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Nian PP, Gordon AM, Baidya J, Miller C, Choueka J. Preoperative Depression Screening in Patients with Distal Radius Fractures: An Evaluation of Its Modifiability on Outcomes for Patients with Depressive Disorder. J Wrist Surg 2024; 13:432-438. [PMID: 39296656 PMCID: PMC11407845 DOI: 10.1055/s-0043-1771340] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Accepted: 06/28/2023] [Indexed: 09/21/2024]
Abstract
Background It is unclear whether nonpharmacologic intervention for depressive disorder (DD) in the preoperative period can prevent postoperative complications in hand surgery patients. Questions/Purpose The aims were to evaluate whether psychotherapy visits/depression screenings within 90 days of open reduction and internal fixation (ORIF) for distal radius fractures (DRFs) were associated with lower rates of (1) medical complications and (2) health care utilization (emergency department [ED] visits and readmissions). Methods A retrospective analysis of an administrative claims database from 2010 to 2021 was performed. DD patients who underwent ORIF for DRF were 1:5 propensity score matched by comorbidities, including those who did ( n = 8,993) and did not ( n = 44,503) attend a psychotherapy visit/depression screening 90 days before surgery. Multivariate logistic regression models were constructed to compare the odds ratio (OR) of medical complications, ED visits, and readmissions within 90 days. The p -values less than 0.001 were significant. Results DD patients who did not attend a preoperative psychotherapy visit/depression screening experienced fivefold higher odds of total medical complications (25.66 vs. 5.27%; OR: 5.25, p < 0.0001), including surgical site infections (1.23 vs. 0.14%; OR: 8.71, p < 0.0001), deep wound infections (0.98 vs. 0.17%; OR: 6.00, p < 0.0001), and transfusions (1.64 vs. 0.22%; OR: 7.61, p < 0.0001). Those who did not attend a psychotherapy visit/depression screening experienced higher odds of ED utilizations (9.71 vs. 2.71%; OR: 3.87, p < 0.0001), however, no difference in readmissions (3.40 vs. 3.54%; OR: 0.96, p = 0.569). Conclusion Depression screening may be a helpful preoperative intervention to optimize patients with DD undergoing hand surgery to minimize postoperative complications and health care utilization. Level of Evidence Level III.
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Affiliation(s)
- Patrick P Nian
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Adam M Gordon
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
- Questrom School of Business, Boston University, Boston, Massachusetts
| | - Joydeep Baidya
- College of Medicine, SUNY Downstate Health Sciences University, Brooklyn, New York
| | - Chaim Miller
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
| | - Jack Choueka
- Department of Orthopaedic Surgery, Maimonides Medical Center, Brooklyn, New York
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Broekman M, Brinkman N, Davids F, van den Bekerom M, Ring D, Doornberg J, Ramtin S, Jayakumar P. Surgeon Prioritization of Mental, Social, and Pathophysiological Aspects of Health Among People With Traumatic and Nontraumatic Musculoskeletal Conditions. J Am Acad Orthop Surg 2024; 32:e869-e879. [PMID: 38810227 DOI: 10.5435/jaaos-d-23-00962] [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: 10/16/2023] [Accepted: 04/15/2024] [Indexed: 05/31/2024] Open
Abstract
BACKGROUND There is mounting evidence that, among musculoskeletal patients, variation in capability has more notable associations with variations in mental and social health factors than with variation in pathophysiology severity. This study sought factors that could limit the integration of this evidence into more comprehensive care models. METHODS In two scenario-based experiments, surgeon participants in an international collaborative, the Science of Variation Group, reviewed scenarios of (a) nontraumatic (83 participants) and (b) trauma-related (130 participants) pathophysiologies for which tests and treatments were discretionary. The following demographic, mental, and social health elements were varied randomly: sex, age, race/ethnicity, mindsets, social health aspects, and specific pathophysiologies. For each scenario, participants rated their likelihood to offer surgery (continuous) and their sense of presence of an opportunity to address better mental or social health in treatment (yes or no). Factors associated with each rating were sought in multivariable analysis. RESULTS Greater likelihood to offer discretionary surgery for nontraumatic pathophysiologies was associated with greater pathophysiology severity, trapeziometacarpal arthritis, and greater distress and unhelpful thoughts regarding symptoms. Lateral elbow enthesopathy was associated with a lower likelihood. For trauma-related pathophysiologies, an ankle fracture with slight articular subluxation was associated with greater likelihood to offer surgery, and several other trauma-related pathophysiologies were associated with a lower likelihood. For both nontraumatic and trauma-related pathophysiologies, surgeons noticed unhelpful thinking, distress, and social issues as reasons to consider addressing mental and social health in treatment, relatively independent of pathophysiology. CONCLUSION Surgeons seem to recognize opportunities to address mental and social needs but ultimately base their decision to offer discretionary surgery on pathophysiological factors. CLINICAL RELEVANCE Comprehensive, whole-person care for musculoskeletal illness might be supported by strategies for ensuring that aspects of stress and distress that contribute to greater symptom intensity are not misinterpreted as a reflection of greater pathophysiology severity.
