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van Kooij YE, Ter Stege MHP, de Ridder WA, Hoogendam L, Hovius SER, MacDermid JC, Selles RW, Wouters RM. The Validity and Responsiveness of the Patient-Specific Functional Scale in Patients With First Carpometacarpal Osteoarthritis. J Hand Surg Am 2024:S0363-5023(24)00197-7. [PMID: 38934999 DOI: 10.1016/j.jhsa.2024.04.006] [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: 12/03/2023] [Revised: 04/02/2024] [Accepted: 04/17/2024] [Indexed: 06/28/2024]
Abstract
PURPOSE The purpose of this study was to assess the content, construct, and discriminative validity and responsiveness of the Patient-Specific Functional Scale (PSFS) in patients with thumb carpometacarpal arthritis. METHODS Data were collected at Xpert Clinics, comprising 34 outpatient hand surgery and hand therapy clinics in the Netherlands. We included 267 patients for content validity and 323 patients for construct validity and responsiveness. The PSFS items were classified into the International Classification of Function Core Set for Hand Conditions to assess content validity. We used hypothesis testing to investigate the construct validity and responsiveness. The Michigan Hand Outcomes Questionnaire was used as a comparator instrument. The standardized response mean was calculated to evaluate the magnitude of change. For discriminative validity, we used independent t tests to discriminate between satisfied and dissatisfied patients. RESULTS We classified 98% of the PSFS items in the International Classification of Function "activities" and "participation" domains, indicating good content validity. Two of six hypotheses for construct validity and three of six hypotheses for responsiveness were confirmed. The standardized response mean for the PSFS was 0.57 (0.46-0.68) and 0.47 (0.35-0.58) for the Michigan Hand Outcomes Questionnaire total score. The mean PSFS score showed good discriminative validity because it could distinguish between satisfied and dissatisfied patients at the 3-month follow-up. CONCLUSIONS The PSFS scores showed good content and discriminative validity in patients with first carpometacarpal arthritis. Hypothesis testing for responsiveness and construct validity indicates that the PSFS measures a unique construct different from the Michigan Hand Outcomes Questionnaire. CLINICAL RELEVANCE The PSFS may be a useful scale for measuring the patient-specific status of individuals with thumb carpometacarpal arthritis.
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Affiliation(s)
- Yara E van Kooij
- Xpert Clinics, Xpert Handtherapie, Eindhoven, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands.
| | - Marloes H P Ter Stege
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Equipe Zorgbedrijven, Xpert Clinics, Eindhoven, Netherlands
| | - Willemijn A de Ridder
- Xpert Clinics, Xpert Handtherapie, Eindhoven, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Lisa Hoogendam
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands; Equipe Zorgbedrijven, Xpert Clinics, Eindhoven, Netherlands
| | - Steven E R Hovius
- Department of Plastic, Reconstructive, and Hand Surgery, Radboud University Medical Centre, Nijmegen, the Netherlands
| | - Joy C MacDermid
- Department of Surgery, School of Physical Therapy, Western University, London, Ontario, Canada; Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Ontario, Canada
| | - Ruud W Selles
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
| | - Robbert M Wouters
- Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
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Bu X, Wang Y, Du Y, Mu C, Zhang W, Wang P. Bridge the gap caused by public health crises: medical humanization and communication skills build a psychological bond that satisfies patients. Int J Equity Health 2024; 23:40. [PMID: 38409009 PMCID: PMC10898071 DOI: 10.1186/s12939-024-02116-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 01/20/2024] [Indexed: 02/28/2024] Open
Abstract
BACKGROUND Patient satisfaction is an important outcome domain of patient-centered care. Medical humanization follows the patient-centered principle and provides a more holistic view to treat patients. The COVID-19 pandemic posed significant barriers to maintaining medical humanization. However, empirical study on the relationship between medical humanization and patient satisfaction is clearly absent. OBJECTIVES We examined the mediation effects of communication on the relationship between medical humanization and patient satisfaction when faced with a huge public health crisis like the COVID-19 pandemic, and the moderation effect of medical institutional trust on the mediation models. METHODS A cross-sectional survey study was performed. A final sample size of 1445 patients was surveyed on medical humanization, communication, patient satisfaction and medical institutional trust. RESULTS All correlations were significantly positive across the main variables (r = 0.35-0.67, p < 0.001 for all) except for medical institutional trust, which was negatively correlated with the medical humanization (r=-0.14, p < 0.001). Moderated mediation analysis showed that the indirect effect of medical humanization on patient satisfaction through communication was significant (b = 0.22, 95% CI: 0.18 ~ 0.25). Medical institutional trust significantly moderated the effect of medical humanization on patient satisfaction (b=-0.09, p < 0.001) and the effect of medical humanization on communication (b= -0.14, p < 0.001). CONCLUSION Medical humanization positively influence patient satisfaction, communication mediated the association between medical humanization and patient satisfaction, and medical institutional trust negatively moderated the effects of medical humanization on patient satisfaction and communication. These findings suggest that humanistic communication contributes to patient satisfaction in the face of a huge public health crisis, and patients' evaluation of satisfaction is also regulated by rational cognition.
