity levels and undertaking exercise.

“What people say and what people do are often two different things,” she added.

“Having access to more accurate and insightful information will help health professionals better support their patients to engage with activity and exercise. It may also open opportunities for pain science education, exposure-based therapy, or cognitive functional therapy…things that would not usually be considered for someone who said that they were not scared to exercise.”

Study details

People with painful knee osteoarthritis hold negative implicit attitudes towards activity

Brian Pulling, Felicity Braithwaite, Tasha Stanton et al.

Published in Pain on 16 April 2024

Abstract

Negative attitudes/beliefs surrounding osteoarthritis, pain, and activity contribute to reduced physical activity in people with knee osteoarthritis (KOA). These attitudes/beliefs are assessed using self-report questionnaires, relying on information one is consciously aware of and willing to disclose. Automatic (ie, implicit) assessment of attitudes does not rely on conscious reflection and may identify features unique from self-report. We developed an implicit association test that explored associations between images of a person moving/twisting their knee (activity) or sitting/standing (rest), and perceived threat (safe vs dangerous). We hypothesised that people with KOA would have greater implicit threat–activity associations (vs pain-free and non-knee pain controls), with implicit attitudes only weakly correlating with self-reported measures (pain knowledge, osteoarthritis/pain/activity beliefs, fear of movement). Participants (n = 558) completed an online survey: 223 had painful KOA (n = 157 female, 64.5 ± 8.9 years); 207 were pain free (n = 157 female, 49.3 ± 15.3 years); and 99 had non-KOA lower limb pain (n = 74 female, 47.5 ± 15.04 years). An implicit association between “danger” and “activity” was present in those with and without limb pain (KOA: 0.36, 95% CI 0.28-0.44; pain free: 0.13, 95% CI 0.04-0.22; non-KOA lower limb pain 0.11, 95% CI −0.03 to 0.24) but was significantly greater in the KOA group than in the pain free (P < 0.001) and non-KOA lower limb pain (P = 0.004) groups. Correlations between implicit and self-reported measures were nonsignificant or weak (rho = −0.29 to 0.19, P < 0.001 to P = 0.767). People with painful KOA hold heightened implicit threat–activity associations, capturing information unique to that from self-report questionnaires. Evaluating links between implicit threat–activity associations and real-world behaviour, including physical activity levels, is warranted.

https://www.medicalbrief.co.za/why-knee-osteoarthritis-patients-avoid-restorative-activity-australian-study/

We do what we can to help.
.

Crazy Socks for Docs” ( ) is an annual event which highlights mental health challenges experienced by doctors and makes it OK to talk about them.
​
Just like any person doctors can experience the full range of mental health issues - anxiety, depression, burnout, fear, anger and more.
​
The high-pressure nature of the job and some of the circumstances doctors are exposed to – not to mention working hours and conditions – can leave doctors vulnerable. Concerningly, doctors have a high su***de rate compared to most other professions.
​

History of

Crazy Socks for Docs was created by Victorian doctor Geoff Toogood in 2017, who has lived experience of depression and anxiety.

After wearing odd socks to work one day, Dr Toogood found people were talking behind his back and questioning his mental health. The reality was, his new puppy had been eating his socks but he was struck by the stigma and discrimination still associated with mental health and wellbeing.
​
The initiative – now a global movement – calls upon people everywhere to wear fun socks on the first Friday in June, to raise awareness and normalise the mental health conversation. You can read more on https://lnkd.in/dCpKz2eQ

SASMOA began supporting Crazy Socks for Docs in 2019 and it has grown each year.

Don’t worry. Take a deep breath, clear the mechanism and just start somewhere.

South African Spine Society 2024.


Our National Panel discussing High Cervical management strategies and challenges in SA.
I am proud to stay I worked & trained with three of them personally ( ) and learnt much from the other three professionally.

Everyday should be nurses day. Salute to those brave souls that practice the toughest job in healthcare. #2024

As South Africans we are all very well trained, researched and practiced in managing viral respiratory infection surges, having fought a recent air borne aerosol spread pandemic in Covid, better than most. As we know from experience things can change for the worst very quickly. So rather plan for the worst and hope for the best.

If you do get sick, it is time to make a plan.
Be responsible and reasonable in your care.
Cover your sneeze or cough.
Avoid large gatherings or high risk people if you are sick, wear a mask if you can’t.
Communicate with your work place if you are ill.
Inform and consult your doctor if you require more than the usual over the counter symptomatic medications available.
Vaccinate if you are a high risk patient or consider it if you would like added protection against the flu.