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Affiliation(s)
- Melle Broekman
- From the Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX (Broekman, Brinkman, Davids, Ring, Ramtin, and Jayakumar), Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, the Netherlands (Broekman and van den Bekerom), the Department of Orthopaedic Trauma Surgery, Universitair Medisch Centrum Groningen, Groningen, the Netherlands (Doornberg)
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Suojärvi N, Waris E. Radiographic measurements in distal radius fracture evaluation: a review of current techniques and a recommendation for standardization. Acta Radiol 2024; 65:1065-1079. [PMID: 39043232 DOI: 10.1177/02841851241266369] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/25/2024]
Abstract
Radiographic measurements play a crucial role in evaluating the alignment of distal radius fractures (DRFs). Various manual methods have been used to perform the measurements, but they are susceptible to inaccuracies. Recently, computer-aided methods have become available. This review explores the methods commonly used to assess DRFs. The review introduces the different measurement techniques, discusses the sources of measurement errors and measurement reliability, and provides a recommendation for their use. Radiographic measurements used in the evaluation of DRFs are not reliable. Standardizing the measurement techniques is crucial to address this and automated image analysis could help improve accuracy and reliability.
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Affiliation(s)
- Nora Suojärvi
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
| | - Eero Waris
- Department of Hand Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland
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Mehta SP, Karagiannopoulos C, Pepin ME, Ballantyne BT, Michlovitz S, MacDermid JC, Grewal R, Martin RL. Distal Radius Fracture Rehabilitation. J Orthop Sports Phys Ther 2024; 54:CPG1-CPG78. [PMID: 39213418 DOI: 10.2519/jospt.2024.0301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/04/2024]
Abstract
Distal radius fracture (DRF) is arguably the most common upper extremity fracture resulting from a fall accident. These clinical practice guidelines (CPG) were developed to guide all aspects of the management of DRF by physical therapists and other rehabilitation practitioners, such as certified hand therapists. This CPG employed a systematic review methodology to locate, appraise, and synthesize contemporary evidence while developing practice recommendations for determining the prognosis of outcomes, examination, and interventions while managing individuals with DRF. The quality of the primary studies found in the literature search was appraised using standardized tools. The strength of the available evidence for a particular practice domain (e.g., prognosis or intervention) was graded as strong, moderate, weak, or conflicting, where such gradings guided the level of obligation for each practice recommendation. Lastly, the CPG also provided the gaps in the evidence pool for the rehabilitation of DRF that future research efforts can address. J Orthop Sports Phys Ther 2024;54(9):CPG1-CPG78. doi:10.2519/jospt.2024.0301.
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Broekman MM, Verweij LPE, Doornberg JN, Floor S, Ring D, van den Bekerom MPJ. Determinants of pain intensity and magnitude of incapability more than two years after arthroscopic Bankart repair for anterior shoulder instability. JSES Int 2024; 8:941-945. [PMID: 39280142 PMCID: PMC11401566 DOI: 10.1016/j.jseint.2024.05.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/18/2024] Open
Abstract
Background Individuals treated with arthroscopic Bankart repair after anterior shoulder dislocations experience varied discomfort and incapability. The aim of this study was to determine the relative association of mental health and physical health factors with 1) magnitude of capability and 2) pain intensity 2 or more years after surgery. Methods This cross-sectional study evaluated 80 military patients that experienced one or more traumatic anterior shoulder dislocations a minimum of 2 years after arthroscopic Bankart repair without remplissage. We measured capability (Oxford Shoulder Instability Score), pain intensity using an 11-point ordinal scale, symptoms of anxiety (Generalized Anxiety Disorder-2 questionnaire), symptoms of depression (Patient Health Questionnaire-2), catastrophic thinking (Pain Catastrophizing Scale-4), and kinesiophobia (Tampa scale for kinesiophobia-4). We also identified preoperative presence of a Hill-Sachs lesion on radiographs and postoperative occurrence of subluxation or a dislocation episode. A negative binominal regression analysis sought factors associated with magnitude of incapability and pain intensity. Results Greater incapability was strongly associated with both greater kinesiophobia (Regression Coefficient [RC] = -0.50; 95% confidence interval [CI] = -0.73 to -0.26; P ≤ .01) and repeat surgery (RC = -0.27; 95% CI = -0.41 to -0.13; P ≤ .01). Greater pain intensity was only strongly associated with greater kinesiophobia (RC = 0.25; 95% CI = 0.039 to 0.46; P = .021). Conclusion The observation that greater unhelpful thinking is associated with greater pain intensity and greater magnitude of incapability after a Bankart repair for anterior shoulder instability, whereas pathophysiological factors such as glenoid bone loss were not, emphasizes the degree to which mindset is associated with musculoskeletal health.
