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Luk MLM, Chan ACM, Cho JSY, Ng DMT, Lam ICY, Yau ELK, Miller T, Pang MYC. Predictors of chronic pain and disability in patients treated conservatively after distal radius fracture: a prospective cohort study. INTERNATIONAL ORTHOPAEDICS 2023; 47:1535-1543. [PMID: 36973426 DOI: 10.1007/s00264-023-05785-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
PURPOSE To determine predictors of chronic pain and disability among patients with distal radius fractures (DRF) treated conservatively with closed reduction and cast immobilization. METHODS This was a prospective cohort study. Information on patient characteristics, post-reduction radiographic parameters, finger and wrist range of motion, psychological status (Hospital Anxiety and Depression Scale or HADS), pain (Numeric Rating Scale or NRS), and self-perceived disability (Disabilities of the Arm, Should, and Hand or DASH) were taken at baseline, cast removal, and 24 weeks. Differences in outcomes between time points were determined using analysis of variance. Multiple linear regressions were used to determine predictors of pain and disability at 24 weeks. RESULTS One hundred forty patients with DRF (70% women, age: 67.0 ± 17.9) completed 24 weeks of follow-up and were included in the analysis. NRS (off-cast), range of ulnar deviation (off-cast), and greater occupational demands were significant predictors of pain at week 24 (adjusted R2 = 0.331, p < 0.001). Significant predictors of perceived disability at week 24 were HADS (off cast), sex (female), dominant-hand injury, and range of ulnar deviation (off cast) (adjusted R2 = 0.265, p < 0.001). CONCLUSIONS Off-cast NRS and HADS scores are important modifiable predictors of patient-reported pain and disability at 24 weeks in patients with DRF. These factors should be targeted in the prevention of chronic pain and disability post-DRF.
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Ratajczak P, Meller P, Kopciuch D, Paczkowska A, Zaprutko T, Kus K. Assessment of Patients' Quality of Life during Conservative Treatment after Distal Radius Fracture. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:14758. [PMID: 36429478 PMCID: PMC9691041 DOI: 10.3390/ijerph192214758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Revised: 11/07/2022] [Accepted: 11/08/2022] [Indexed: 06/16/2023]
Abstract
Introduction: This study aimed to assess patients' quality of life after distal radius fracture treatment (at least six months, but no more than ten years, after the treatment) based on the analysis of objective and subjective parameters and the influence of the fractured side on the final results. Materials and Methods: The study sample consisted of 30 women who claimed to be right-handed, divided depending on the side of the fracture (left vs. right limb). Patients were evaluated with a goniometer for active wrist movement, pronation, and supination in the elbow joint. Furthermore, the global grip strength of the upper limb was assessed using a dynamometer (Biometrics Ltd.) device, after which patients were asked to complete a wrist evaluation questionnaire (PRWE) and the Polish version of the SF-36 questionnaire assessing the quality of life. Results: There were statistically significant differences in the active movement of the wrist of the injured limb compared to the non-injured limb. In addition, inferior results were reported for injury of the right limb to those of the left. Conclusions: Injury of the right limb as opposed to injury of the left limb can have a negative impact on the assessment of quality of life in patients with right-limb dominance.
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Marchewka J, Marchewka W, Golec E. Quality of life after distal radius fractures. REHABILITACJA MEDYCZNA 2021. [DOI: 10.5604/01.3001.0014.8656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Introduction: Distal radius fractures (DRFs) are among the most commonly seen types of fractures worldwide. Numerous studies suggested that surgical treatment of DRFs results in better quality of life.
Objectives: The aim of this study was to assess long-term quality of life after operative and nonoperative treatment of distal radius fractures among adults.
Material and methods: We retrospectively studied 207 patients with isolated DRF (mean age 64 ±17.9 years, women comprised 150 (72.5%), men 57 (27.5%). There were no significant differences in sex, age, hand dominancy, energy of trauma, AO type fracture and comorbidities between patients treated operatively (n=101) and nonoperatively (n=106). After 3.9 ±1.6 years (mean ±SD) quality of life assessment was conducted using Short Form Health Survey (SF-36) and International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ). Functional outcomes were evaluated using Disabilities of the Arm, Shoulder and Hand (DASH) and Patient Rated Wrist Evaluation (PRWE) questionnaires.
Results: Quality of life in operatively treated distal radius fracture patients was better than amongst those treated nonsurgically. However, after subdivision of cohorts we observed no such differences regardless of treatment method in patients aged ≥ 50 years. SF-36 and IOF QLQ scores were correlated with DASH and PRWE results.
Conclusions: Quality of life questionnaires are useful tools for determining outcomes after distal radius fractures. Operative treatment may not always be superior to nonoperative management especially in patients aged 50 years or above with distal radius fractures.