Public urged to get flu jab as cases spike

The national Department of Health and the eThekwini Municipality have both appealed to the public to get their flu vaccinations.

By Karen Singh
Published May 3, 2024

Weeks ahead of the flu season, doctors have noticed a spike in the number of patients with the flu over the past two weeks, some of whom have had to see a medical practitioner twice.

The national Department of Health and the eThekwini Municipality have both appealed to the public to get their flu vaccinations.

Department spokesperson Foster Mohale said respiratory syncytial virus (RSV) is currently at peak circulation in the country and influenza virus infections are starting to increase while Covid-19 continues to circulate at low levels.

“While most diseases caused by influenza, RSV and Sars-Cov-2 viruses are mild, these viruses may cause severe illness and even death among citizens around the country, particularly in individuals with conditions placing them at high risk of severe disease,” he said.

The head of eThekwini’s Health Unit, Rose van Heerden, said the flu virus was at its peak across the country and the public is encouraged to use the City’s clinics if they have flu symptoms.

“The respiratory syncytial virus (RSV) is reported to be on the rise nationally. The virus primarily affects young children but can also lead to breathing problems in older individuals,” said Van Heerden.

Dr Rinesh Chetty, who worked as a Covid-19 medical officer during the pandemic, noted a relative increase in the number of influenza infections, among others, compared to previous years.

He said patients who have had a bad flu have the usual high-risk patient profiles.

These include people above 65 years of age; patients with underlying illnesses, especially heart and lung disease; people living with HIV or tuberculosis; and pregnant women, who are presenting with respiratory viral infections that require specialist or hospital care.

A specialist physician and pulmonologist, Professor Kennedy Nyamande, said based on his observations the flu was worse this year compared to recent years.

Nyamande said they were seeing quite a lot of cases with symptoms that include fever, cough, headache and muscle pains.

Respiratory panel PCR tests had also been positive for Influenza A, he said.

He said the patients with comorbidities and the elderly tend to be sicker and may require closer observation.

“In the last two weeks there has been a surge in cases. It looks like the numbers will definitely go up even more,” said Nyamande.

Dr Kams Govender, a GP in Hillcrest, said the flu season started a bit earlier than normal this year.

“We are seeing an increase over the last two weeks but nothing really crazy – just normal symptoms like a runny nose, sore throat, fever and body pains.

Most of them are viral and most are recovering,” he said.

He said he had noticed that some of his patients were very fatigued.

“It’s very similar to our normal flu season... all my patients so far have responded well to treatment but some are taking a little longer to recover,” said Govender, adding that people get into trouble when, for example, they go to the gym while fighting the flu, which impacts their immune system.

Govender noted that he as well as his colleague were busy with flu patients but they were managing. “We are seeing 40 to 50 patients a day.”

https://www.iol.co.za/mercury/news/public-urged-to-get-flu-jab-as-cases-spike-d556b1bf-38f4-4c9e-8793-7051e37f704f?fbclid=IwZXh0bgNhZW0CMTEAAR39gzy3uBY18evskAr7t36l6-LH0qmot9c7tSVa9xKqNk6mMGi1ucDhOhc_aem_AcVqXdJruhqyV-_tS1c_ENUmNspbNaIvTXjCR0KBSQo4Ud7v79xGkJ5xupVlMVK87juUz_mpGQFjydVINebltUi5&mibextid=KR3qBd

Public urged to get flu jab as cases spike Doctors have noticed a spike in the number of patients with the flu over the past two weeks, some of whom have had to see a medical practitioner twice.

SUBLUXATION AND DISLOCATION OF RADIAL HEAD

Preschool children, particularly girls, are vulnerable to transient subluxation (incomplete dislocation) of the head of the radius (also called “nursemaid’s elbow” or “pulled elbow”). The history of these dislocations is typical. The child is suddenly lifted (je**ed) by the upper limb while the forearm is pronated (e.g., lifting a child). The child may cry out, refuse to use the limb, and protect their limb by holding it with the elbow flexed and the forearm pronated.

The sudden pulling of the upper limb tears the distal attachment of the anular ligament, where it is loosely attached to the neck of the radius. The radial head then moves distally, partially out of the “socket” formed by the anular ligament. The proximal part of the torn ligament may become trapped between the head of the radius and the capitulum of the humerus.