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Affiliation(s)
- Melle M Broekman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
| | - Lukas P E Verweij
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Amsterdam, The Netherlands
| | - Job N Doornberg
- Department of Orthopedic Trauma Surgery, Universitair Medisch Centrum Groningen, Groningen, The Netherlands
| | - Sebastiaan Floor
- Department of Orthopedic Surgery, Centraal Militair Hospitaal, Utrecht, The Netherlands
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Michel P J van den Bekerom
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, The Netherlands
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Amsterdam, The Netherlands
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Dy CJ, Brogan DM, Lee SK, Desai MJ, Loeffler BJ, Tuffaha SH. The Influence of Psychosocial Factors on Disability and Expected Improvement Before Surgery for Adult Traumatic Brachial Plexus Injury. J Hand Surg Am 2024; 49:729-735. [PMID: 37498270 PMCID: PMC10818022 DOI: 10.1016/j.jhsa.2023.05.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/25/2022] [Revised: 05/11/2023] [Accepted: 05/24/2023] [Indexed: 07/28/2023]
Abstract
PURPOSE Psychosocial factors influence pain and recovery after extremity trauma and may be targets for early intervention. This may be of particular interest for patients with adult traumatic brachial plexus injury (BPI), given the broad and devastating impact of the injury. We hypothesized that there would be an association between depressive symptoms, anxiety, and pain interference with preoperative disability and expectations for improvement after BPI surgery. METHODS We enrolled 34 patients into a prospective multicenter cohort study for those undergoing surgery for adult traumatic BPI. Before surgery, participants completed Patient-Reported Outcome Measurement Information System scales for pain interference, anxiety, and depressive symptoms, and a validated BPI-specific measure of disability and expected improvement. We performed Pearson correlation analysis between pain interference, anxiety symptoms, and depressive symptoms with (A) disability and (B) expected improvement. We created separate linear regression models for (A) disability and (B) expected improvement including adjustment for severity of plexus injury, age, sex, and race. RESULTS Among 34 patients, there was a moderate, statistically significant, correlation between preoperative depressive symptoms and higher disability. This remained significant in a linear regression model adjusted for severity of plexus injury, age, sex, and race. There was no association between severity of plexus injury and disability. Depressive symptoms also were moderately, but significantly, correlated with higher expected improvement. This remained significant in a linear regression model adjusted for severity of plexus injury, age, sex, and race. CONCLUSIONS Depressive symptoms are associated with greater disability and higher expected improvement before BPI surgery. Screening for depressive symptoms can help BPI teams identify patients who would benefit from early referral to mental health specialists and tailor appropriate expectations counseling for functional recovery. We did not find an association between severity of BPI and patient-reported disability, suggesting either that the scale may lack validity or that the sample is biased. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Christopher J Dy
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO.
| | - David M Brogan
- Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO
| | - Steve K Lee
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY
| | - Mihir J Desai
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Sami H Tuffaha
- Department of Plastic and Reconstructive Surgery, Johns Hopkins School of Medicine, Baltimore, MD
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Moos C, Abrahamsen C, Viberg B, Jensen CM. Adult patients' experiences after a distal radius fracture - A qualitative systematic review. Int J Orthop Trauma Nurs 2024; 54:101101. [PMID: 38640647 DOI: 10.1016/j.ijotn.2024.101101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2024] [Revised: 04/01/2024] [Accepted: 04/08/2024] [Indexed: 04/21/2024]
Abstract
BACKGROUND Distal radius fractures are a common presentation in emergency departments. Synthesis of qualitative research of treatment, care and rehabilitation this fracture presents from the patient perspective could improve clinical practice and care. The purpose of this systematic review was to synthesize the qualitative literature on patient experiences after sustaining a distal radius fracture. METHODS We searched Embase, MEDLINE, CINAHL, Psycinfo and CINAHL to identify qualitative studies published from database conception to May 2023. All studies were screened, extracted, analysed and quality assessed by two blinded reviewers. A thematic synthesis approach was used to analyse the findings from included studies. RESULTS A total of 9 studies interviewing 160 unique patients were included. We identified 3 themes in relation to patient experiences after sustaining a distal radius fracture: 1) Concerns about dependency, 2) Fear and pain and 3) Motivators for recovery. The themes did not exist as sharply demarcated topics but were intertwined with patients reflecting that more information and knowledge could assist in managing expectations and the recovery period. CONCLUSION Our synthesis highlighted that adult patients with DRF experience a lack of information about the care and treatment inhibiting independence and successful management of expectations due to pain, fear and lack of motivation. Our findings can inform orthopaedic units and assist in tailoring information to patient needs.
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Affiliation(s)
- Caroline Moos
- Department of Clinical Research, University Hospital of Southern Denmark, Aabenraa, Denmark
| | - Charlotte Abrahamsen
- Department of Orthopaedic Surgery, Kolding Hospital, Denmark; Department of Regional Health Research, University of Southern Denmark, Denmark
| | - Bjarke Viberg
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark
| | - Charlotte Myhre Jensen
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Denmark; Department of Clinical Research, University of Southern Denmark, Denmark.