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Affiliation(s)
- Jakub Marchewka
- Department of Physiotherapy, University of Physical Education, Kraków, Poland / Department of Physiotherapy, University of Physical Education, Kraków, Poland
| | | | - Edward Golec
- Department of Physiotherapy, University of Physical Education, Kraków, Poland
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van Bruggen SGJ, Lameijer CM, Terwee CB. Structural validity and construct validity of the Dutch-Flemish PROMIS ® physical function-upper extremity version 2.0 item bank in Dutch patients with upper extremity injuries. Disabil Rehabil 2019; 43:1176-1184. [PMID: 31411908 DOI: 10.1080/09638288.2019.1651908] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Aim of this study was to validate the Dutch-Flemish Patient-Reported Outcomes Measurement Information System Physical Function - Upper Extremity version 2.0 item bank in patients with upper extremity injuries. MATERIALS AND METHODS Cross-sectional study. Structural validity was assessed using Confirmatory Factor Analysis examining unidimensionality. In addition, a bi-factor model was fitted. Internal consistency was assessed by Cronbach's alpha. Construct validity was examined by assessing correlations with legacy instruments Disability of Arm Shoulder and Hand, Patient Reported Wrist Evaluation and Michigan Hand Questionnaire subscale Activities in Daily Life. RESULTS A total of 303 patients (144 female) with mean age of 50 years (standard deviation 18) were included. Confirmatory Factor Analysis showed Comparative Fit Index of 0.94, a Tucker Lewis Index of 0.93, a Root Mean Square Error of Approximation of 0.12 and a Standardized Root Mean Residual of 0.09. Factor loadings were all above 0.70. Bifactor analysis showed an omega-H of 0.79 and Explained Common Variance of 0.67. The correlations with the legacy instruments were as expected or higher than expected. CONCLUSION The Dutch-Flemish Patient-Reported Outcomes Measurement Information System Physical Function - Upper Extremity version 2.0 item bank measures a unidimensional trait and sufficient construct validity was found.IMPLICATIONS FOR REHABILITATIONCompleting Patient Reported Outcomes is time-consuming for patients and interpretability of outcomes is sometimes unclear due to some variation in psychometric properties.Computerized Adaptive Testing reduces the burden for patients by using an algorithm which decreases the amount of questions that need to be answered to 4 to 7 items.The Dutch-Flemish Patient-Reported Outcomes Measurement Information System Physical Function - Upper Extremity version 2.0 item bank measures a unidimensional trait and has sufficient structural validity, internal consistency and construct validity.After calibration of the Patient-Reported Outcomes Measurement Information System Physical Function - Upper Extremity version 2.0, the item bank is operable to use with Computerized Adaptive Testing.
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Affiliation(s)
- Suus G J van Bruggen
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Charlotte M Lameijer
- Department of Trauma Surgery, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health Research Institute, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
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Truong JL, Doherty C, Suh N. The Effect of Socioeconomic Factors on Outcomes of Distal Radius Fractures: A Systematic Review. Hand (N Y) 2018; 13:509-515. [PMID: 29020814 PMCID: PMC6109905 DOI: 10.1177/1558944717735945] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Socioeconomic factors are known to affect outcomes for both medical and surgical conditions. The purpose of this systematic review was to assess the current evidence regarding the effect of socioeconomic factors such as income, geographic location, educational level, and occupation on clinical outcomes after distal radius fractures. METHODS A systematic search strategy was performed to identify studies commenting on the effect of socioeconomic factors on clinical outcomes following open or closed distal radius fracture repair. Abstract and full-text screening was performed by 2 independent reviewers, and articles were evaluated by Structured Effectiveness Quality Evaluation Scale (SEQES). Treatment outcomes of interest included, but were not limited to, pain, function, range of motion, and grip strength. RESULTS There were 1745 studies that met our inclusion and exclusion criteria for abstract screening. Of these, 48 studies met our inclusion criteria for full-text screening and 20 studies met our criteria for quality analysis with the SEQES score. There were 3 studies of high quality, 16 of moderate quality, and 1 of low quality. Meta-analyses were not possible due to the variability in outcomes of interest across papers. CONCLUSIONS Patient factors indicative of socioeconomic status are relevant predictors of functional outcome after distal radius fractures. There is currently limited evidence in this area of research, and further examination should be considered to improve outcomes from a patient and system standpoint.
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Affiliation(s)
- Jessica L. Truong
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada
| | - Chris Doherty
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada
| | - Nina Suh
- St. Joseph’s Health Care, London,
Ontario, Canada,University of Western Ontario, London,
Canada,Nina Suh, Department of Surgery, University
of Western Ontario, 900 Richmond Street, London, Ontario, Canada N6A 4V2.