The source of pain is the pinched anular ligament. Treatment of the subluxation consists of supination of the child’s forearm while the elbow is flexed. https://www.facebook.com/share/p/9HSRMorPns1eqfXo/?mibextid=cR73hX

Know the difference between medical aid, medical insurance due to looming expiry of medical exemptions

The health insurance market is at a crossroads in 2024 as exemptions under the Medical Schemes Act are set to expire.

By Dhivana Rajgopaul
Published Mar 22, 2024

According to Profmed, the expiration raises concerns for thousands of South Africans regarding the sustainability of health insurance products and the potential impact on consumers nationwide.

"2024 becomes a critical year for the health insurance market as exemptions granted under the Medical Schemes Act are due to expire in March,“ said CEO of Profmed, Craig Comrie.

“Without these exemptions, health insurance products may be forced to transition into medical schemes and will be subject to stringent regulatory requirements which will result in large premium increases."

Comrie believes that health insurance products were always expected to face this day, and the impending expiration of exemptions poses significant challenges for consumers.

The potential consequences of regulatory changes cannot be understated.

Comrie shares two major impacts:

– some individuals may transition into medical scheme environments

– others may find themselves without coverage.

“People need to seriously consider the implications and understand the difference between health insurance and medical aid,” stated Comrie.

What are the differences?

Lerato Mosiah, the former CEO of the Health Funders Association and the current executive director of the Leato Group shares the differences between medical aid and medical insurance.

Medical aid

One of the key differences lies in the level of cover provided, which is determined by the medical aid benefit option you have chosen.

According to Mosiah, medical aids offer more comprehensive cover than medical insurance products because they are compelled by law to pay for a defined set of Prescribed Minimum Benefits (PMBs).

Some of the benefits include emergency medical treatment as well as cover of 271 medical conditions and 26 chronic conditions.

Mosiah said: “This means that even if your chosen benefit option provides basic cover, your medical aid must provide cover for all the costs related to these PMBs”.

Some medical aids may require members to seek treatment for these conditions from doctors and healthcare facilities that are part of their designated service providers (DSP) networks.

Medical insurance

According to Dischem, medical insurance, commonly known as health insurance, is a form of insurance cover that focuses on essential healthcare needs and covers those medical expenses or part thereof.

Medical insurance products have limitations on what they cover.

“They are not required by law to cover the PMBs, and therefore, generally only cover certain specific health-related events,” Mosiah said.

Medical insurance products cannot fully cover people for medical costs such as costs related to a hospital visit.

Hospital cash plans will generally pay out a fixed lump sum. While the idea of receiving a lump sum may seem attractive, the lump sum may not be enough to cover the costs related to a hospital stay.

Important medical aid and medical insurance facts:

Medical aids are strictly governed and must adhere to the Medical Schemes Act.

All medical aids are not-for-profit organisations and must abide by a set of rules.

Medical schemes are required to hold sufficient reserves to protect their members by ensuring their continued operation and sustainability.

A certain portion of a person’s medical aid contribution is tax deductible.

Mosiah said: “While medical insurance products may seem to be more cost-effective, they do not provide the level of benefits offered by medical aids. Understanding the difference between medical aid and medical insurance is critical to ensure that your family is adequately protected”.

IOL Business

Know the difference between medical aid, medical insurance due to looming expiry of medical exemptions It is vital that people understand the difference medical aid and medical insurance due to the looming expiration of health insurance exemptions.

10 ways to manage your medical expenses
Partner
·6 Feb 2024

“As you begin 2024 with a clean slate in terms of medical aid benefits, it’s a good time to look at ways to manage medical expenses,” says Lee Callakoppen, Principal Officer of Bonitas Medical Fund.

Here are 10 tips to empower yourself in managing medical expenses.

Click here to join the Medical Aid for South Africa.
1. Designated Service Providers (DSPs) and networks

Healthcare costs in South Africa are generally unregulated which means providers are free to charge any tariff.

“Using DSPs and hospital networks means that favourable tariffs for members have been negotiated,” explains Callakoppen.

“Using networks also means you can reduce or eliminate co-payments.”

2. Tariffs and rates of payments

The Scheme Rate is the amount a scheme will pay for specific treatments and procedures. However, 100% of the scheme rate doesn’t necessarily mean 100% of the account will be paid.