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Luijten MAJ, Haverman L, Terwee CB, Poeze M, Verbeek DO. Enhancing the Evaluation of Physical Function Following Orthopaedic Trauma Care: Comparison of PROMIS Computerized Adaptive Testing and Short Musculoskeletal Function Assessment. J Orthop Trauma 2024; 38:390-396. [PMID: 38837210 DOI: 10.1097/bot.0000000000002814] [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] [Accepted: 04/01/2024] [Indexed: 06/07/2024]
Abstract
OBJECTIVES To compare measurement properties of Patient-Reported Outcomes Measurement Information System (PROMIS) (physical function [PF] and pain interference [PI]) computerized adaptive testing to traditional Short Musculoskeletal Function Assessment (SMFA) (dysfunction index [DI] and bother index [BI]). To explore factors associated with PROMIS scores. METHODS DESIGN Cross-sectional study. SETTING Level I Trauma Center. PATIENT SELECTION CRITERIA Isolated upper/lower extremity fracture patients were recruited from the orthopaedic trauma outpatient clinic (October 1, 2021 to January 1, 2023). OUTCOME MEASURES Correlations (Pearson), reliability (standard error [SE] [T score]), efficiency (amount of information per item [1 - SE2/Nitems]), and floor/ceiling effects were assessed. An r > 0.7 represented high correlation, and SE ≤ 2.2 represented sufficient reliability. Factors associated with worse PROMIS scores were also identified. RESULTS In total, 202 patients completed PROMs at median 98 days follow-up. Correlations between PROMIS-PF and SMFA-DI, and PROMIS-PI and SMFA-BI were -0.84 and 0.65. Reliability was very high for both instruments (mean SE 2.0 [PROMIS-PF], SE 2.1 [PROMIS-PI], and SE 1.2 [SMFA-DI], SE 1.8 [SMFA-BI]). Relative efficiency for PROMIS-PF versus SMFA-DI, and PROMIS-PI versus SMFA-BI was 7.8 (SD 2.5) and 4.1 (SD 1.7), respectively. Neither PROMIS nor SMFA exhibited floor/ceiling effects. In the multivariable regression analyses, elevated levels of depression, among other factors, showed an (independent) association with worse PROMIS-PF and PROMIS-PI scores. CONCLUSIONS PROMIS-PF and PROMIS-PI CATs showed a (high and moderate) correlation with SMFA and hence measure a comparable construct of physical function and discomfort. As computerized adaptive tests are much more efficient to administer, they present a compelling alternative to SMFA for evaluating impact of fracture treatment. The relation between symptoms of depression and PROMIS scores emphasizes the importance of psychosocial aspects of health in orthopaedic trauma patients. LEVEL OF EVIDENCE Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Michiel A J Luijten
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
| | - Lotte Haverman
- Department of Child and Adolescent Psychiatry and Psychosocial Care, Emma Children's Hospital, Amsterdam UMC Location AMC, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Mental Health and Digital Health Amsterdam, The Netherlands; and
| | - Caroline B Terwee
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Methodology, Amsterdam, The Netherlands
| | - Martijn Poeze
- Department of Surgery, Division of Trauma, Maastricht University Medical Center+, Maastricht, The Netherlands
| | - Diederik O Verbeek
- Department of Surgery, Division of Trauma, Maastricht University Medical Center+, Maastricht, The Netherlands
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Bredy TM, Glasgow C, Liddle J, Colwell S, Holding J, Swan S, Patterson F. Considering occupational performance during recovery of distal radius fracture: A scoping review. Aust Occup Ther J 2024. [PMID: 38803065 DOI: 10.1111/1440-1630.12965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2024] [Revised: 05/05/2024] [Accepted: 05/06/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION Distal radius fracture (DRF) is one of the most common upper extremity fractures treated by hand therapists and can lead to chronic physical impairment and reduced occupational performance. This scoping review aimed to reveal what is currently known about occupational performance following DRF and to explore if and how occupational performance is defined and considered in the research. METHODS This review was guided by the PRISMA-Scoping review and the Joanna Briggs Institute (JBI) guidelines. Relevant databases were searched, and studies that addressed occupation performance in adult participants following DRF were included. The findings were summarised according to the components of occupational performance (person, occupation, and environment), and quality was measured using the Mixed Methods Appraisal Tool. RESULTS Forty-three articles met the eligibility criteria for inclusion. All of the studies discussed at least two components of occupational performance, while 25 recognised all three. The consideration of occupational performance was dominated by biomechanical issues associated with the person component (i.e. range of motion, strength). There was some acknowledgement of the psychosocial aspects of the person and, to a lesser extent, the environment, as well as the impact of both on return to occupational performance. CONCLUSION Despite occupational performance being at the core of occupational therapy theory, its consideration within the context of research on DRF appears to be focussed on the person component of occupational performance and on biomechanical issues. Further research is recommended to determine how much this reflects current clinical practice and if a more comprehensive consideration of occupational performance will improve rates of recovery following DRF. CONSUMER AND COMMUNITY INVOLVEMENT As part of the protocol development for this review, consumers and stakeholders were consulted. They provided feedback on clarity and importance of the research questions. PLAIN LANGUAGE SUMMARY A distal radius fracture happens when you break the bone on the thumb side of your wrist. This type of injury often occurs when you fall and land on an outstretched hand. It is one of the more common injuries that hand therapists see in their practice. For some people, recovering from this fracture can take a long time and come with a lot of pain, difficulty moving, and emotional stress. These problems can make it hard to do everyday things like driving, cooking, or getting dressed. It can also affect both paid and unpaid work as well as leisure and social activities, making life more difficult for everyone involved. The findings from this review suggest that the current research usually focuses on how the body physically heals from this type of injury, but it does not pay as much attention to the emotional and social impact on healing. Also, it does not always discuss the activities that are important to the person, or the environment where they live, work, and socialise. This may show a gap in the research regarding our full comprehension of recovery from distal radius fractures. Taking a broader view and approach to recovery, considering a person's emotions, social life, environment, and daily activities, could help people recover fully and get back to their previous life routines and roles after this type of injury.
