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41. Level of Care for Musculoskeletal Surgery

outside the inpatient hospital setting or is expected to be noncompliant with perioperative care (example: severe anxiety about receiving surgery in a nonhospital setting) • Functional status o Patient unable to care for individual needs o Functional impairment likely to necessitate inpatient rehabilitation after surgery (example: moderate to severe myelopathy) o Patient is at high risk for falls Note: The presence of medical and/or psychiatric comorbidities alone may not always justify an inpatient (...) Health. All Rights Reserved. Level of Care for Musculoskeletal Surgery and Procedures 12 Joint Outpatient Level of Care: Joint Surgery Historically, orthopedic hip, knee, and shoulder arthroscopic and sports medicine procedures (Figure 2) have been done on an outpatient basis. The performance of orthopedic arthroscopic and sports medicine procedures in the inpatient setting is generally considered not medically necessary. Requests to perform these procedures inpatient should be considered rare

2018 AIM Specialty Health

42. Appropriate Use Criteria: Imaging of the Spine

, the request will often require a peer-to-peer conversation to understand the individual circumstances that support the medically necessity of performing all imaging studies simultaneously. Examples of multiple imaging studies that may require a peer-to-peer conversation include: ¾ CT brain and CT sinus for headache ¾ MRI brain and MRA brain for headache ¾ MRI cervical spine and MRI shoulder for pain indications ¾ MRI lumbar spine and MRI hip for pain indications ¾ MRI or CT of multiple spine levels (...) Association of Electrodiagnostic Medicine, and the American Academy of Physical Medicine and Rehabilitation. Neurology. 2005;64(2):199-207.MRI Thoracic Spine | Copyright © 2018. AIM Specialty Health. All Rights Reserved. 17 CPT Codes 72146 MRI of thoracic spine, without contrast 72147 MRI of thoracic spine, with contrast 72157 MRI of thoracic spine, without contrast, followed by re-imaging with contrast Standard Anatomic Coverage ? Entire thoracic spine (T1-T12), from the cervicothoracic region through

2018 AIM Specialty Health

43. Practice Parameter for Electrodiagnostic Studies in Carpal Tunnel Syndrome: Summary Statement

STATEMENT* AMERICAN ASSOCIATION OF ELECTRODIAGNOSTIC MEDICINE, AMERICAN ACADEMY OF NEUROLOGY, and AMERICAN ACADEMY OF PHYSICAL MEDICINE AND REHABILITATION Carpal tunnel syndrome (CTS) is a common clinical problem and frequently requires surgical therapy. The results of electrodiagnostic (EDX) studies have been found to be highly sensitive and specific for the * Ap p roved b y th e American Association of Electrodiagnostic Medicine: J anuary 2002, original document ap p roved Ap ril 1993 . Ap p roved b y (...) , th e use of different cut- p oints to define an ab normal value, and differences in th e average severity of th e CTS p atients in th e different studies. ?Results b ased on a single study . RECOMMENDATIONS REGARDING EDX STUDIES TO CONFIRM A CLINICAL DIAGNOSIS OF CTS The recommendations below are identical to those made and endorsed in 1993 by the American Academy of Neurology, 3 the American Academy of Physical Medicine and Rehabilitation, 4 and the American Association of Electrodiagnostic

2002 American Association of Neuromuscular & Electrodiagnostic Medicine

44. Clinical Guideline on the Treatment of Carpal Tunnel Syndrome

postoperatively after routine carpal tunnel surgery (Grade B, Level II). We make no recommendation for or against the use of postoperative rehabilitation. (Inconclusive, Level II). Recommendation 9 We suggest physicians use one or more of the following instruments when assessing patients’ responses to CTS treatment for research: • Boston Carpal Tunnel Questionnaire (disease-specific) • DASH – Disabilities of the arm, shoulder, and hand (region-specific; upper limb) • MHQ – Michigan Hand Outcomes Questionnaire (...) Center Drive 2130 Taubman Health Care Center Ann Arbor, MI 48109-0340 Plastic and Reconstructive Surgery Peter C Amadio, MD Mayo Clinic 200 1st St S W Rochester, MN 55902-3008 Orthopaedic Hand Surgeon Michael Andary, MD Michigan State University B401 W Fee Hall (PMR) East Lansing, MI 48824-1316 Physical Medicine and Rehabilitation Neurology Richard W. Barth, MD 2021 K St Ste 400 Washington, DC 20006-1003 AAOS Board of Councilors Orthopaedic Hand Surgeon Kent Maupin, MD 1111 Leffingwell NE Ste 200

