• A preliminary study of violent incidents in a special hospital (Rampton)

      Larkin, Emmet P.; Murtagh, Sylvester; Jones, Sue (1988)
      A six-month prospective study of violent incidents was carried out in a Special Hospital (Rampton). Comparisons were made with results from earlier studies in general psychiatric hospitals. As might be expected, incidents occurred more frequently in the Special Hospital. These incidents were also more serious in nature and resulted in greater injury. Although more patients in the Special Hospital were involved in incidents, only a small number of patients accounted for the majority of these. Female patients, who comprised 25% of the Special Hospital population, were involved in 75% of the incidents. Nursing staff were three times as likely to be assaulted as patients.
    • An investigation of the factors associated with an increased risk of psychological morbidity in burn injured patients

      Tedstone, Josephine E. (1998)
      Previous research aimed at identifying factors that increase the risk of major burns patients experiencing psychological problems post-burn has generally ignored the potential role of psychological factors. In a prospective study, patients with burn injuries ranging from < 1 per cent up to 40 per cent were interviewed within 2 weeks of sustaining the burn and followed up at ca 3 months post-burn in order to assess the effects of both non-psychological and psychological factors on their subsequent mental health. The factors investigated included burn related information, demographic information, previous psychiatric history, levels of psychological morbidity at 2 weeks post-burn, responsibility for the injury, previous life events, compensation claims and factors from the coping literature including appraisal, coping strategies and coping efficacy. Forward stepwise multiple regression analyses were used to investigate the relationships between these factors and subsequent mental health. Post-burn psychological morbidity was strongly associated with psychological factors including levels of psychological morbidity in the first 2 weeks of sustaining the injury and factors from the coping literature.;
    • An investigation of the prevalence of psychological morbidity in burn-injured patients

      Tedstone, Josephine E. (1997)
      Research on the psychological impact of burn injuries has concentrated on major burns, while small burns have been largely neglected. In a prospective study, 45 patients with burn injuries ranging from 1 per cent or less up to 40 per cent total body surface area were assessed using semi-structured interviews within 2 weeks of sustaining the burn, and followed-up at approximately 3 months postburn to investigate the prevalence of mental health problems. The prevalence of clinically significant levels of anxiety, intrusions and avoidance remained similar at 2 weeks and 3 months postburn, however, the prevalence of depression and Post Traumatic Stress Disorder (PTSD) increased 6- and 4-times, respectively, by 3 months. Patients with small burn injuries of 1 per cent or less also experienced clinically significant levels of psychological difficulties postburn. The implications for the identification of patients at risk of future psychological morbidity are discussed.;
    • Are cervical collars effective and safe in prehospital spinal cord injury management?

      Hodgett, Rachel (2020)
      Background: In the UK, around 500?600 people a year sustain traumatic injuries to the spinal cord, half of which involve the cervical spine. UK ambulance guidelines stipulate that if immobilisation is indicated, the entire spine should be immobilised using an orthopaedic scoop stretcher, head restraints and a rigid cervical collar. However, the use of cervical collars is being debated in the paramedic profession. Although they were originally considered harmless and used as a precautionary measure, an increasing amount of evidence suggests otherwise and it is argued that they can do more harm than good. Therefore, it is debatable whether using them is consistent with the principles of patient safety and evidence-based practice. Aim: A literature review was carried out to comprehensively examine research surrounding the adverse effects of cervical collars and the range of movement they allow to gain a comprehensive understanding of their efficacy. Methods: The EBSCOhost Health Science Research database was searched. Seven articles were found and chosen for inclusion in the literature review. Results: Two themes were identified regarding cervical collars: adverse effects and range of movement. Conclusion: Evidence suggests that cervical collars can cause more harm than good, and UK ambulance guidelines for spinal immobilisation should be reconsidered.
    • Axonal degeneration and demyelination following traumatic spinal cord injury: A systematic review and meta-analysis

