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Rezansoff A, Firth AD, Bryant DM, Litchfield R, McCormack RG, Heard M, MacDonald PB, Spalding T, Verdonk PCM, Peterson D, Bardana D, Getgood AMJ. Anterior Cruciate Ligament Reconstruction Plus Lateral Extra-articular Tenodesis Has a Similar Return-to-Sport Rate to Anterior Cruciate Ligament Reconstruction Alone but a Lower Failure Rate. Arthroscopy 2024; 40:384-396.e1. [PMID: 37270112 DOI: 10.1016/j.arthro.2023.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/13/2022] [Revised: 03/02/2023] [Accepted: 05/17/2023] [Indexed: 06/05/2023]
Abstract
PURPOSE To determine whether the addition of lateral extra-articular tenodesis (LET) to anterior cruciate ligament reconstruction (ACLR) would improve return-to-sport (RTS) rates in young, active patients who play high-risk sports. METHODS This multicenter randomized controlled trial compared standard hamstring tendon ACLR with combined ACLR and LET using a strip of the iliotibial band (modified Lemaire technique). Patients aged 25 years or younger with an anterior cruciate ligament-deficient knee were included. Patients also had to meet 2 of the following criteria: (1) pivot-shift grade 2 or greater, (2) participation in a high-risk or pivoting sport, and (3) generalized ligamentous laxity. Time to return and level of RTS were determined via administration of a questionnaire at 24 months postoperatively. RESULTS We randomized 618 patients in this study, 553 of whom played high-risk sports preoperatively. The proportion of patients who did not RTS was similar between the ACLR (11%) and ACLR-LET (14%) groups; however, the graft rupture rate was significantly different (11.2% in ACLR group vs 4.1% in ACLR-LET group, P = .004). The most cited reason for no RTS was lack of confidence and/or fear of reinjury. A stable knee was associated with nearly 2 times greater odds of returning to a high-level high-risk sport postoperatively (odds ratio, 1.92; 95% confidence interval, 1.11-3.35; P = .02). There were no significant differences in patient-reported functional outcomes or hop test results between groups (P > .05). Patients who returned to high-risk sports had better hamstring symmetry than those who did not RTS (P = .001). CONCLUSIONS At 24 months postoperatively, patients who underwent ACLR plus LET had a similar RTS rate to those who underwent ACLR alone. Although the subgroup analysis did not show a statistically significant increase in RTS with the addition of LET, on returning, the addition of LET kept subjects playing longer by reducing graft failure rates. LEVEL OF EVIDENCE Level I, randomized controlled trial.
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Affiliation(s)
- Alex Rezansoff
- University of Calgary Sport Medicine Centre, Calgary, Canada
| | - Andrew D Firth
- Health and Rehabilitation Sciences, Faculty of Health Sciences, Western University, London, Canada
| | - Dianne M Bryant
- Fowler Kennedy Sport Medicine Clinic, London, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada; School of Physical Therapy, Western University, London, Canada
| | - Robert Litchfield
- Fowler Kennedy Sport Medicine Clinic, London, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada
| | - Robert G McCormack
- Department of Orthopedics, University of British Columbia, Vancouver, Canada; New West Orthopaedic & Sports Medicine Centre, New Westminster, Canada
| | - Mark Heard
- Department of Surgery, University of Calgary, Calgary, Canada; Banff Sport Medicine, Banff, Canada
| | - Peter B MacDonald
- Department of Surgery, University of Manitoba, Winnipeg, Canada; Pan Am Clinic, Winnipeg, Canada
| | - Tim Spalding
- University Hospitals Coventry and Warwickshire National Health Service Trust, Coventry, England
| | - Peter C M Verdonk
- Department of Physical Medicine and Orthopedics, Ghent University, Ghent, Belgium; Antwerp Orthopedic Center, Antwerp, Belgium
| | - Devin Peterson
- Department of Surgery, Queen's University, Kingston, Canada
| | - Davide Bardana
- Department of Surgery, McMaster University, Hamilton, Canada; Department of Surgery, Queen's University, Kingston, Canada
| | - Alan M J Getgood
- Fowler Kennedy Sport Medicine Clinic, London, Canada; Department of Surgery, Schulich School of Medicine and Dentistry, Western University, London, Canada.