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Affiliation(s)
- Xiaoou Bu
- Faculty of Education, East China Normal University, No. 3663 North Zhongshan Road, 200062, Shanghai, China.
- College of Medical Humanities and Management, Wenzhou Medical University, 325035, Wenzhou, China.
| | - Yao Wang
- Faculty of Education, East China Normal University, No. 3663 North Zhongshan Road, 200062, Shanghai, China
| | - Yawen Du
- Faculty of Education, East China Normal University, No. 3663 North Zhongshan Road, 200062, Shanghai, China
| | - Chuanglu Mu
- School of Marxism, East China Normal University, 200241, Shanghai, China
| | - Wenjun Zhang
- Faculty of Education, East China Normal University, No. 3663 North Zhongshan Road, 200062, Shanghai, China
| | - Pei Wang
- College of Medical Humanities and Management, Wenzhou Medical University, 325035, Wenzhou, China.
- Key Research Center of Philosophy and Social Sciences of Zhejiang Province, Wenzhou Medical University, 325035, Wenzhou, China.
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Koopman JE, Smit JM, Wouters RM, Selles RW, Michiel Zuidam J, Hundepool CA. Incision techniques for trigger thumb release: a comparison of outcomes of four types of skin incision. J Hand Surg Eur Vol 2024:17531934241232341. [PMID: 38366371 DOI: 10.1177/17531934241232341] [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] [Indexed: 02/18/2024]
Abstract
Although trigger thumb release is commonly performed, there is no consensus on the optimal skin incision. This study aimed to compare outcomes of four incision techniques, including V-shaped, oblique, transverse and longitudinal incisions. Outcomes included the Michigan Hand Outcomes Questionnaire, satisfaction with the treatment and postoperative complications. The results of 875 patients who underwent trigger thumb release were assessed. All groups demonstrated improvement in self-reported hand function (range of 10-14 points), pain (25-27 points) and aesthetics (4-7 points) from baseline to 3 months postoperatively with no differences between incision techniques. Of the patients, 76% reported good or excellent satisfaction with the outcome of treatment. Satisfaction and complication rates of the different incision techniques were similar. These findings imply that there is no clear benefit of one type of incision over another for trigger thumb release, suggesting that surgeons may use the technique of their preference.Level of evidence: III.
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Affiliation(s)
- Jaimy E Koopman
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Jeroen M Smit
- Hand and Wrist Center, Xpert Clinics, The Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - J Michiel Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
| | - Caroline A Hundepool
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Centre, Rotterdam, The Netherlands
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Shaer SA, van der Palen J, Teunissen J, Fink A, van der Heijden B, Zöphel O. An alternative treatment for degenerative triangular fibrocartilage complex injuries with distal radioulnar joint instability: first experience with 48 patients. J Hand Surg Eur Vol 2024; 49:240-249. [PMID: 37694851 PMCID: PMC10845826 DOI: 10.1177/17531934231197942] [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: 09/20/2023] [Revised: 07/20/2023] [Accepted: 08/13/2023] [Indexed: 09/12/2023]
Abstract
Treatment of ulnar impaction syndrome combined with distal radioulnar joint instability due to irreparable degenerative triangular fibrocartilage complex injuries can be complex. We describe the outcomes of a novel technique for restoring distal radioulnar stability due to ulnar impaction syndrome using a distally based extensor carpi ulnaris tendon strip combined with ulnar shortening osteotomy in 48 patients. Patients were assessed using standardized outcome measurements. The patient-rated wrist/hand evaluation total score improved from 66 (SD 15) at intake to 40 (SD 25) at 3 months, and 28 (SD 23) at 12 months postoperatively (p < 0.001). Wrist extension and flexion improved significantly at 12 months from 53° (SD 11) to 65° (SD 8) (p < 0.001) and from 45° (SD 10) to 56° (SD 12) (p = 0.01), respectively. Adding a distally based longitudinal extensor carpi ulnaris strip to ulnar shortening osteotomy for restoring distal radioulnar joint stability seems to be an effective treatment in patients with irreparable degenerative triangular fibrocartilage complex injuries due to ulnar impaction syndrome. Level of evidence: IV.