      Shokraneh, Farhad (2019)
      The pathophysiology of spinal cord injury (SCI) related processes of axonal degeneration and demyelination are poorly understood. The present systematic review and meta-analysis were performed such to establish quantitative results of animal studies regarding the role of injury severity, SCI models and level of injury on the pathophysiology of axon and myelin sheath degeneration. 39 related articles were included in the analysis. The compiled data showed that the total number of axons, number of myelinated axons, myelin sheath thickness, axonal conduction velocity, and internode length steadily decreased as time elapsed from the injury (P<sub>for trend</sub>&lt;0.0001). The rate of axonal retrograde degeneration was affected by SCI model and severity of the injury. Axonal degeneration was higher in injuries of the thoracic region. The SCI model and the site of the injury also affected axonal retrograde degeneration. The number of myelinated axons in the caudal region of the injury was significantly higher than the lesion site and the rostral region. The findings of the present meta-analysis show that the pathophysiology of axons and myelin sheath differ in various phases of SCI and are affected by multiple factors related to the injury.<br/>Copyright &#xa9; 2019 Elsevier B.V.
    • Clinical and cost effectiveness of memory rehabilitation following traumatic brain injury: a pragmatic cluster randomized controlled trial

      das Nair, Roshan (2019)
      Objective: To evaluate the clinical and cost effectiveness of a group-based memory rehabilitation programme for people with traumatic brain injury. Design: Multicentre, pragmatic, observer-blinded, randomized controlled trial in England. Setting: Community. Participants: People with memory problems following traumatic brain injury, aged 18–69 years, able to travel to group sessions, communicate in English, and give consent. Interventions: A total of 10 weekly group sessions of manualized memory rehabilitation plus usual care (intervention) vs. usual care alone (control). Main measures: The primary outcome was the patient-reported Everyday Memory Questionnaire (EMQ-p) at six months post randomization. Secondary outcomes were assessed at 6 and 12 months post randomization. Results: We randomized 328 participants. There were no clinically important differences in the primary outcome between arms at six-month follow-up (mean EMQ-p score: 38.8 (SD 26.1) in intervention and 44.1 (SD 24.6) in control arms, adjusted difference in means: –2.1, 95% confidence interval (CI): –6.7 to 2.5, p = 0.37) or 12-month follow-up. Objectively assessed memory ability favoured the memory rehabilitation arm at the 6-month, but not at the 12-month outcome. There were no between-arm differences in mood, experience of brain injury, or relative/friend assessment of patient’s everyday memory outcomes, but goal attainment scores favoured the memory rehabilitation arm at both outcome time points. Health economic analyses suggested that the intervention was unlikely to be cost effective. No safety concerns were raised. Conclusion: This memory rehabilitation programme did not lead to reduced forgetting in daily life for a heterogeneous sample of people with traumatic brain injury. Further research will need to examine who benefits most from such interventions. © The Author(s) 2019.
    • Clinical and ethical challenges in undertaking LIMPRINT in vulnerable populations

      Bussey, Rachel; Whiston, Siobhan (2019)
      Background and Study Objective: To estimate the prevalence of chronic edema (CO) and wounds within two vulnerable populations, a male high security prison in the East Midlands (United Kingdom) and residential and nursing homes in the United Kingdom and Australia. Methods and Results: Methods for screening for CO and wounds were adapted from the main LIMPRINT methodology. Prison Population: In total, 195 inmates were recruited with 22 (11%) having CO. While the majority were white Caucasian (156/83.4%) a further 20 (10.7%) were dark skinned with 11 (5.95%) from other minority populations. Comorbidities included 123 (63%) smokers, 22 (11%) alcohol dependant, 60 (31%) with mental health problems, and 35 (18%) a history of self-harm. Only three had a current wound with 30 (16%) having had a traumatic stab wound. Residential and Nursing Homes (United Kingdom and Australia): In the United Kingdom, the total population available for inclusion was 189 with only 137 (73%) recruited. Seventy-two of the 137 (52%) suffered from CO and a further 16 (23%) had a history of cellulitis. Results from the Australian residential care facilities have been published in full. In summary, of the 37 participants 20 (54%) experienced CO with 25 (68%) having comorbidities and 11 (30%) having a concurrent wound. Conclusion: Obtaining an accurate picture of the prevalence and impact of CO in vulnerable populations is extremely challenging due to issues of access and consent. Lack of reliable data for these populations will contribute to poor service provision.
    • A comparison of the nationally important infection prevention and control documents in NHS England and NHS Scotland

      Robinson, Jude (2020)
      Background: The devolution of health to Scotland in 1999, led for the first time in the NHS, to different priorities and success indicators for infection prevention and control (IPC). This project sought to understand, compare and evaluate the national IPC priorities and available indicators of success. Aim: To identify the national IPC priorities alongside national indicators of success. Methods: Critical analysis of nationally produced documents and publicly available infection-related data up to March 2018. Findings: For both NHS Scotland and England the local and national IPC priorities are evidenced by: (1) people being cared for in an IPC-safe environment; (2) staff following IPC-safe procedures; and (3) organisations continuously striving not just to attain standards, but to improve on them. If national agencies that produce data were also charged with using a Continuous Quality Improvement (CQI) model, then there would be further opportunities to detect and improve on successes. © The Author(s) 2020.
    • Early general hypothermia improves motor function after spinal cord injury in rats; a systematic review and meta-analysis