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Affiliation(s)
- Terra M Bredy
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Celeste Glasgow
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
- Department of Occupational Therapy, Ipswich Hospital, Ipswich, Queensland, Australia
- Department of Occupational Therapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Jacki Liddle
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
- Department of Occupational Therapy, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | | | - Jessica Holding
- Department of Occupational Therapy, Griffith University, Nathan, Queensland, Australia
| | - Sarah Swan
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
| | - Freyr Patterson
- Department of Occupational Therapy, School of Health and Rehabilitation Sciences, The University of Queensland, St. Lucia, Queensland, Australia
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Van Boxtel ME, Jauregui I, Valiquette A, Sullivan C, Graf A, Hanley J. The Effect of Social Deprivation on Hospital Utilization Following Distal Radius Fracture Treatment. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2024; 6:333-337. [PMID: 38817768 PMCID: PMC11133802 DOI: 10.1016/j.jhsg.2024.01.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/01/2024] Open
Abstract
Purpose Social determinants of health disparities have been shown to adversely impact outcomes following distal radius fracture (DRF) treatment. Identifying risk factors for increased hospital use following DRF has been historically difficult; however, it is of utmost concern to orthopedic surgeons to improve outcomes and decrease the total cost of care. The effect of social deprivation following DRF has yet to be fully investigated. Methods This is a retrospective cohort analysis of a single institution's experience in treating DRF with either an operative or nonsurgical modality between 2005 and 2020. Patient demographic information and health care utilization (hospital readmission, emergency department [ED] visitation, office visits, and telephone use) were collected from within 90 days of treatment. Area Deprivation Index (ADI) national percentiles were recorded. Patients were stratified into terciles based on their relative level of deprivation, and their outcomes were compared. Secondary analyses included stratifying patients based on treatment modality, race, and legal sex. Results In total, 2,149 patients were included. The least, intermediate, and most deprived groups consisted of 552, 1,067, and 530 patients, respectively. Risk factors for hospital readmission included higher levels of relative deprivation. Identifying as Black or African American and nonsurgical management were risk factors for increased ED visitation. No differences in rate of hospital readmission, ED visitation, office visitation, or telephone use were seen based on deprivation level. Conclusions High levels of social deprivation, treatment modality, race, and legal sex disparities may influence the amount of hospital resource utilization following DRF treatment. Understanding and identifying risk factors for greater resource utilization can help to mitigate inappropriate use and decrease health care costs. We hope to use these findings to guide clinical decision making, educate patient populations, and optimize outcomes following DRF treatment. Type of Study/Level of Evidence Therapeutic III.