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Ali M, Brogren E, Wagner P, Atroshi I. Association Between Distal Radial Fracture Malunion and Patient-Reported Activity Limitations: A Long-Term Follow-up. J Bone Joint Surg Am 2018; 100:633-639. [PMID: 29664849 DOI: 10.2106/jbjs.17.00107] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND The long-term effect of distal radial fracture malunion on activity limitations is unknown. Between 2001 and 2002, we conducted a prospective cohort study of all patients with distal radial fracture treated with casting or percutaneous fixation in northeast Scania in Sweden. In that original study, the patients completed the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire at baseline and at 2 years. We performed a long-term follow-up study of patients who were 18 to 65 years of age at the time of the fracture to investigate the association between fracture malunion and activity limitations. METHODS In this long-term follow-up, patients who had participated in the original study completed the DASH questionnaire and a visual analog scale (VAS) for pain and for satisfaction (scored, 0 [best] to 100) and underwent radiographic and physical examinations at 12 to 14 years after the fracture. We defined malunion as dorsal angulation of ≥10°, ulnar variance of ≥3 mm, and/or radial inclination of ≤15°. We also assessed the presence of radiocarpal osteoarthritis and ulnar styloid nonunion. The primary outcome was the change in DASH score from baseline. Secondary outcomes were DASH, pain, and satisfaction scores, wrist range of motion, and grip strength at the time of the follow-up. RESULTS Of 85 eligible patients, 63 (74%) responded to the questionnaires and underwent examinations. Malunion was found in 25 patients, osteoarthritis was found in 38 patients, and styloid nonunion was found in 9 patients. Compared with patients without malunion, those with malunion had significantly worse DASH scores from baseline to 12 to 14 years (p = 0.002); the adjusted mean difference was 11 points (95% confidence interval [CI], 4 to 17 points). Similarly, follow-up scores were significantly worse among patients with malunion; the adjusted mean difference was 14 points (95% CI, 7 to 22 points; p < 0.001) for DASH scores, 10 points (95% CI, 0 to 20 points; p = 0.049) for VAS pain scores, and 26 points (95% CI, 11 to 41 points; p = 0.001) for VAS satisfaction scores. No differences were found in range of motion or grip strength. Osteoarthritis (mostly mild) and styloid nonunion had no significant association (p > 0.05) with DASH scores, VAS pain or satisfaction scores, or grip strength. CONCLUSIONS Patients who sustain a distal radial fracture at the age of 18 to 65 years and develop malunion are more likely to have worse long-term outcomes including activity limitations and pain. LEVEL OF EVIDENCE Prognostic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Muhanned Ali
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Hässleholm, Sweden
| | - Elisabeth Brogren
- Department of Hand Surgery, Skåne University Hospital, Malmö, Sweden
| | - Philippe Wagner
- Centre for Clinical Research, Uppsala University, Västmanland County Hospital, Västerås, Sweden
| | - Isam Atroshi
- Department of Orthopedics, Kristianstad and Hässleholm Hospitals, Hässleholm, Sweden.,Department of Clinical Sciences - Orthopedics, Lund University, Lund, Sweden
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Lameijer CM, ten Duis HJ, Vroling D, Hartlief MT, El Moumni M, van der Sluis CK. Prevalence of posttraumatic arthritis following distal radius fractures in non-osteoporotic patients and the association with radiological measurements, clinician and patient-reported outcomes. Arch Orthop Trauma Surg 2018; 138:1699-1712. [PMID: 30317380 PMCID: PMC6224009 DOI: 10.1007/s00402-018-3046-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Indexed: 12/30/2022]
Abstract
INTRODUCTION Outcomes of non-osteoporotic patients who sustained a distal radius fracture (DRF) have not gained much attention in recent literature. The aims of this study were to determine the prevalence of posttraumatic arthritis (PA), to analyze associations of radiological measurements, clinician-reported and patient-reported outcomes (CROs and PROs) with PA and gain insight into employment changes after DRF in non-osteoporotic patients. METHODS Non-osteoporotic patients following a DRF were selected. Radiographs of both wrists were obtained at follow-up and the degree of PA was determined. Radiological measurements consisted of grading of PA, ulnar variance, radial length, radial inclination, dorsal tilt, distal radio-ulnar joint width, scapholunate dissociation, step-off and gap. Active range of motion and grip strength measurements were performed and all patients filled in four questionnaires to assess pain, upper extremity functioning, and health status (Disability of Arm, Shoulder and Hand; Patient Reported Wrist Evaluation; Michigan Hand Questionnaire; Short Form-36). RESULTS Seventy-three patients (32 women, 41 men) with a mean age of 33.5 (SD 9.2) years were included. Prevalence of PA was 32% at a median follow-up of 62.0 months. Patients with PA had statistically significant longer radial length (1.1 mm, 95% CI - 2.1; - 0.0, p = 0.045). Patients with PA had a statistically significant diminished flexion/extension arc of motion (12.0°, p = 0.008) and ulnar/radial deviation arc of motion (6.3°, p = 0.018). When corrected for dominance, all grip strength measurements were not statistically significantly different between patients with and without PA. Statistically significant poorer PROs in patients with PA were the MHQ subscales general functioning (65 versus 75, p = 0.018), esthetics (94 versus 100, p = 0.037), satisfaction (75 versus 92, p = 0.042) and total score of the MHQ (83 versus 91, p = 0.044), as well as the SF-36 subscale physical functioning (95 versus 100, p = 0.028). In regression analyses the DASH, PRWE function and PRWE total were statistically significantly associated with flexion/extension arc of motion. Seven patients (10%) changed or left their occupation because of the DRF. CONCLUSION Non-osteoporotic patients had a considerably high prevalence of PA following DRFs, despite a relatively short follow-up time. Patients with longer radial length more often had PA. Irrespective of AO/OTA fracture type, patients with PA had diminished range of motion, but no altered grip strength measurements. Non-osteoporotic patients following DRFs perceived diminished general functioning and dissatisfaction, which was impacted by the diminished active range of motion. Pain or impaired general health status was not reported. The PRO MHQ might be a valuable evaluation tool in this patient group. Change of occupation following DRFs should receive attention in further research.