      Shokraneh, Farhad (2020)
      IntroductionThere is still controversy about the effect of early hypothermia on the outcome of spinal cord injury (SCI). The aim of this review article is to investigate the effect of local or general hypothermia on improving the locomotion after traumatic SCI.MethodsElectronic databases (Medline and Embase) were searched from inception until May 7, 2018. Two independent reviewers screened and summarized the relevant experimental studies on hypothermia efficacy in traumatic SCI. The data were analyzed and the findings were presented as pooled standardized mean difference (SMD) and 95% confidence interval (95% CI).Results20 papers containing 30 separate experiments were included in meta-analysis. The onset of hypothermia varied between 0 and 240 minutes after SCI. Administration of hypothermia has a positive effect on locomotion following SCI (SMD=0.56 95% CI: 0.18-0.95, p=0.004). Subgroup analysis showed that general hypothermia improves locomotion recovery (SMD =0.89, 95% CI: 0.42 to 1.36; p <0.0001), while local hypothermia does not have a significant effect on motor recovery (SMD=0.20, 95 % CI: -0.36-0.76, p=0.478). In addition, general hypothermia was found to affect motor recovery only if its duration was between 2 and 8 hours (SMD=0.89; p<0.0001) and the target temperature for induction of hypothermia was between 32 and 35° C (SMD=0.83; p<0.0001).ConclusionWe found that general hypothermia improves locomotion after SCI in rats. Duration of induction and the target temperature are two essential considerations for general therapeutic hypothermia.
    • Efficacy of hydrogels for repair of traumatic spinal cord injuries: A systematic review and meta-analysis

      Shokraneh, Farhad (2021)
      Hydrogels have been used as promising biomaterials for regeneration and control of pathophysiological events after traumatic spinal cord injuries (TSCI). However, no systematic comparison was conducted to show the effect of hydrogels on pathophysiological events. This study was designed to address this issue and evaluate the regenerative potential of hydrogels after TSCI. From 2857 records found in MEDLINE and EMBASE databases (April 23, 2021), 49 articles were included based on our inclusion/exclusion criteria. All studies discussing the effect of hydrogels on at least one of the main pathophysiological events after TSCI, including inflammation, axon growth, remyelination, glial scar formation, cavity size, and locomotor functional recovery were included. For statistical analysis, we used mean difference with 95% confidence intervals for locomotor functional recovery. The results showed that both natural and synthetic hydrogels could reduce the inflammatory response, hinder glial scar formation, and promote axon growth and vascularization. Also, the meta-analysis of the BBB score showed that using the hydrogels can lead to locomotor functional recovery. It was found that hydrogels are more efficient when used in transection and hemisection injuries (SMD: 1.89; 95% CI: 1.26, 2.52; P < .00001) compared to other injury models. The pre-formed implanted hydrogels (SMD: 1.79; 95% CI: 1.24, 2.34; P < .00001) found to be more effective compared to injection (SMD: 1.58; 95% CI: 0.64, 2.52; P = 0.0009). In conclusion, based on the available evidence, it was concluded that hydrogel composition as well as implantation method are dominant factors affecting tissue regeneration after TSCI and should be chosen according to the injury model in animal studies.
    • Evaluation of an alcohol-related brain injury (ARBI) diagnostic service pilot