2008 Congress of Neurological Surgeons

45. Botulinum neurotoxin for the treatment of movement disorders

context. The evidence supporting BoNT use in hemifacial spasm is suboptimal. The large magnitude of effects in the initial open label studies likely has discouraged efforts to study BoNT in properly controlled clinical trials. No studies have compared BoNT with the other major treatment alternatives, including oral pharmacologic and surgical therapy. Cervical dystonia. Cervical dystonia (CD) is a focal dystonia causing involuntary activation of the muscles of the neck and shoulders resulting (...) in abnormal, sustained, and painful posturing of the head, neck, and shoulders. There are limited data assessing oral medications for cervical dystonia. Recent surgical studies, including deep brain stimulation, show promise. Out of approximately 80 studies of BoNT in the treatment of CD, 14 controlled studies were identified, including seven Class I studies (four with BoNT-A, three with BoNT-B) (table e-3). Botox® and Myobloc® are FDA approved for use in CD. Three Class I studies enrolled BoNT-naïve CD

2008 American Academy of Neurology

46. Diagnosis and Treatment of Cervical Radiculopathy from Degenerative Disorders

with or with- out upper extremity clinical findings should prompt evaluation for a C4 radiculopathy and that this eval- uation should include C4 sensory testing. Post et al 38 reported a retrospective case series re- viewing experience with the surgical management of a series of 10 patients with C7-T1 herniations. Symptoms included shoulder pain radiating into the lateral aspect of the hand, hand weakness and weakness in finger flexion, finger extension and in- trinsic hand muscles. Sensation and DTRs were un (...) - remarkable. MRI on each patient revealed a soft disc compressing the C8 nerve root. Recovery of hand strength was noted in each patient; however, recov- ery was incomplete in two patients with symptoms greater than four months. In critique, no validated outcome measures were used and the sample size was small. This study provides Level IV evidence that C8 radiculopathy usually presents as weakness of the hand and pain radiating to shoulder, scapu- lar area, and to the fourth and fifth fingers. Physi- cal

2010 North American Spine Society

48. Thoracic Outlet Syndrome - Neurogenic

will not be authorized. Effective Date October 1, 2010; hyperlink and formatting update September 2016 Page 3 II. INTRODUCTION This guideline is to be used by physicians, claim managers, occupational nurses, and utilization review staff. The emphasis is on accurate diagnosis and treatment that is curative or rehabilitative (see WAC 296-20-01002 for definitions). An electrodiagnostic worksheet and guideline summary are appended to the end of this document. This guideline was developed in 2010 by the Washington (...) Holding tools or objects above shoulder level Reaching overhead Carrying heavy weights Several occupations have been associated with nTOS. This is not an exhaustive list and is meant only as a guide in the consideration of work-relatedness: Dry wall hanger or plasterer Assembly line inspector Welder Shelf stocker Beautician Dental hygienist IV. MAKING THE DIAGNOSIS A. SYMPTOMS AND SIGNS A case definition of confirmed nTOS includes appropriate symptoms, objective physical findings ("signs

2010 Washington State Department of Labor and Industries

49. Heart Disease and Stroke Statistics

participation in cardiac rehabilitation after an acute MI. Between 2011 and 2015, compared with patients who did not participate in cardiac rehabilitation, those who declared such participation were less likely to be female (OR, 0.76; 95% CI, 0.65–0.90; P =0.002) or black (OR, 0.70; 95% CI, 0.53–0.93; P =0.014), were less well educated (high school versus college graduate: OR, 0.69; 95% CI, 0.59–0.81; P <0.001 and less than high school versus college graduate: OR, 0.47; 95% CI, 0.37–0.61; P <0.001

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2019 American Heart Association

50. AIM Clinical Appropriateness Guidelines for Joint Surgery

AIM Clinical Appropriateness Guidelines for Joint Surgery Appropriate.Safe.Affordable © 2019 AIM Specialty Health 2062-0119 v.2 Joint Surgery Guidelines Musculoskeletal Program Clinical Appropriateness Guidelines Joint Surgery EFFECTIVE JANUARY 1, 2019 LAST REVIEWED JULY 17, 2017 Copyright © 2019. AIM Specialty Health. All Rights Reserved. Joint Surgery 2 Table of Contents Joint Surgery Guidelines 1 Description and Application of the Guidelines 4 Shoulder Arthroplasty 5 Description & Scope 5 (...) General Requirements and Documentation 5 Indications and Criteria 7 Contraindications 8 Exclusions 8 Selected References 9 CPT Codes 9 History 9 Shoulder Arthroscopy and Open Procedures 10 Description 10 General requirements 10 Indications and Criteria 11 Selected References 16 CPT Codes 16 History 17 Hip Arthroplasty 18 Description & Scope 18 General Requirements and Documentation 18 Indications and Criteria 20 Contraindications 20 Selected References 20 CPT Codes 21 Appendix 21 History 22 Hip