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Affiliation(s)
- C. M. Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - H. J. ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - D. Vroling
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. T. Hartlief
- Rehabilitation Center ‘Revalidatie Friesland’, Leeuwarden, The Netherlands
| | - M. El Moumni
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, Postbox 30.001, Huispostcode BA51, 9700 RB Groningen, The Netherlands
| | - C. K. van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Lameijer CM, Ten Duis HJ, Dusseldorp IV, Dijkstra PU, van der Sluis CK. Prevalence of posttraumatic arthritis and the association with outcome measures following distal radius fractures in non-osteoporotic patients: a systematic review. Arch Orthop Trauma Surg 2017; 137:1499-1513. [PMID: 28770349 PMCID: PMC5644687 DOI: 10.1007/s00402-017-2765-0] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 01/22/2023]
Abstract
INTRODUCTION The objective of this systematic review was to analyze (1) prevalence of radiological posttraumatic arthritis (PA), (2) associations of PA with outcome measures and (3) predictors of PA following distal radius fractures in non-osteoporotic patients. MATERIALS AND METHODS Nineteen studies were included (10 open source data). RESULTS In total, 733 patients were described with a weighted mean age of 37 years (range 25-54) at the time of the injury. Follow-up ranged from 13 months to 38 years. Overall prevalence of PA was 50% and 37% in the open source data. Radial deviation was significantly worse in patients with PA (N = 49, mean 14°, SD 6° versus N = 55, mean 17°, SD 6°, p = 0.037). No analysis could be performed regarding patient reported outcome measures, because of limited data. Articular incongruence was a significant predictor for PA. CONCLUSIONS A high prevalence of PA was found in non-osteoporotic patients following a distal radius fracture. PA following a distal radial fracture was associated with a limited radial deviation and flexion, but not with grip strength. Articular incongruence predicted PA. Patient reported outcome measures should be investigated more thoroughly to be able to understand the value of using these instruments in interpreting outcome in follow-up of non-osteoporotic patients following a distal radius fracture. LEVEL OF EVIDENCE Level of evidence 3 (Phillips et al. Levels of Evidence-Oxford Centre for Evidence-based Medicine, 1).
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Affiliation(s)
- C M Lameijer
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 30.001, Huispostcode BA51, 9700 RB, Groningen, The Netherlands.
| | - H J Ten Duis
- Department of Trauma Surgery, University Medical Center Groningen, University of Groningen, 30.001, Huispostcode BA51, 9700 RB, Groningen, The Netherlands
| | - I van Dusseldorp
- Medical Center Leeuwarden, MCL Academy, Leeuwarden, The Netherlands
| | - P U Dijkstra
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
- Department of Oral and Maxillofacial Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - C K van der Sluis
- Department of Rehabilitation Medicine, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Trajectories in quality of life of patients with a fracture of the distal radius or ankle using latent class analysis. Qual Life Res 2017; 26:3251-3265. [PMID: 28766080 PMCID: PMC5681973 DOI: 10.1007/s11136-017-1670-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/26/2017] [Indexed: 12/05/2022]
Abstract
Purpose This prospective study aimed to identify the different trajectories of quality of life (QOL) in patients with distal radius fractures (DRF) and ankle fractures (AF). Secondly, it was examined if subgroups could be characterized by sociodemographic, clinical, and psychological variables. Methods Patients (n = 543) completed the World Health Organization Quality of Life assessment instrument-Bref (WHOQOL-Bref), the pain, coping, and cognitions questionnaire, NEO-five factor inventory (neuroticism and extraversion), and the state-trait anxiety inventory (short version) a few days after fracture (i.e., pre-injury QOL reported). The WHOQOL-Bref was also completed at three, six, and 12 months post-fracture. Latent class trajectory analysis (i.e., regression model) including the Step 3 method was performed in Latent Gold 5.0. Results The number of classes ranged from three to five for the WHOQOL-Bref facet and the four domains with a total variance explained ranging from 71.6 to 79.4%. Sex was only significant for physical and psychological QOL (p < 0.05), whereas age showed significance for overall, physical, psychological, and environmental QOL (p < 0.05). Type of treatment or fracture type was not significant (p > 0.05). Percentages of chronic comorbidities were 1.8 (i.e., social QOL) to 4.5 (i.e., physical QOL) higher in the lowest compared to the highest QOL classes. Trait anxiety, neuroticism, extraversion, pain catastrophizing, and internal pain locus of control were significantly different between QOL trajectories (p < 0.05). Conclusions The importance of a biopsychosocial model in trauma care was confirmed. The different courses of QOL after fracture were defined by several sociodemographic and clinical variables as well as psychological characteristics. Based on the identified characteristics, patients at risk for lower QOL may be recognized earlier by health care providers offering opportunities for monitoring and intervention.