      Jawahar, Kaanthan; Katshu, Mohammad Z.; Ellison, James, M. A.; Rhinds, David (2020)
      Objectives/Aims To pilot an ARBI diagnostic service within a community substance misuse team (delivered in partnership with the NHS by a 3rd sector organisation). Background Alcohol-related brain injury (ARBI) is an umbrella term encompassing alcohol-related cognitive impairment, alcohol-related ‘dementias’, Wernicke’s encephalopathy and Korsakoff’s syndrome. It is the result of prolonged and harmful alcohol misuse, developing through direct neuronal damage from alcohol as well as chronic deficient states of vitamin B1 (thiamine). Anecdotally, it is felt that those affected by ARBI can struggle to access the necessary expertise for diagnosis and ongoing management. Methods A widespread stakeholder engagement process led to the development of a standard operating procedure for the pilot service, utilising a process mapping technique. The service received referrals between September 2018 and January 2019. During this time, assessments were carried out in line with the standard operating procedure by the authors. Referrers were also asked to complete a questionnaire for their views on the service. Results Referrals were received from several sources within the host third sector organisation. Heterogeneity was seen in presentations and diagnoses made were not limited to ARBI. Referrers spoke highly of the service and how it had positively benefitted their patients going forwards, providing clarity around diagnoses and thus being able to access appropriate support going forwards. There was a clear need demonstrated for such a service. Conclusions Anecdotally patients with ARBI are viewed as a marginalised group who struggle to access the necessary expertise for diagnosis and ongoing management. This service pilot was successful in filling that gap. Work is ongoing through discussions with local NHS healthcare system partners, including acute trusts, commissioners, mental health, the 3rd sector and Social Care, to devise a more sustainable pathway based upon this pilot service. At present, this is taking the form of an acute hospital ‘in-reach’ pathway to be trialled in an acute trust. This will provide the basis of a business case for a pathway across the STP footprint.
    • Factors affecting the delivery and acceptability of the ROWTATE telehealth vocational rehabilitation intervention for traumatic injury survivors: A mixed-methods study

      Patel, Priya (2021)
      Background: Returning to work after traumatic injury can be problematic. We developed a vocational telerehabilitation (VR) intervention for trauma survivors, delivered by trained occupational therapists (OTs) and clinical psychologists (CPs), and explored factors affecting delivery and acceptability in a feasibility study. Methods: Surveys pre- (5 OTs, 2 CPs) and post-training (3 OTs, 1 CP); interviews pre- (5 OTs, 2 CPs) and post-intervention (4 trauma survivors, 4 OTs, 2 CPs). Mean survey scores for 14 theoretical domains identified telerehabilitation barriers (score ≤ 3.5) and facilitators (score ≥ 5). Interviews were transcribed and thematically analysed. Results: Surveys: pre-training, the only barrier was therapists’ intentions to use telerehabilitation (mean = 3.40 ± 0.23), post-training, 13/14 domains were facilitators. Interviews: barriers/facilitators included environmental context/resources (e.g., technology, patient engagement, privacy/disruptions, travel and access); beliefs about capabilities (e.g., building rapport, complex assessments, knowledge/confidence, third-party feedback and communication style); optimism (e.g., impossible assessments, novel working methods, perceived importance and patient/therapist reluctance) and social/professional role/identity (e.g., therapeutic methods). Training and experience of intervention delivery addressed some barriers and increased facilitators. The intervention was acceptable to trauma survivors and therapists. Conclusion: Despite training and experience in intervention delivery, some barriers remained. Providing some face-to-face delivery where necessary may address certain barriers, but strategies are required to address other barriers.
    • Improved healing rates for simple venous leg ulcers in the community setting

      Wilson, Annabel (2018)
      Background: The need for improvements in leg ulcer management has finally been recognised, following Guest et al (2015) Burden of wounds study and the launch of the new best practice statement from Wounds UK. The study highlighted unsafe practice taking place within primary care and the need for a change in the training and education of leg ulcer management across the National Health Service (NHS). Aims: Prior to making any improvements within the Trust, data showed the average healing rate across the Trust to be a disappointing 41%, further reflecting the data found in Guest et al study. The goal set within the Trust for healing simple venous leg ulcers is a 75% healing rate within 20 weeks. In order to improve practice, patient outcomes and achieve the goal set within the Trust, the Tissue Viability team implemented 6 key steps within the Trust. The 6 key steps comprise of an online interactive leg ulcer theory training package, Video’s demonstrating how to perform compression bandaging and an ABPI Doppler assessment, Updated Leg ulcer handbook, Algorithm, Updated assessment and care plan templates and Leg Ulcer clinic co-ordinator meetings have been commenced. Method: The data collected for the healing rates within the Trust will validate whether the changes implemented have been successful in overall improving practice and patient outcomes. Results: The latest data shows 90 -100% healing rate since the training has been embedded into practice alongside a quality improvement plan. Conclusions: The training is already demonstrating improvements in clinical practice, patient outcomes and a better use of resources. This will result in cost savings for the NHS and free up healthcare professionals valuable time.
    • Improving patients' experience of dressing removal in practice