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Affiliation(s)
| | - Isaias Jauregui
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Andrew Valiquette
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Connor Sullivan
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Alexander Graf
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
| | - Jessica Hanley
- Department of Orthopaedic Surgery, Medical College of Wisconsin, Milwaukee, WI
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Chen K, Hynes KK, Dirschl D, Wolf JM, Strelzow JA. Depression, anxiety, and post-traumatic stress disorder following upper versus lower extremity fractures. Injury 2024; 55:111242. [PMID: 38044162 DOI: 10.1016/j.injury.2023.111242] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 11/16/2023] [Accepted: 11/24/2023] [Indexed: 12/05/2023]
Abstract
INTRODUCTION Orthopaedic trauma has been linked to major depressive disorder (MDD), generalized anxiety disorder (GAD), and post-traumatic stress disorder (PTSD). Post-injury rates of psychiatric diagnoses and their relationship to various injury characteristics are not well characterized. We aimed to determine the association between orthopaedic trauma and MDD, GAD, and PTSD diagnoses at 5-year follow-up. METHODS A national insurance claims database was used to create upper extremity fracture (UEF) and lower extremity fracture (LEF) cohorts, with further stratification by isolated versus multiple fractures. Patient undergoing elective upper or lower extremity orthopaedic procedures served as controls. Rates of post-injury psychiatric diagnoses were calculated. Univariate logistic regression was conducted after matching in a 1:1 ratio based on relevant comorbidities such as psychiatric history. All significant variables were included in multivariate analysis. RESULTS A total of 308,578 UEF patients and 360,510 LEF patients were identified. Within the UEF cohort, the diagnosis rates following either isolated or multiple fractures were identified: MDD (25% to 30%), GAD (10% to 11%), and PTSD (4%). LEF cohort rates were as follows: MDD (30% to 38%), GAD (11% to 14%), and PTSD (4% to 7%). Compared to non-injured controls, both the UEF and LEF cohorts were associated with higher rates of all psychiatric diagnoses. In comparing UEF and LEF cohorts, isolated UEF was associated with MDD, GAD, and PTSD; however, multiple UEF was associated with MDD and GAD, whereas multiple LEF was associated with PTSD. CONCLUSION Psychiatric pathology is prevalent following orthopaedic trauma. Even after controlling for psychiatric history, orthopaedic trauma is independently associated with post-injury psychiatric diagnoses and may be more predictive of PTSD and GAD than of MDD. Upper extremity fractures may portend higher psychiatric risk. With negative stigma surrounding mental health and the early role of orthopaedic surgeons in providing care, it is imperative to normalize psychiatric care with patients and discuss warning symptoms that may indicate the onset of psychiatric disorders. LEVEL OF EVIDENCE Prognostic, Level III.
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Affiliation(s)
- Kevin Chen
- The University of Chicago, Pritzker School of Medicine, Biological Sciences Learning Center, 924 E. 57th St., Ste. 104, Chicago, IL 60637, USA.
| | - Kelly K Hynes
- The University of Chicago Medicine, Department of Orthopaedic Surgery and Rehabilitation Medicine, 5758 S. Maryland Ave., Dept. 4B, Chicago, IL, USA
| | - Douglas Dirschl
- Baylor College of Medicine, Department of Orthopaedic Surgery, 7200 Cambridge St., Ste. 10A, Houston, TX 77030, USA
| | - Jennifer Moriatis Wolf
- The University of Chicago Medicine, Department of Orthopaedic Surgery and Rehabilitation Medicine, 5758 S. Maryland Ave., Dept. 4B, Chicago, IL, USA
| | - Jason A Strelzow
- The University of Chicago Medicine, Department of Orthopaedic Surgery and Rehabilitation Medicine, 5758 S. Maryland Ave., Dept. 4B, Chicago, IL, USA
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Broekman MM, Brinkman N, Swanson D, Ring D, van den Bekerom M, Jawa A. Variations in 1-year Trajectories of Levels of Pain and Capability After Shoulder Arthroplasty Are Associated With Baseline Mental Health. Clin Orthop Relat Res 2024; 482:514-522. [PMID: 37678387 PMCID: PMC10871746 DOI: 10.1097/corr.0000000000002821] [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: 03/09/2023] [Accepted: 07/20/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND There is variability in the trajectories of pain intensity and magnitude of incapability after shoulder arthroplasty. A better understanding of the degree to which variation in recovery trajectories relates to aspects of mental health can inform the development of comprehensive biopsychosocial care strategies. QUESTIONS/PURPOSES (1) Do pain intensities at baseline and the trajectories during recovery differ between groups when stratified by mental health composite summary score, arthroplasty type, and revision surgery? (2) Do magnitudes of capability at baseline and the trajectories during recovery differ between these groups? METHODS We used a registry of 755 patients who underwent shoulder arthroplasty by a single surgeon at a specialized urban orthopaedic hospital that recorded the mental component summary (MCS) score of the Veterans RAND 12, a measure of shoulder-specific comfort and capability (American Shoulder and Elbow Surgeons [ASES] score, which ranges from 0 to 100 points, with a score of 0 indicating worse capability and pain and 100 indicating better capability and pain and a minimum clinically important difference of 6.4), and the VAS for pain intensity (range 0 [representing no pain] to 10 [representing the worst pain possible], with a minimum clinically important difference of 1.4) preoperatively, 2 weeks postoperatively, and 6 weeks, 3 months, 6 months, and 1 year after surgery. Forty-nine percent (368 of 755) of the patients were men, with a mean age of 68 ± 8 years, and 77% (585) were treated with reverse total shoulder arthroplasty (rTSA). Unconditional linear and quadratic growth models were generated to identify the general shape of recovery for both outcomes (linear versus quadratic). We then constructed conditional growth