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Sluys KP, Shults J, Richmond TS. Health related quality of life and return to work after minor extremity injuries: A longitudinal study comparing upper versus lower extremity injuries. Injury 2016; 47:824-31. [PMID: 26965363 PMCID: PMC4837070 DOI: 10.1016/j.injury.2016.02.019] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 02/25/2016] [Indexed: 02/02/2023]
Abstract
PURPOSE To investigate the impact on health related quality of life (HRQL) during the first year after minor extremity injury and to determine whether there is a difference in recovery patterns and return to work between upper extremity injuries (UEI) and lower extremity injuries (LEI). METHOD A total of 181 adults' age 18 years or older randomly selected from patients admitted to an emergency department with minor injuries were studied. HRQL was measured using the Functional Status Questionnaire (FSQ) at 1-2 weeks, 3, 6, and 12-months post-injury. Pre-injury FSQ scores were measured retrospectively at admission. A quasi-least square (QLS) model was constructed to examine differences of FSQ scores at each measuring point for UEI and LEI. RESULTS Fractures of the knee/lower leg (25%) were the most frequently injured body area. Slips or falls (57%) and traffic-related events (22%) were the most common injury causes. The mean ISS was 4.2 (SD 0.86). Both groups had significant declines in the FSQ scores physical and social functioning at 1-2 weeks after injury. Patients with UEI made larger improvements in the first 3 months post-injury versus patients with LEI whose improvements extended over the first 6 months. None of the groups reached the pre-injury FSQ scores during the first post-injury year except in the subscale work performance where UEI exceeded the pre-injury scores. At 12 months post-injury, significant lower FSQ scores remained in the LEI group compared to the UEI group in intermediate activities of daily living (p=0.036, d 0.4) and work performance (p=0.004, d 0.7). The return to work at 3 months and 12 months were 76% and 88% for UEI and 58% and 77% for LEI. No significant differences were found between groups in the FSQ scale mental health and social interaction. CONCLUSIONS LEI had the highest impact on HRQL and return to work during the first year which exceeded the consequences of UEI. These findings contribute to the information about the consequences of injury in order to give sufficient prognostic information to patients and different stakeholders. Future investigations should aim to investigate specific minor extremity injuries and identify factors that facilitate recovery and return to work.
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Affiliation(s)
- Kerstin Prignitz Sluys
- Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden,Red Cross University College, Stockholm, Sweden,Corresponding author at: Department of Molecular Medicine and Surgery, Karolinska Institutet, Karolinska University Hospital Solna L1:00, SE-171 76 Stockholm, Sweden. Tel.: +46-(0)8-587 516 53.
| | - Justine Shults
- Center for Clinical Epidemiology and Biostatistics University of Pennsylvania School of Medicine, Philadelphia, PA, USA
| | - Therese S. Richmond
- Department of Biobehavioral Health Sciences, University of Pennsylvania School of Nursing, Philadelphia, PA, USA
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Van Son MAC, De Vries J, Roukema JA, Gosens T, Verhofstad MHJ, Den Oudsten BL. The course of health status and (health-related) quality of life following fracture of the lower extremity: a 6-month follow-up study. Qual Life Res 2015; 25:1285-94. [PMID: 26537977 PMCID: PMC4840217 DOI: 10.1007/s11136-015-1167-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/22/2015] [Indexed: 11/01/2022]
Abstract
PURPOSE The aim of this prospective study was to describe the course of health status (HS), health-related quality of life, and quality of life (QOL) in patients with lower extremity fractures (LEF) up to 6 months post-fracture. METHODS Patients (n = 171; age range 18-100 years) completed the World Health Organization Quality of Life assessment instrument-Bref (WHOQOL-Bref) and the Short Musculoskeletal Function Assessment questionnaire (SMFA) at time of diagnosis (i.e., pre-injury status), 1 week, and 6 months post-fracture. Linear mixed modeling was performed. RESULTS Interaction effects of time with treatment were detected for the WHOQOL-Bref facet Overall QOL and General health (p = .002) and Physical health (p = .003). Patients did not return to their pre-injury Physical health, Psychological health, and Environment 6 months post-fracture (p < .05). No effects were found for Social relationships. The SMFA subscale Lower extremity dysfunction showed main effects for time and treatment (p < .0001) with full recovery at 6 months (p = .998). An interaction effect of time with treatment was found for Daily life consequences (p < .0001) with nonoperatively treated patients showing full recovery (p = 1.00), whereas surgically treated patients did not (p = .002). CONCLUSIONS Six months after LEF, patients still experienced impaired physical and psychological health on the WHOQOL-Bref compared to their pre-injury status. However, patients showed full recovery on SMFA Lower extremity dysfunction, indicating that the choice of the questionnaire influences the derived conclusions. LEF did not affect satisfaction with social relationships.