      Reevell, Geraldine; Anders, Tessa (2016)
      Repeated application/removal of adhesive dressings and tapes can cause skin stripping in and around wounds, resulting in pain, increased wound size, delayed healing, inflammation and increased risk of infection. Adhesive tapes and dressings are also used widely in many care settings to secure tubes, monitors and drains, while the more fragile skin of children and the elderly is at increased risk of epidermal stripping when adhesive dressings are removed. Here, the authors use a series of case studies to demonstrate how Appeel® Sterile Liquid Sachet and Spray applications (CliniMed Ltd), part of the Appeel Sterile Medical Adhesive Remover range, help with adhesive removal, reducing pain and trauma. This article examines how Appeel Sterile removes dressings, tapes and other medical adhesive appliances quickly and easily from both intact and broken skin, resulting in reductions in pain, trauma, use of analgesia, infection risk, cost of dressings and nursing time. |
    • Keeping children safe at home: Protocol for three matched case-control studies of modifiable risk factors for falls

      Stewart, Jane (2012)
      Background Childhood falls result in considerable morbidity, mortality and health service use. Despite this, little evidence exists on protective factors or effective falls prevention interventions in young children. Objectives To estimate ORs for three types of medically attended fall injuries in young children in relation to safety equipment, safety behaviours and hazard reduction and explore differential effects by child and family factors and injury severity. Design Three multicentre case-control studies in UK hospitals with validation of parental reported exposures using home observations. Cases are aged 0-4 years with a medically attended fall injury occurring at home, matched on age and sex with community controls. Children attending hospital for other types of injury will serve as unmatched hospital controls. Matched analyses will use conditional logistic regression to adjust for potential confounding variables. Unmatched analyses will use unconditional logistic regression, adjusted for age, sex, deprivation and distance from hospital in addition to other confounders. Each study requires 496 cases and 1984 controls to detect an OR of 0.7, with 80% power, 5% significance level, a correlation between cases and controls of 0.1 and a range of exposure prevalences. Main outcome measures Falls on stairs, on one level and from furniture. Discussion As the largest in the field to date, these case control studies will adjust for potential confounders, validate measures of exposure and investigate modifiable risk factors for specific falls injury mechanisms. Findings should enhance the evidence base for falls prevention for young children.
    • Management of a patient with a coccyx ulcer in a nursing home

      Anders, Tessa (2017)
      Older people are at increased risk of developing pressure ulcers. They are also more likely to have comorbidities that increase the challenges of managing such a wound. This article reviews a complex case in which a 77-year-old woman with dementia and incontinence developed an ulcer on her coccyx. The ulcer became infected several times and proved resistant to several types of treatment before negative pressure wound therapy with Nanova was instigated.
    • Mental health and other factors associated with work productivity after injury in the UK: multicentre cohort study

      Morriss, Richard K. (2021)
      Introduction Mental health conditions are a major contributor to productivity loss and are common after injury. This study quantifies postinjury productivity loss and its association with preinjury and postinjury mental health, injury, demographic, health, social and other factors.Methods Multicentre, longitudinal study recruiting hospitalised employed individuals aged 16–69 years with unintentional injuries, followed up at 1, 2, 4 and 12 months. Participants completed questionnaires on injury, demographic factors, health (including mental health), social factors, other factors and on-the-job productivity upon return to work (RTW). ORs were estimated for above median productivity loss using random effects logistic regression.Results 217 adults had made an RTW at 2, 4 or 12 months after injury: 29% at 2 months, 66% at 4 months and 83% at 12 months. Productivity loss reduced over time: 3.3% of working time at 2 months, 1.7% at 4 months, 1% at 12 months. Significantly higher productivity loss was associated with preinjury psychiatric conditions (OR 21.40, 95% CI 3.50 to 130.78) and post-traumatic stress avoidance symptoms at 1 month (OR for 1-unit increase in score 1.15, 95% CI 1.07 to 1.22). Significantly lower productivity loss was associated with male gender (OR 0.32, 95% CI 0.14 to 0.74), upper and lower limb injuries (vs other body regions, OR 0.15, 95% CI 0.03 to 0.81) and sports injuries (vs home, OR 0.18, 95% CI 0.04 to 0.78). Preinjury psychiatric conditions and gender remained significant in analysis of multiply imputed data.Conclusions Unintentional injury results in substantial productivity loss. Females, those with preinjury psychiatric conditions and those with post-traumatic stress avoidance symptoms experience greater productivity loss and may require additional support to enable successful RTW.No data are available.
    • Modifiable risk factors for scald injury in children under 5 years of age: A multi-centre case-control study