2019 AIM Specialty Health

51. Spine imaging

circumstances that support the medically necessity of performing all imaging studies simultaneously. Examples of multiple imaging studies that may require a peer-to-peer conversation include: ? CT brain and CT sinus for headache ? MRI brain and MRA brain for headache ? MRI cervical spine and MRI shoulder for pain indications ? MRI lumbar spine and MRI hip for pain indications ? MRI or CT of multiple spine levels for pain or radicular indications ? MRI foot and MRI ankle for pain indications ? Bilateral

2019 AIM Specialty Health

52. Extremity imaging

Derangement 20 Adhesive capsulitis (Adult only) 20 Labral tear – hip 20 Labral tear – shoulder 21 Ligament tear – knee 22 Meniscal tear/injury 22 Rotator cuff tear (Adult only) 23 Tendon injuries-foot and ankle 24 Tendon rupture – biceps or triceps 24 Tendon rupture – foot and ankle 25 Triangular fibrocartilage complex tear 25 Ulnar collateral ligament tear (elbow or thumb) 25 Ligament and tendon injuries not listed elsewhere 25 Miscellaneous Joint Conditions 26 Avascular necrosis 26 Chondromalacia (...) cervical spine and MRI shoulder for pain indications ? MRI lumbar spine and MRI hip for pain indications ? MRI or CT of multiple spine levels for pain or radicular indications ? MRI foot and MRI ankle for pain indications ? Bilateral exams, particularly comparison studies There are certain clinical scenarios where simultaneous ordering of multiple imaging studies is consistent with current literature and/or standards of medical practice. These include: ? Oncologic imaging – Considerations include

2019 AIM Specialty Health

53. Chronic pain disorder medical treatment guideline.

evaluation and diagnostic procedures for patients with chronic pain disorders and for further descriptions of the therapies discussed below. The grades of recommendations ( Some, Good, Strong ) are defined at the end of the Major Recommendations field. Therapeutic Procedures—Non-operative Non-operative therapeutic rehabilitation is applied to patients with chronic and complex problems of de-conditioning and functional disability. Treatment modalities may be utilized sequentially or concomitantly (...) or returned to modified or restricted duty during their rehabilitation at the earliest appropriate time. Refer to "Return-to-Work" below for detailed information. Reassessment of the patient's status in terms of functional improvement should be documented after each treatment. If patients are not responding within the recommended time periods, alternative treatment interventions, further diagnostic studies, or consultations should be pursued. Continued treatment should be monitored using objective

2017 National Guideline Clearinghouse (partial archive)

54. Neck pain: revision 2017.

manipulation and/or mobilization. ( Grade of Recommendation: C ) Subacute For patients with subacute neck pain with mobility deficits: Clinicians should provide neck and shoulder girdle endurance exercises. ( Grade of Recommendation: B ) Clinicians may provide thoracic manipulation and cervical manipulation and/or mobilization. ( Grade of Recommendation: C ) Chronic For patients with chronic neck pain with mobility deficits: Clinicians should provide a multimodal approach of the following: Thoracic (...) manipulation and cervical manipulation or mobilization Mixed exercise for cervical/scapulothoracic regions: neuromuscular exercise (e.g., coordination, proprioception, and postural training), stretching, strengthening, endurance training, aerobic conditioning, and cognitive affective elements Dry needling, laser, or intermittent mechanical/manual traction ( Grade of Recommendation: B ) Clinicians may provide neck, shoulder girdle, and trunk endurance exercise approaches and patient education and counseling

2017 National Guideline Clearinghouse (partial archive)

55. Final recommendation statement: adolescent idiopathic scoliosis: screening.

children and adolescents aged 10 to 18 years. This recommendation does not apply to children and adolescents presenting for evaluation of back pain, breathing difficulties, abnormal radiography findings or other imaging studies, or obvious deformities in spinal curvature. Screening Tests Most screening tests for adolescent idiopathic scoliosis are noninvasive. Screening is usually done by visual inspection of the spine to look for asymmetry of the shoulders, shoulder blades, and hips. In the United (...) on Scoliosis Orthopaedic and Rehabilitation Treatment. The type of evidence supporting the recommendations is not specifically stated. Benefits of Early Detection and Intervention or Treatment The U.S. Preventive Services Task Force (USPSTF) found no direct evidence regarding the effect of screening for adolescent idiopathic scoliosis on patient-centered health outcomes. The USPSTF found inadequate evidence on the treatment of idiopathic scoliosis (Cobb angle <50° at diagnosis) in adolescents with exercise