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Affiliation(s)
- M. A. C. Van Son
- />CoRPS, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
- />Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - J. De Vries
- />CoRPS, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
- />Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - J. A. Roukema
- />CoRPS, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
- />Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - T. Gosens
- />Department of Orthopaedics, St. Elisabeth Hospital, Tilburg, The Netherlands
| | - M. H. J. Verhofstad
- />Department of Surgery, St. Elisabeth Hospital, Tilburg, The Netherlands
- />Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - B. L. Den Oudsten
- />CoRPS, Department of Medical and Clinical Psychology, Tilburg University, P.O. Box 90153, 5000 LE Tilburg, The Netherlands
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Tomaszewski KA, Henry BM, Paradowski J, Kłosiński M, Walocha E, Golec J, Kucharska E, Dudkiewicz Z. Cross cultural adaptation of the English version of the IOF-QLQ to Polish, to assess the health-related quality-of-life of patients after a distal radius fracture. Health Qual Life Outcomes 2015; 13:158. [PMID: 26416429 PMCID: PMC4587858 DOI: 10.1186/s12955-015-0354-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2015] [Accepted: 09/18/2015] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND A distal radius fracture (DRF) is a common injury that can cause significant pain and lead to a prolonged decrease in physical, emotional, and social functioning. In modern randomized clinical trials, assessing outcomes after a DRF, health-related quality-of-life (HRQoL) is a "must-be" endpoint. Additionally, HRQoL assessments are essential in the clinical decision-making process. The aim of this study to cross-culturally adapt the International Osteoporosis Foundation Quality of Life Questionnaire (IOF QLQ) for patients with a DRF to Polish. METHODS A standard forward-backward translation procedure and pilot-testing were used to prepare the Polish version of the IOF QLQ for use in this case-control study. Patients were eligible if they were between 18-80 years and were within 1-3 days after a non-comminuted DRF. The study group was gender and aged matched with healthy controls. All DRF patients filled out the Polish version of the IOF QLQ, the SF-36 and a demographic questionnaire. Assessment points were set as soon as possible after the fracture, 7 days, 6 weeks, 3, 6, 12, and 18 months after the fracture. Standard validity and reliability analyses were performed. RESULTS Ninety-seven patients (73 women - 75.3%) with a mean age of 62.4 ± 7.1 years agreed to take part in the study. The control group consisted of 81 patients (60 women - 74.1%) with a mean age 63.9 ± 8.2 years. No significant differences were found between the mean age of patients and controls (p = 0.19). Cronbach's alpha coefficients showed positive internal consistency (0.79-0.89). The interclass correlations for the IOF QLQ domains and the overall score ranged from 0.85 to 0.92. Satisfactory convergent and discriminant validity of the IOF QLQ was seen. CONCLUSIONS The Polish version of the IOF QLQ for patients with a DRF is a reliable and valid tool for measuring HRQoL. It can be fully recommended for use in clinical settings in the Polish population. When combined with the SF-36 the IOF QLQ allows to obtain a comprehensive HRQoL assessment in patients with a DRF.
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Affiliation(s)
- Krzysztof A Tomaszewski
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland.
- Department of Orthopaedics and Trauma Surgery, 5th Military Hospital, Krakow, Poland.
| | - Brandon Michael Henry
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
| | - Jan Paradowski
- Department of Orthopaedics and Trauma Surgery, 5th Military Hospital, Krakow, Poland
| | - Michał Kłosiński
- Department of Anatomy, Jagiellonian University Medical College, 12 Kopernika St, 31-034, Krakow, Poland
- Department of Traumatology and Neuroorthopaedics, Rydygier Specialistic Hospital, Krakow, Poland
| | - Ewa Walocha
- Department of Clinical Nursing, Institute of Nursing, Jagiellonian University Medical College, Krakow, Poland
| | - Joanna Golec
- Department of Orthopaedics and Trauma Surgery, 5th Military Hospital, Krakow, Poland
| | - Ewa Kucharska
- Center for Medical Postgraduate Education, Jagiellonian University Medical College, Krakow, Poland
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Van der Woude DAA, Pijnenborg JMA, de Vries J. Health status and quality of life in postpartum women: a systematic review of associated factors. Eur J Obstet Gynecol Reprod Biol 2014; 185:45-52. [PMID: 25522118 DOI: 10.1016/j.ejogrb.2014.11.041] [Citation(s) in RCA: 50] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2014] [Accepted: 11/27/2014] [Indexed: 01/13/2023]
Abstract
Since health care is becoming more and more patient centered, patient-reported outcomes such as quality of life (QOL) and health status (HS) are becoming increasingly important. The aim of this systematic review was to provide an overview of physical, psychological, and social domains of QOL and HS in postpartum women, and to assess which factors are associated with QOL and HS domains postpartum. A computerized literature search was performed using the PubMed, PsycINFO, and Cochrane databases. Studies were selected if the three domains of QOL or HS were measured in a (sub)group of postpartum women, by using validated standardized questionnaires. The methodological quality of the 66 included studies was examined by two independent reviewers. All three domains of QOL were impaired in postpartum women with urinary incontinence, with even worse QOL in women with mixed urinary incontinence. Mental QOL was impaired in women with urge urinary incontinence after cesarean section. Social QOL was decreased in HIV-positive women. HS was impaired in all three domains in postpartum depressed women. Physical HS was impaired after cesarean section for at least two months postpartum. Additional supportive interventions from health care social support were not associated with improved HS. Urinary incontinence and being HIV-positive seemed to be associated with impaired QOL. Postpartum depression and a cesarean section seemed to be associated with impaired HS. Prospective longitudinal research is needed in order to draw valid conclusions regarding postpartum HS and QOL, and the predictive value of the associated factors.