Ask for a quote from your practitioner and/or hospital ahead of any procedure. If there is a major discrepancy, try and negotiate an adjusted fee.

3. The value-add benefits

Make use of the free wellness screening and testing offered by your medical aid.

There has been an intensified drive to detect, prevent or manage various chronic conditions as well as vaccinate against potential diseases and conditions.

“After completing an online wellness questionnaire or a wellness screening, you are able to access the ‘Benefit Booster’ providing access of up to R5 000 in additional funds to use for out-of-hospital expenses.”

The Bonitas ‘Be Better Benefit’ includes an annual wellness screening, per beneficiary, to check blood pressure, blood glucose, BMI and cholesterol.

It’s about being on the right path to good health and wellness.

Other benefits include Flu vaccines, HIV tests, lipograms, mammograms, prostate screening, pap smears, pneumococcal vaccines, whooping cough boosters, HPV vaccines, stool tests for colon cancer, dental fissure sealants, online hearing screenings and contraceptives.

4. Ask your pharmacists

Ask your pharmacists for over-the-counter medications for less serious illnesses.

Pharmacists are able to provide sound medical advice about problems like rashes, colds or illnesses that are not severe.

Also use generic medications where possible. A generic’s active ingredient or drug content is identical but is between 30% and 80% cheaper.

5. Managed Care

The prevalence of Non-Communicable Diseases (NCDs) has been increasing year-on-year, so have mental health issues, which is a risk factor for NCDs and vice versa.

For this reason, it is important to make full use the Care programmes your medical aid offers.

“At Bonitas we offer support for NCDs through a range of Care programmes including Audiology, HIV/AIDS, cancer, diabetes, mental health, back and neck, hip and knee replacements as well as hospital-at-home.”

6. Remember to pre-authorise

Pre-authorisation is required for all hospital admissions, out-of-hospital screenings and procedures.

Always ask if there are any co-payments or sub-limits that will apply and how to avoid these.

For planned procedures, make sure you use a DSP or check whether the procedure can be in the doctor’s rooms or a day clinic.

7. Be aware of consulting after hours

Be careful about using after-hours consultations or emergency rooms unless it’s absolutely necessary.

In a bona fide medical emergency, one has no choice and this usually results in admission to hospital.

8. Manage your chronic medicine correctly

The golden rule for chronic illness benefits is to try to use the medication on the scheme’s formulary and to obtain this from a specified pharmacy, either on the network or a DSP.

9. PMBs

Make sure you understand what is covered under Prescribed Minimum Benefits (PMBs) and to use a DSP to ensure that claims are paid from risk, not from your medical savings account.

10. Gap Cover

Gap Cover is designed to cover the difference or part of the difference between what the medical scheme pays and the service provider charges for in-hospital procedures/treatment and specified outpatient procedures.

Ensuring you ‘work smarter’ with the benefits and medical expenses during the year, is a win-win situation for your health and pocket.

10 ways to manage your medical expenses As you begin 2024 with a clean slate in terms of medical aid benefits, it is a great time to look at ways to manage your medical expenses.

We have a new practitioner that has joined our team. He offers great relaxation therapy for less than medical aid rates. #2024

Movember is an annual event involving the growing of moustaches during the month of November to raise awareness of men's health issues, such as prostate cancer, testicular cancer, and men's su***de.

As an orthopaedic spinal surgeon that has treated many spinal injuries sustained following motor vehicle accidents, I am yet to treat any quadriplegic patient that wore a seatbelt. As we enter the high risk holiday period, please make the effort and be aware of everyone’s safety on the road. Btw: In instances where the third party's failure to wear a seatbelt (motor vehicle driver / passenger) or to wear a safety helmet (motor cyclist) contributes to the severity of the injuries such failure is taken into consideration by the RAF when assessing the amount of compensation due to the third party.

Thank you to the “Solar Film Foundation” for sponsoring our new Signage.

Medicentre Floor 3 suite 202
78 Ismail C Meer street
(Formerly Lorne street)
Opposite City Hospital
Durban
South Africa
4001
Ph:(031)309 1210
Ph: (031) 825 4586
Ph:(031)811 3010
Email: [email protected]

Our theatre and our hearts glow green. 'iAfrika

Studies indicate workers’ compensation patients fare worse than counterparts following lumbar spine surgery

8th September 2023 1890

Two studies recently published in the peer-reviewed Journal of Neurosurgery: Spine have found that workers’ compensation patients undergoing lumbar spine surgery fare worse post-surgery than other patients undergoing the same procedures.