2018 National Guideline Clearinghouse (partial archive)

56. Perineal care

of anal sphincter defect (e.g. defect > 30 degrees) o Low anorectal manometric pressures (e.g. incremental squeeze pressure 4 kg · OP position · Instrumental birth · Shoulder dystocia · Prolonged second stage · Midline episiotomy · Previous OASIS Woman elects vaginal birth? Elective CS Yes Yes No No Yes *Experienced clinician: The clinician best able to provide the required clinical care in the context of the clinical circumstances and local and HHS resources and structure. May include clinicians (...) and pelvic floor muscles. Pelvic floor muscle training A program of exercises used to rehabilitate the function of the pelvic floor muscles. Perineal injury Includes perineal soft tissue damage, tearing and episiotomy. Perineal tears Includes perineal tearing but not injury such as bruising, swelling, surgical incision (episiotomy). Reinfibulation Procedure to narrow the vaginal opening in a woman after she has been deinfibulated; also known as re-suturing. 1 Restrictive use episiotomy Where episiotomy

2018 Queensland Health

57. All-Terrain Vehicle Injuries, Prevention of

protective equipment on injury severity and none studying any possible effect independent of helmet use. [ ],[ ] There was one pediatric and one adult study including drivers and riders in both organized sport and recreational environments with contradictory results (Table 3). Protective equipment including vests, boots, shin guards, and pads for the shoulders, knees, and elbows are currently marketed for ATV riders. No study could be found which only separated helmets from other protective gear; however (...) of change between the two time periods. McBride et al. [ ] furthered investigated the outcomes of ATV legislation in North Carolina by comparing a larger time period (2003–2008), and found that children without helmets were five times more likely to have a head or neck injury ( p = 0.01). Passengers were five times more likely to die or require discharge to a rehabilitation facility ( p = 0.03) and 13 times more likely to suffer a head and neck injury ( p < 0.01) when compared to drivers. The authors

2018 Eastern Association for the Surgery of Trauma

58. Back Pain

Stratification Tool (STarT Back) This tool is available in Epic as a documentation flowsheet, review flowsheet, and secure message. It is also available in hard copy. STarT Back Over the last 2 weeks….. Disagree 0 Agree 1 1. My back pain has spread down my leg(s) at some time in the last 2 weeks 2. I have had pain in the shoulder or neck at some time in the last 2 weeks 3. I have only walked short distances because of my back pain 4. In the last 2 weeks, I have dressed more slowly than usual because of back (...) with Chronic Conditions workshops X X Physical therapy X X Yoga X X Tai chi X X Relaxation therapy (meditation, progressive muscle relaxation, biofeedback, guided visualization) X X Acupuncture X X Spinal manipulation (chiropractic) X X Massage X X NSAIDs X X Duloxetine X X Physical Medicine & Rehabilitation/Spine Care Clinic (where available) X Psychotherapy (cognitive behavioral therapy for pain, mindfulness- based stress reduction) Note: Self-referral for physical therapy, acupuncture, or spinal

2017 Kaiser Permanente Clinical Guidelines

59. Guidelines for the Prevention and Management of Pain, Agitation/Sedation, Delirium, Immobility, and Sleep Disruption in Adult Patients in the ICU

, Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption). Each section created Population, Intervention, Comparison, and Outcome, and nonactionable, descriptive questions based on perceived clinical relevance. The guideline group then voted their ranking, and patients prioritized their importance. For each Population, Intervention, Comparison, and Outcome question, sections searched the best available evidence, determined its quality, and formulated recommendations as “strong (...) ,” “conditional,” or “good” practice statements based on Grading of Recommendations Assessment, Development and Evaluation principles. In addition, evidence gaps and clinical caveats were explicitly identified. Results: The Pain , Agitation/ Sedation , Delirium , Immobility ( mobilization /rehabilitation), and Sleep (disruption) panel issued 37 recommendations (three strong and 34 conditional), two good practice statements, and 32 ungraded, nonactionable statements. Three questions from the patient-centered

2018 Society of Critical Care Medicine


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