models and curves for pain intensity and the magnitude of capability showing mean baseline scores and the rates of recovery that determine the trajectory, accounting for mental health (MCS) quartiles, primary or revision arthroplasty, and TSA or reverse TSA in separate models. Because pain intensity and capability showed quadratic trends, we created trajectories using the square of time. RESULTS Patients in the worst two MCS quartiles had greater pain intensity at baseline than patients in the best quartile (difference in baseline for bottom quartile: 0.93 [95% CI 0.72 to 1.1]; p < 0.01; difference in baseline for next-worst quartile: 0.36 [95% CI 0.16 to 0.57]; p < 0.01). The rates of change in recovery from pain intensity were not different among groups (p > 0.10). Patients with revision surgery had greater baseline pain (difference: 1.1 [95% CI 0.7 to 1.5]; p < 0.01) but no difference in rates of recovery (difference: 0.031 [95% CI 0.035 to 0.097]; p = 0.36). There were no differences in baseline pain intensity and rates of recovery between patients with reverse TSA and those with TSA (baseline pain difference: -0.20 [95% CI -0.38 to -0.03]; p = 0.18; difference in rate of recovery: -0.005 [95% CI -0.035 to 0.025]; p = 0.74). Patients in the worst two MCS quartiles had worse baseline capability than patients in the best quartile (difference in baseline for bottom quartile: -8.9 [95% CI -10 to -7.4]; p < 0.001; difference in baseline for the next-worst quartile: -4.9 [95% CI -6.4 to -3.4]; p < 0.01), with no differences in rates of recovery (p > 0.10). Patients with revision surgery had lower baseline capability (difference in baseline: -13 [95% CI -15 to -9.7]; p < 0.01), with a slower rate of recovery (difference in rate of recovery: -0.56 [95% CI -1.0 to -0.079]; p = 0.021). There were no differences in baseline capability or rates of recovery between TSA and reverse TSA. CONCLUSION The observation that preoperative and 1-year comfort and capability are associated with mental health factors and with similar recovery trajectories reminds us that assessment and treatment of mental health is best considered an integral aspect of musculoskeletal care. Future studies can address how prioritization of mental health in musculoskeletal care strategies might reduce variation in the 1-year outcomes of discretionary surgeries such as shoulder arthroplasty. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Melle Martijn Broekman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, the Netherlands
| | - Niels Brinkman
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Daniel Swanson
- Shoulder Surgery, Boston Sports & Shoulder Center, Boston, MA, USA
| | - David Ring
- Department of Surgery and Perioperative Care, Dell Medical School at the University of Texas at Austin, Austin, TX, USA
| | - Michel van den Bekerom
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit van Amsterdam, Amsterdam, the Netherlands
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Amsterdam, the Netherlands
| | - Andrew Jawa
- Shoulder Surgery, Boston Sports & Shoulder Center, Boston, MA, USA
- Division of Shoulder Arthroplasty, New England Baptist Hospital, Boston, MA, USA
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13
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Mackinnon T, Samuel TD, Hayter E, Lee G, Huntley D, Hardman J, Anakwe RE. Long-Term Follow-up (14 to 25 Years) Following Closed Reduction and Early Movement for Simple Dislocation of the Elbow. J Bone Joint Surg Am 2023; 105:1489-1493. [PMID: 37616331 PMCID: PMC10540751 DOI: 10.2106/jbjs.23.00288] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/26/2023]
Abstract
BACKGROUND We have previously reported on the midterm outcomes after a nonoperative protocol to treat simple dislocations of the elbow that included a short period of splinting followed by early movement. We have now performed extended follow-up of the original patient group from the prior study to determine whether the excellent results that previously had been reported were maintained in the long term and also to determine the rate of and need for any late surgical intervention. METHODS We attempted to contact all of the patients from the original study group. We requested that they complete the Oxford Elbow Score (OES) survey, the Disabilities of the Arm, Shoulder and Hand (DASH) questionnaire, and a validated patient satisfaction questionnaire. Patients also were requested to attend a face-to-face assessment to have a clinical examination that included neurovascular, range-of-motion, and ligamentous stability assessments. RESULTS Seventy-one patients from the original patient group agreed to participate in the new study. The mean duration of follow-up was 19.3 years. At the time of the final follow-up, patients reported excellent functional outcome scores and a preserved functional range of movement in the injured elbow. The mean OES was 91.6 points, the mean DASH score was 5.22 points, and the mean satisfaction score was 90.9 points. None of the patients had undergone delayed or secondary surgery for instability during the interval period. CONCLUSIONS This study demonstrated that the original excellent outcomes following treatment with a protocol of a short period of splinting and early movement remained excellent and were maintained into the very long term. LEVEL OF EVIDENCE Therapeutic Level IV . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Thomas Mackinnon
- Department of Trauma and Orthopaedic Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, England
| | - Thomas D Samuel
- Department of Trauma and Orthopaedic Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, England
| | - Edward Hayter
- Department of Trauma and Orthopaedic Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, England
| | - George Lee
- Department of Trauma and Orthopaedic Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, England
| | - Daniel Huntley
- Department of Trauma and Orthopaedic Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, England
| | - John Hardman
- Department of Trauma and Orthopaedic Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, England
| | - Raymond E Anakwe
- Department of Trauma and Orthopaedic Surgery, St. Mary's Hospital, Imperial College Healthcare NHS Trust, London, England