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Affiliation(s)
- Daisy A A Van der Woude
- CoRPS, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Gynecology and Obstetrics, Maastricht University Medical Center, Maastricht, The Netherlands.
| | | | - Jolanda de Vries
- CoRPS, Department of Medical and Clinical Psychology, Tilburg University, Tilburg, The Netherlands; Department of Medical Psychology, St. Elisabeth Hospital, Tilburg, The Netherlands
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Wilson S, Sharp CA, Davie MWJ. Health-related quality of life in women referred for bone density assessment: relationships with bone mineral density, fracture and co-morbidity. Qual Life Res 2014; 24:1235-43. [PMID: 25413779 DOI: 10.1007/s11136-014-0851-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/03/2014] [Indexed: 11/28/2022]
Abstract
PURPOSE To identify variables that might influence health-related quality of life (HRQoL) in patients with and without a history of fracture, attending bone mineral density (BMD) assessment prior to diagnosis of osteoporosis. METHODS This cross-sectional study included 312 newly referred postmenopausal women attending for a DXA scan, without a diagnosis of osteoporosis. Data were obtained from the medical history and the General Practitioner's letter. HRQoL, using SF36 was scored using published algorithms with reference to an age-related population from England. Regression analyses were used to determine relationships between HRQoL and BMD, age, fracture status and co-morbidities. RESULTS For all patients, the age-related physical component summary (PCS) and mental component summary (MCS) scores were 46 ± 10 and 47 ± 10, respectively. Controlling for confounding variables, low BMD at the femoral neck was associated with worse PCS scores (p = 0.010) and MCS scores (p = 0.034) in patients without fracture. In patients with a history of fracture, this relationship was less evident, and younger age (p < 0.00), increasing BMI (p = 0.016) and number of co-morbidities (p = 0.042) were associated with reductions in PCS scores. CONCLUSIONS Patients referred for BMD assessment before a diagnosis of osteoporosis had reduced PCS scores. In patients without fracture, low BMD contributed to this reduction in health-related quality of life. Low PCS scores in patients with fracture were seen only in younger subjects with osteoporosis.
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Affiliation(s)
- Sally Wilson
- School of Sport Health and Exercise Sciences, Bangor University, George Building, Holyhead Road, Bangor, Gwynedd, LL57 2PZ, UK,
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de Putter CE, Selles RW, Haagsma JA, Polinder S, Panneman MJM, Hovius SER, Burdorf A, van Beeck EF. Health-related quality of life after upper extremity injuries and predictors for suboptimal outcome. Injury 2014; 45:1752-8. [PMID: 25150751 DOI: 10.1016/j.injury.2014.07.016] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/14/2014] [Revised: 07/12/2014] [Accepted: 07/17/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE The purpose of this study was to examine the impact of upper extremity injuries (UEIs) on health-related quality of life (HRQoL) in adult patients compared with victims of other types of injuries and with the general population, in order to establish recovery patterns of different types of UEIs and determine predictors for suboptimal outcome in the long term. METHODS Data were obtained from the Dutch Injury Surveillance System, from the National Hospital Discharge Registry, and from a patient follow-up survey. A total of 608 patients (aged ≥18 years) with an UEI were included. The main outcome measure was HRQoL measured at 2.5, 5, 9 and 24 months after UEI according to the EuroQol-5D (EQ-5D). The predictors for the suboptimal outcome were examined by multivariate linear regression analyses. RESULTS For non-hospitalized UEI patients, a substantial loss in HRQoL was observed after 2.5 months which improved to the level of the general population norms by 24 months. For hospitalized UEI patients, HRQoL improved from 2.5 to 24 months but remained far below population norms. The more proximal UEI had a lower HRQoL and a slower recovery of HRQoL than distal injuries. At all time points, the proportion of UEI patients with limitations on the health domains self-care, usual activities and complaints of pain and/or discomfort was higher than in the group of all injuries. Female gender, higher age, low educational level, co-morbidity, shoulder or upper arm injury, multiple injuries and hospitalization are independent predictors for long-term loss in HRQoL. CONCLUSIONS The impact of UEI exceeds the health consequences of the group with all injuries, for both non-hospitalized and hospitalized patients. The presence of UEI substantially reduces HRQoL in the short and long term, mainly due to limitations on the health domains self-care, usual activities and complaints of pain and/or discomfort. CLINICAL RELEVANCE The impact of UEIs on HRQoL exceeds the health consequences of the group with all injuries. Proximal UEIs had a lower HRQoL and slower recovery than distal injuries. The predictors for the outcome on specific UEIs need to be further investigated in clinical studies, to understand how these differences affect patient-reported outcome measures. These data provide additional insight into treatment outcome and are needed to improve quality of care.