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Schwartz CE, Rohde G, Biletch E, Stuart RBB, Huang IC, Lipscomb J, Stark RB, Skolasky RL. If it's information, it's not "bias": a scoping review and proposed nomenclature for future response-shift research. Qual Life Res 2021; 31:2247-2257. [PMID: 34705159 DOI: 10.1007/s11136-021-03023-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/15/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The growth in response-shift methods has enabled a stronger empirical foundation to investigate response-shift phenomena in quality-of-life (QOL) research; but many of these methods utilize certain language in framing the research question(s) and interpreting results that treats response-shift effects as "bias," "noise," "nuisance," or otherwise warranting removal from the results rather than as information that matters. The present project will describe the various ways in which researchers have framed the questions for investigating response-shift issues and interpreted the findings, and will develop a nomenclature for such that highlights the important information about resilience reflected by response-shift findings. METHODS A scoping review was done of the QOL and response-shift literature (n = 1100 articles) from 1963 to 2020. After culling only empirical response-shift articles, raters characterized how investigators framed and interpreted study research questions (n = 164 articles). RESULTS Of 10 methods used, papers using four of them utilized terms like "bias" and aimed to remove response-shift effects to reveal "true change." Yet, the investigators' reflections on their own conclusions suggested that they do not truly believe that response shift is error to be removed. A structured nomenclature is proposed for discussing response-shift results in a range of research contexts and response-shift detection methods. CONCLUSIONS It is time for a concerted and focused effort to change the nomenclature of those methods that demonstrated this misinterpretation. Only by framing and interpreting response shift as information, not bias, can we improve our understanding and methods to help to distill outcomes with and without response-shift effects.
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Affiliation(s)
- Carolyn E Schwartz
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA. .,Departments of Medicine and Orthopaedic Surgery, Tufts University Medical School, Boston, MA, USA.
| | - Gudrun Rohde
- Department of Clincal Research Sorlandet Hospital, Faculty of Health and Sport Sciences at University of Agder, Kristiansand, Norway
| | - Elijah Biletch
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA
| | | | - I-Chan Huang
- Department of Epidemiology and Cancer Control, St. Jude Children's Research Hospital, Memphis, TN, USA
| | - Joseph Lipscomb
- Department of Health Policy and Management, Rollins School of Public Health, and the Winship Cancer Institute, Emory University, Atlanta, GA, USA
| | - Roland B Stark
- DeltaQuest Foundation, Inc., 31 Mitchell Road, Concord, MA, 01742, USA
| | - Richard L Skolasky
- Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Investigation of measurement invariance in longitudinal health-related quality of life in preemptive or previously dialyzed kidney transplant recipients. Qual Life Res 2021; 31:607-620. [PMID: 34173173 DOI: 10.1007/s11136-021-02916-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/14/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE Kidney transplantation (KT) can impact patients' evaluation of health-related quality of life (HRQoL) as they adapt to their new life with a graft and its changes. Patients may adapt to KT in a different way, depending on whether they were on dialysis prior to transplantation or not (i.e. preemptive group). This may result in lack of measurement invariance between these patients' groups and/or over time (i.e. response shift, RS) which may invalidate the between-group comparison of HRQoL change scores. The aim of this study was to investigate and compare RS before and after KT between these two patients' groups. Measurement invariance was investigated between groups and over time with three measurement occasions. METHODS Adult patients completed the SF-36 at the last visit before KT, and 3, 6 months after. A structural equation model-based procedure was used to (i) detect and take into account measurement non-invariance between groups and RS, if appropriate, (ii) identify the period of occurrence of RS, (iii) study the heterogeneity of RS between the two groups. RESULTS Before KT (i.e. baseline), measurement invariance was not rejected between dialyzed (n = 196) and preemptive (n = 178) patients' groups. Between baseline and 3 months after KT, similar uniform recalibration was detected on the general health domain in both groups. Uniform recalibration was found between 3- and 6 months after KT on the vitality domain for preemptive patients only. CONCLUSION HRQoL, adjusted for RS, increased overall for preemptive and dialyzed kidney transplant patients after transplantation. RS may reflect differing adaptation processes following KT.