- Imperial College London, London, England
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Loomis KJ, Roll SC, Hardison ME. The role of therapist-patient relationships in facilitating engagement and adherence in upper extremity rehabilitation. Work 2023; 76:1083-1098. [PMID: 37248936 DOI: 10.3233/wor-220384] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/31/2023] Open
Abstract
BACKGROUND Active patient engagement and adherence are essential for successful rehabilitation outcomes, particularly in complex cases such as work-related musculoskeletal injuries. Although the therapist-patient relationship is a significant component of successful care coordination, there has been limited examination of this relationship within upper extremity musculoskeletal rehabilitation. OBJECTIVE To explore therapists' perspectives on how the therapist-patient relationship intersects with engagement and adherence in the provision of holistic and collaborative rehabilitation services. METHODS Data were collected from four therapists over three months. Descriptive statistics were generated from the Sport Injury Rehabilitation Adherence Scale (SIRAS) and the Rehabilitation Therapy Engagement Scale (RTES) completed by therapists following visits from a sub-sample of patients (n = 14). Weekly semi-structured group interviews (n = 13) were analyzed using an iterative grounded theory-informed process. Emerging themes were identified, refined, and situated within the context of quantitative results. RESULTS SIRAS scores averaged 14.4 (SD: 1.0) and RTES scores averaged 42.5 (SD: 3.5), indicating high perceived patient engagement and adherence. Four themes emerged from therapist interviews: (1) dynamic power; (2) co-constructed engagement; (3) emotional states; (4) complementary therapy contexts. CONCLUSION In this engaged and adherent setting, therapist-patient relationships were complex and intimate, and extended beyond education and physical interventions. Careful management of this relationship was central to active patient participation and engagement. Incorporating holistic techniques may provide more structure for managing and communicating these aspects of care. These findings provide a preliminary understanding of the impact of therapeutic relationships on engagement and collaborative care.
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Affiliation(s)
- Katherine J Loomis
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Shawn C Roll
- Chan Division of Occupational Science and Occupational Therapy, University of Southern California, Los Angeles, CA, USA
| | - Mark E Hardison
- Occupational Therapy Graduate Program, School of Medicine, University of New Mexico, Albuquerque, NM, USA
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15
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Shipp MM, Sanghavi KK, Kolm P, Zhang G, Miller KE, Giladi AM. Preoperative Patient-Reported Data Indicate the Risk of Prolonged Opioid Use After Hand and Upper Extremity Surgeries. J Hand Surg Am 2022; 47:1068-1075. [PMID: 36031463 PMCID: PMC9637740 DOI: 10.1016/j.jhsa.2022.06.026] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2021] [Revised: 05/16/2022] [Accepted: 06/29/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE Opioids play an important role in pain management after surgery but also increase the risk of prolonged opioid use in patients. The identification of patients who are more likely to use opioids after intended short-term treatment is critical for employing alternative management approaches or targeted interventions for the prevention of opioid-related problems. We used patient-reported data (PRD) and electronic health record information to identify factors predictive of prolonged opioid use after surgery. METHODS We used our institutional registry containing data on all patients who underwent elective upper extremity surgeries. We evaluated factors associated with prolonged opioid use in the cohort from the year 2018 to 2019. We then validated our results using the 2020 cohort. The predictive variables included preoperative PRD and electronic health record data. Opioid use was determined based on patient reports and/or filled opioid prescriptions 3 months after surgery. We conducted bivariate regression, followed by multivariable regression analyses, and model validation using area under the receiver operating curve. RESULTS We included 2,114 patients. In our final model on the 2018-2019 electronic health records and PRD data (n = 1,589), including numerous patient-reported outcome questionnaire scores, patients who were underweight and had undergone trauma-related surgery had higher odds of being on opioids at 3 months. Additionally, each 5-unit decrease in the preoperative Patient-Reported Outcomes Measurement Information System Global Physical Health score was associated with a 30% increased odds of being on opioids at 3 months. The area under the receiver operating curve of our model was 70.4%. On validation using data from the 2020 cohort, the area under the receiver operating curve was 60.3%. The Hosmer-Lemeshow test indicated a good fit. CONCLUSIONS We found that preoperative questionnaire scores were associated with prolonged postoperative opioid use, independent of other variables. Furthermore, PRD may provide unique patient-level insights, alongside other factors, to improve our understanding of postsurgical pain management. TYPE OF STUDY/LEVEL OF EVIDENCE Prognostic II.
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Affiliation(s)
- Michael M Shipp
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD
| | - Kavya K Sanghavi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Paul Kolm
- MedStar Health Research Institute, Hyattsville, MD
| | - Gongliang Zhang
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD; MedStar Health Research Institute, Hyattsville, MD
| | - Kristen E Miller
- MedStar Health Research Institute, Hyattsville, MD; National Center for Human Factors in Healthcare, MedStar Health Research Institute, Hyattsville, MD
| | - Aviram M Giladi
- The Curtis National Hand Center, MedStar Union Memorial Hospital, Baltimore, MD.
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