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Affiliation(s)
- C E de Putter
- Department of Plastic-, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.
| | - R W Selles
- Department of Plastic-, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands; Department of Rehabilitation Medicine and Physical Therapy, Erasmus MC, Rotterdam, The Netherlands.
| | - J A Haagsma
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
| | - S Polinder
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
| | - M J M Panneman
- Consumer and Safety Institute, Amsterdam, The Netherlands.
| | - S E R Hovius
- Department of Plastic-, Reconstructive and Hand Surgery, Erasmus MC, Rotterdam, The Netherlands.
| | - A Burdorf
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
| | - E F van Beeck
- Department of Public Health, Erasmus MC, Rotterdam, The Netherlands.
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Roh YH, Lee BK, Noh JH, Oh JH, Gong HS, Baek GH. Factors delaying recovery after volar plate fixation of distal radius fractures. J Hand Surg Am 2014; 39:1465-70. [PMID: 24908556 DOI: 10.1016/j.jhsa.2014.04.033] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2014] [Revised: 04/15/2014] [Accepted: 04/15/2014] [Indexed: 02/02/2023]
Abstract
PURPOSE To evaluate the factors influencing delayed functional recovery in patients with a distal radius fracture treated by volar plate fixation. METHODS A total of 122 patients with a distal radius fracture treated by volar locking plate were enrolled. The wrist range of motion, grip strength, and functional outcome by the Michigan hand score were assessed 3, 6, and 12 months after surgery. The factors assessed for their influence on delayed functional recovery include age, sex, bone mineral density (BMD), hand dominance, the type of fracture, the energy of trauma, the time to surgery, and the duration of immobilization. A multivariate regression analysis was conducted to identify independent predictors of delayed functional recovery in terms of the Michigan hand score. RESULTS There was a significant decrease in the wrist range of motion in patients with a high-energy trauma, severe type fracture, or increase in duration of immobilization at month 3, whereas only a severe fracture type was associated with a decreased range of motion after 6 and 12 months. An increase in age, a decrease in BMD, and high-energy trauma reduced grip strength at months 3 and 6, whereas only an increase in age and a decrease in BMD reduced grip strength at month 12. According to the multivariate regression analysis, severe type fracture and high-energy trauma reduced functional outcomes at months 3 and 6. Conversely, at month 12, an increase in age and a decrease in BMD reduced functional outcome. CONCLUSIONS An increase in age and a decrease in BMD were important risk factors influencing delayed functional recovery up to 12 months after distal radius fracture surgery, whereas fracture severity and high-energy trauma were associated with decreased functional outcomes up to 6 months after surgery. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Young Hak Roh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Beom Koo Lee
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Jung Ho Noh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea.
| | - Joo Han Oh
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Hyun Sik Gong
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
| | - Goo Hyun Baek
- Department of Orthopaedic Surgery, Gil Medical Center, Gachon University of Medicine, Incheon, South Korea; Department of Orthopaedic Surgery, Kangwon National University Hospital, Gangwon-do, South Korea; Department of Orthopaedic Surgery, Seoul National University College of Medicine, Seoul, South Korea
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Ruckenstuhl P, Bernhardt GA, Sadoghi P, Glehr M, Holzer LA, Leithner A, Wolf M, Gruber G. Quality of life after volar locked plating: a 10-year follow-up study of patients with intra-articular distal radius fractures. BMC Musculoskelet Disord 2014; 15:250. [PMID: 25059690 PMCID: PMC4113487 DOI: 10.1186/1471-2474-15-250] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/25/2014] [Accepted: 07/18/2014] [Indexed: 12/21/2022] Open
Abstract
Background This study aimed to present functional results and patient’s health related quality of life (HRQOL) data ten years after volar locked plate fixation (VPF) of unstable intra-articular distal radial fractures (DRF). Methods Thirty-nine patients with a mean age of sixty-one years were operatively treated with VPF after intra-articular distal radial fractures. They were evaluated two, six, and ten years postoperatively according to the Gartland and Werley score. For subjective evaluation the Short Form 36 (SF-36) and the Disability of Arm, Shoulder and Hand (DASH) questionnaires were adopted. Results Overall, wrist function did not differ significantly two, six and ten years after the operation. Over 90% patients achieved “good” or “excellent” results ten years after surgery according to the Gartland and Werley score. Ten years postoperatively the results of the SF 36 did not differ significantly from the two- and six-year follow-up. Overall findings from the SF-36 did not differ significantly from the data of Austrian and American norm populations. Only in the subscale of mental health (MH) the ten-year follow-up did show significantly poorer results (p = 0.045) compared to the Austrian norm population. The median DASH scores did not show significant differences during the ten-year follow-up period. Conclusion The ten-year results of this single-center study suggest that operative treatment of intra-articular DRF with volar locked plates is a useful and satisfactory therapy option, both in terms of function and HRQOL.
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Affiliation(s)
| | | | | | - Mathias Glehr
- Department of Orthopedic Surgery, Medical University of Graz, Auenbruggerplatz 5-7, Graz 8036, Austria.
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