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Vanier A, Sébille V, Blanchin M, Hardouin JB. The minimal perceived change: a formal model of the responder definition according to the patient's meaning of change for patient-reported outcome data analysis and interpretation. BMC Med Res Methodol 2021; 21:128. [PMID: 34154521 PMCID: PMC8215756 DOI: 10.1186/s12874-021-01307-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Accepted: 05/06/2021] [Indexed: 12/02/2022] Open
Abstract
Background Patient-Reported Outcomes (PROs) are standardized questionnaires used to measure subjective outcomes such as quality of life in healthcare. They are considered paramount to assess the results of therapeutic interventions. However, because their calibration is relative to internal standards in people’s mind, changes in PRO scores are difficult to interpret. Knowing the smallest value in the score that the patient perceives as change can help. An estimator linking the answers to a Patient Global Rating of Change (PGRC: a question measuring the overall feeling of change) with change in PRO scores is frequently used to obtain this value. In the last 30 years, a plethora of methods have been used to obtain these estimates, but there is no consensus on the appropriate method and no formal definition of this value. Methods We propose a model to explain changes in PRO scores and PGRC answers. Results A PGRC measures a construct called the Perceived Change (PC), whose determinants are elicited. Answering a PGRC requires discretizing a continuous PC into a category using threshold values that are random variables. Therefore, the populational value of the Minimal Perceived Change (MPC) is the location parameter value of the threshold on the PC continuum defining the switch from the absence of change to change. Conclusions We show how this model can help to hypothesize what are the appropriate methods to estimate the MPC and its potential to be a rigorous theoretical basis for future work on the interpretation of change in PRO scores.
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Affiliation(s)
- Antoine Vanier
- Inserm-University of Tours-University of Nantes, UMR U1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", 37000, Tours, France. .,Inserm-University Hospital of Tours, CIC 1415, Unit of Methodology-Biostatistics Data Management, 2, Boulevard Tonnellé, 37000, Tours, France.
| | - Véronique Sébille
- Inserm-University of Tours-University of Nantes, UMR U1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", 37000, Tours, France.,University Hospital of Nantes, Unit of Methodology and Biostatistics, 44000, Nantes, France
| | - Myriam Blanchin
- Inserm-University of Tours-University of Nantes, UMR U1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", 37000, Tours, France
| | - Jean-Benoit Hardouin
- Inserm-University of Tours-University of Nantes, UMR U1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", 37000, Tours, France.,University Hospital of Nantes, Unit of Methodology and Biostatistics, 44000, Nantes, France
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Vanier A, Oort FJ, McClimans L, Ow N, Gulek BG, Böhnke JR, Sprangers M, Sébille V, Mayo N. Response shift in patient-reported outcomes: definition, theory, and a revised model. Qual Life Res 2021; 30:3309-3322. [PMID: 33909187 PMCID: PMC8602159 DOI: 10.1007/s11136-021-02846-w] [Citation(s) in RCA: 32] [Impact Index Per Article: 10.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/12/2021] [Indexed: 11/24/2022]
Abstract
Purpose The extant response shift definitions and theoretical response shift models, while helpful, also introduce predicaments and theoretical debates continue. To address these predicaments and stimulate empirical research, we propose a more specific formal definition of response shift and a revised theoretical model. Methods This work is an international collaborative effort and involved a critical assessment of the literature. Results Three main predicaments were identified. First, the formal definitions of response shift need further specification and clarification. Second, previous models were focused on explaining change in the construct intended to be measured rather than explaining the construct at multiple time points and neglected the importance of using at least two time points to investigate response shift. Third, extant models do not explicitly distinguish the measure from the construct. Here we define response shift as an effect occurring whenever observed change (e.g., change in patient-reported outcome measures (PROM) scores) is not fully explained by target change (i.e., change in the construct intended to be measured). The revised model distinguishes the measure (e.g., PROM) from the underlying target construct (e.g., quality of life) at two time points. The major plausible paths are delineated, and the underlying assumptions of this model are explicated. Conclusion It is our hope that this refined definition and model are useful in the further development of response shift theory. The model with its explicit list of assumptions and hypothesized relationships lends itself for critical, empirical examination. Future studies are needed to empirically test the assumptions and hypothesized relationships. Supplementary Information The online version contains supplementary material available at 10.1007/s11136-021-02846-w.