      Stewart, Jane (2016)
      OBJECTIVE: To determine the relationship between a range of modifiable risk factors and medically attended scalds in children under the age of 5 years. METHODS: Multicentre matched case-control study in acute hospitals, minor injury units and GP practices in four study centres in England. Cases comprised 338 children under 5 presenting with a scald, and 1438 control participants matched on age, gender, date of event and study centre. Parents/caregivers completed questionnaires on safety practices, safety equipment use, home hazards and potential confounders. Odds ratios were estimated using conditional logistic regression. RESULTS: Parents of cases were significantly more likely than parents of controls to have left hot drinks within reach of their child (adjusted odds ratio (AOR) 2.33, 95%CI 1.63 to 3.31; population attributable fraction (PAF) 31%). They were more likely not to have taught children rules about climbing on kitchen objects (AOR 1.66, 95%CI 1.12 to 2.47; PAF 20%); what to do or not do when parents are cooking (AOR 1.95, 95%CI 1.33 to 2.85; PAF 26%); and about hot things in the kitchen (AOR 1.89, 95%CI 1.30 to 2.75; PAF 26%). CONCLUSIONS: Some scald injuries may be prevented by parents keeping hot drinks out of reach of children and by teaching children rules about not climbing on objects in the kitchen, what to do or not do whilst parents are cooking using the top of the cooker and about hot objects in the kitchen. Further studies, providing a more sophisticated exploration of the immediate antecedents of scalds are required to quantify associations between other hazards and behaviours and scalds in young children.
    • Optimal care for the management of older people non-weight bearing after lower limb fracture: a consensus study

      Godfrey, Deborah (2021)
      Background: Older people who are non-weight-bearing after a lower limb fracture are at risk of poor outcomes but there are no clinical guidelines for this group of patients. Given the paucity of the research evidence base, we conducted a consensus exercise to ascertain expert opinion about the management of this group. Methods: A three-round e-Delphi technique was planned to use the online JISC survey tool with a multidisciplinary panel of health professionals. Panellists were invited by email via professional organisations and UK NHS Trusts. The initial statements for this study were prepared by the authors based upon the findings of their scoping review. Consensus required >/= 70% agreement with statements. Results: Only 2 survey rounds were required. Ninety panellists, representing seven clinical disciplines, reached consensus for 24 statements about general issues (osteoporosis detection and management, falls risk reduction and nutrition) and specific non-weight bearing issues (such as the need for activity to be promoted during this period). Conclusions: These findings can be used in the generation of a clinical guideline for this group of patients.
    • Optimal management of older people with frailty non-weight bearing after lower limb fracture: a scoping review

      Godfrey, Deborah (2021)
      BACKGROUND: Patients with lower limb fractures who are non-weight bearing are at risk of the complications of the associated immobility and disability, particularly people with frailty, but there is lack of clarity about what constitutes optimal care for such patients. A scoping literature review was conducted to explore what evidence is available for the management of this patient group. METHOD(S): MEDLINE (PubMed) CINAHL, EMBASE and the Cochrane databases of published literature and the HMIC and SIGLE sites for grey literature were searched for primary research studies and expert reports, using an iterative approach initially including the key term 'non-weight bearing'. All study types were included. Analysis was by narrative synthesis. RESULT(S): No papers were identified from a search using the key phrase 'non-weight bearing'. With this term removed, 11 indirectly relevant articles on lower limb fractures were retrieved from the searches of the electronic databases comprising three observational studies, five non-systematic review articles, a systematic review, an opinion piece and a survey of expert opinion that had relevance to restricted weight bearing patients. The observational studies indicated depression, cognition and nutrition affect outcome and hence have indirect relevance to management. The non-systematic reviews articles emphasised the importance of maintaining strength and range of movement during immobilisation and advised an orthogeriatric model of care. Fourteen UK and 97 non-UK guidelines relevant to fragility fractures, falls and osteoporosis management were found in the grey literature, but none made specific recommendations regarding the management of any period of non-weight bearing. DISCUSSION: These findings provide a summary of the evidence base that can be used in the development of a clinical guideline for these patients but is not sufficient. We propose that, a guideline should be developed for these patients using an expert consensus process. Copyright © The Author(s) 2021. Published by Oxford University Press on behalf of the British Geriatrics Society. All rights reserved. For permissions, please email: journals.permissions@oup.com.