“These studies confirm that workers’ compensation patients are significantly more likely to experience greater pain and residual disability, as well as delayed return to work, than other patients who have the same procedures,” noted Gerry Stanley, chief medical officer at Harvard MedTech—an author on both studies. “Consequently, these patients experienced a lower quality of life, higher cost for treatment, and a greater likelihood of reliance on addictive pain medications.”

The results of the studies are set to be discussed at the National Workers’ Compensation and Disability (NWCD) conference (20–22 September, Las Vegas, USA) in a presentation entitled, “Follow the Patient Journey: Sidestep Pitfalls Throughout the Life of a Claim”.

The more recent of these two articles, published in July this year, analysed 9,957 patients who had had 1–4-level anterior cervical discectomy and fusion (ACDF). One-year postoperative improvements, return-to-work rates and satisfaction were all significantly lower for workers’ compensation compared with non-workers’ compensation patients, even though the former patient group had fewer comorbidities and were younger.

Another previous article, published in March, evaluated 29,500 cases, and also found that workers’ compensation patients were significantly more likely to experience greater pain and residual disability, as well as a delayed return to work, than other patients.

The largest study of its kind to date—as per a press release from Harvard Medtech—the research focused on data compiled from patients who underwent 1–4-level lumbar spinal fusion or decompression alone, as reported to the Quality Outcomes Database (QOD). The data included one-year patient-reported outcomes from more than 200 hospital systems between 2012 and 2021. All patients complained of back pain prior to surgery.

The workers’ compensation cohort was younger, more overweight, and less likely to have a college or postgraduate education, than the non-workers’ compensation population; while workers’ compensation patients were also twice as likely to be smokers.

While the study theorised that the reasons for worse outcomes in the workers’ compensation patients could be multifactorial—such as injury severity, socioeconomic factors, and biopsychosocial behaviour like exacerbated illness promoting disability payments—it concluded that identifying the causes for the negative effects on these patients could yield better outcomes.

In its recent release, Harvard Medtech claims that these two studies “confirm what has long been suspected” by indicating that workers’ compensation patients generally do worse than their non-workers’ compensation counterparts following lumbar spine surgery.

Studies indicate workers’ compensation patients fare worse than counterparts following lumbar spine surgery - Spinal News International Two studies recently published in the peer-reviewed Journal of Neurosurgery: Spine have found that workers’ compensation patients undergoing lumbar spine surgery fare worse post-surgery than other patients undergoing the same procedures. “These studies confirm that workers’ compensation patien...

Orthopaedic, Spinal, Pain and Rehab unit.
Medicentre Floor 3 suite 202
78 Ismail C Meer street
(Formerly Lorne street)
Opposite City Hospital
Durban
South Africa
4001
Ph:(031)309 1210
Ph: (031) 825 4586
Ph:(031)811 3010
Email: [email protected]

Did you know that JMH City Hospital has free parking for all patient’s and visitors?

All those requiring secure and safe parking will be allowed to use the 2nd Floor parking area that can be accessed via the Maude Street entrance ramp.

For more information please contact the hospital on 031 314 3000 or email us at [email protected]

Crazy Socks for Docs” ( ) is an annual event which highlights mental health challenges experienced by doctors and makes it OK to talk about them.
​
Just like any person doctors can experience the full range of mental health issues - anxiety, depression, burnout, fear, anger and more.
​
The high-pressure nature of the job and some of the circumstances doctors are exposed to – not to mention working hours and conditions – can leave doctors vulnerable. Concerningly, doctors have a high su***de rate compared to most other professions.
​

History of

Crazy Socks for Docs was created by Victorian doctor Geoff Toogood in 2017, who has lived experience of depression and anxiety.

After wearing odd socks to work one day, Dr Toogood found people were talking behind his back and questioning his mental health. The reality was, his new puppy had been eating his socks but he was struck by the stigma and discrimination still associated with mental health and wellbeing.
​
The initiative – now a global movement – calls upon people everywhere to wear fun socks on the first Friday in June, to raise awareness and normalise the mental health conversation. You can read more on https://lnkd.in/dCpKz2eQ

SASMOA began supporting Crazy Socks for Docs in 2019 and it has grown each year.