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Affiliation(s)
- Antoine Vanier
- Inserm - University of Nantes - University of Tours, UMR 1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", Nantes, France. .,University Hospital of Tours - Inserm, CIC 1415, Unit of Methodology Biostatistics and Data-Management, Tours, France. .,Inserm U1246 Sphere, Institut de Recherche en Santé 2 - Université de Nantes, 22, Boulevard Bénoni-Goullin, 44200, Nantes, France.
| | - Frans J Oort
- University of Amsterdam, Research Institute of Child Development and Education, Amsterdam, The Netherlands
| | - Leah McClimans
- Department of Philosophy, University of South Carolina, Columbia, SC, USA
| | - Nikki Ow
- Center for Outcomes Research and Evaluation, McGill University, Montreal, Canada
| | - Bernice G Gulek
- Harborview Medical Center, University of Washington, Seattle, WA, USA.,College of Nursing, Washington State University, Spokane, WA, USA
| | - Jan R Böhnke
- School of Health Sciences, University of Dundee, Dundee, UK
| | - Mirjam Sprangers
- Department of Medical Psychology, Location AMC, Research Institute Amsterdam Public Health, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Véronique Sébille
- Inserm - University of Nantes - University of Tours, UMR 1246 Sphere "Methods in Patient-Centered Outcomes and Health Research", Nantes, France.,Unit of Methodology in Clinical Research and Biostatistics, University Hospital of Nantes, Nantes, France
| | - Nancy Mayo
- Center for Outcomes Research and Evaluation, McGill University, Montreal, Canada.,Division of Clinical Epidemiology, Department of Medicine, McGill University Health Centre Research Institute, Montreal, Canada
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Carlier IVE, van Eeden WA, de Jong K, Giltay EJ, van Noorden MS, van der Feltz-Cornelis C, Zitman FG, Kelderman H, van Hemert AM. Testing for response shift in treatment evaluation of change in self-reported psychopathology amongst secondary psychiatric care outpatients. Int J Methods Psychiatr Res 2019; 28:e1785. [PMID: 31206911 PMCID: PMC6852603 DOI: 10.1002/mpr.1785] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Revised: 03/18/2019] [Accepted: 04/01/2019] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVES If patients change their perspective due to treatment, this may alter the way they conceptualize, prioritize, or calibrate questionnaire items. These psychological changes, also called "response shifts," may pose a threat to the measurement of therapeutic change in patients. Therefore, it is important to test the occurrence of response shift in patients across their treatment. METHODS This study focused on self-reported psychological distress/psychopathology in a naturalistic sample of 206 psychiatric outpatients. Longitudinal measurement invariance tests were computed across treatment in order to detect response shifts. RESULTS Compared with before treatment, post-treatment psychopathology scores showed an increase in model fit and factor loading, suggesting that symptoms became more coherently interrelated within their psychopathology domains. Reconceptualization (depression/mood) and reprioritization (somatic and cognitive problems) response shift types were found in several items. We found no recalibration response shift. CONCLUSION This study provides further evidence that response shift can occur in adult psychiatric patients across their mental health treatment. Future research is needed to determine whether response shift implies an unwanted potential bias in treatment evaluation or a desired cognitive change intended by treatment.
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Affiliation(s)
- Ingrid V E Carlier
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Wessel A van Eeden
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Kim de Jong
- Clinical Psychology Unit, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Erik J Giltay
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | | | | | - Frans G Zitman
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
| | - Henk Kelderman
- Department of Methodology and Statistics, Institute of Psychology, Leiden University, Leiden, The Netherlands
| | - Albert M van Hemert
- Department of Psychiatry, Leiden University Medical Centre, Leiden, The Netherlands
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Montreal Accord on Patient-Reported Outcomes (PROs) use series - Paper 2: terminology proposed to measure what matters in health. J Clin Epidemiol 2017; 89:119-124. [PMID: 28433673 DOI: 10.1016/j.jclinepi.2017.04.013] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2015] [Revised: 03/15/2017] [Accepted: 04/09/2017] [Indexed: 12/26/2022]
Abstract
BACKGROUND We outline different health outcomes and describe how multiple perspectives can be harnessed to optimize accuracy of key data collected about patients with chronic conditions. The terms health status, health-related quality of life, and quality of life are often used interchangeably without recognizing that they have different meanings, as are the terms used to refer to the different components of function. Although the advantages and limitations of existing frameworks and perspectives are largely understood, greater precision is needed when using health outcome terminology and identifying optimal sources of information. OBJECTIVE A refinement of the current taxonomy is proposed to distinguish between patient-reported outcomes and self-report outcomes and expand the concept of clinically reported outcomes to include those assessed by performance and emerging technologies. DISCUSSION Health outcomes yield important information that can be used to improve the lives of many people. Now is the time to "talk the talk" as part of larger coordinated efforts within and across countries to identify and measure what matters most in health.
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