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Affiliation(s)
- Sanharib Al Shaer
- Department of Surgery, UMC Utrecht, Utrecht, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
| | - Job van der Palen
- Department of Epidemiology, Medisch Spectrum Twente, Enschede & Section Cognition, Data and Education, Faculty BMS, University of Twente, Enschede, The Netherlands
| | - Joris Teunissen
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Alexandra Fink
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis ‘s-Hertogenbosch, The Netherlands
| | - Oliver Zöphel
- Hand and Wrist Center, Xpert Clinics, Handtherapy, Enschede, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Ziekenhuisgroep Twente, Hengelo, The Netherlands
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Esteban Lopez LM, Hoogendam L, Vermeulen GM, Tsehaie J, Slijper HP, Selles RW, Wouters RM. Long-Term Outcomes of Nonsurgical Treatment of Thumb Carpometacarpal Osteoarthritis: A Cohort Study. J Bone Joint Surg Am 2023; 105:1837-1845. [PMID: 37903291 PMCID: PMC10695337 DOI: 10.2106/jbjs.22.01116] [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] [Indexed: 11/01/2023]
Abstract
BACKGROUND Although nonsurgical treatment of thumb carpometacarpal (CMC-1) osteoarthritis (OA) provides short-term improvement, the durability of these effects beyond 1 year is unknown. In this study, we investigated patient-reported pain and limitations in activities of daily living (ADL) at >5 years following nonsurgical treatment (i.e., exercise therapy and use of an orthosis) for CMC-1 OA. We hypothesized that pain and limitations in ADL would not worsen after 12 months. Secondary outcomes were satisfaction with treatment results and health-related quality of life at >5 years of follow-up and the rate of conversion to surgery. METHODS This was a multicenter, prospective cohort study using 2 overlapping samples. The change in the Michigan Hand Outcomes Questionnaire (MHQ) subscales of pain and ADL between 12 months and >5 years was the primary outcome as measured in the first sample (n = 170), which consisted of patients who did not undergo conversion to surgery. Additional measurement time points included baseline and 3 months. We evaluated conversion to surgery in a second sample, which included all patients who responded to the invitation for this follow-up study (n = 217). RESULTS At a median follow-up of 6.6 years (range, 5.1 to 8.7 years), the score on the MHQ pain subscale did not differ significantly from that at 12 months. The score on the MHQ ADL improved by 4.4 points (95% confidence interval [CI],1.5 to 7.2) compared with 12 months, but this was not clinically relevant. At >5 years, 5% of the patients rated their satisfaction as "poor," 14% as "moderate," 26% as "fair," 39% as "good," and 16% as "excellent." The median EuroQol-5 Dimensions-5 Levels (EQ-5D-5L) index score was 0.852 (range, 0.135 to 1). The rate of conversion to surgery was 22% (95% CI,16.4% to 27.7%) at a median follow-up of 7 years (range, 5.5 to 9.0 years). CONCLUSIONS We found positive outcomes at >5 years of follow-up for nonsurgical treatment of CMC-1 OA, with no worsening of pain or of limitations in ADL after 12 months. Our findings support nonsurgical treatment as the first treatment choice and suggest that treatment effects are sustainable. LEVEL OF EVIDENCE Therapeutic Level II . See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Lisa M.J. Esteban Lopez
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Center for Hand Therapy, Xpert Handtherapie, Eindhoven, The Netherlands
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Eindhoven, The Netherlands
| | | | - Jonathan Tsehaie
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Harm P. Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Robbert M. Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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Luong KP, Vissers LCM, Domela Nieuwenhuis I, Hazenkamp LS, Hummelink S, Slijper HP, Ulrich DJO. Factors Associated with Treatment Outcome Satisfaction Six Months after Upper Blepharoplasty: A Large Cohort Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5260. [PMID: 37718993 PMCID: PMC10501473 DOI: 10.1097/gox.0000000000005260] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2023] [Accepted: 07/21/2023] [Indexed: 09/19/2023]
Abstract
Background Upper blepharoplasty is the most popular facial cosmetic surgery. Although there are a variety of reasons to undergo this procedure, all patients expect an optimal cosmetic result. However, little is known about the factors that influence satisfaction with treatment outcome. Objectives We assessed to what extent patient characteristics, clinician-rated and postsurgical outcome measures, and patient-reported satisfaction with facial appearance and quality-of-life are associated with patient-reported satisfaction with treatment outcome after a primary upper blepharoplasty. Methods This study was performed in 583 patients with an upper blepharoplasty between 2016 and 2021. The primary outcome was satisfaction with treatment outcome 6 months postoperatively using the FACE-Q. Determinants were baseline patient characteristics (demographics), preoperative and postoperative clinician-rated and surgical outcome measures, and preoperative and postoperative FACE-Q appearance and quality-of-life scales. Hierarchical linear regression analysis was used to determine how much of the variance in satisfaction with outcome could be explained by these groups of determinants. Results A total of 63% of the variance could be explained by the five groups of determinants of which 8% was explained by the baseline patient characteristics and clinician-rated and patient-reported outcomes together, another 8% by the postoperative clinician-rated outcomes, and the remaining 47% by the postoperative patient-reported outcomes. Conclusions Patient characteristics, clinician-rated outcome measures, and baseline FACE-Q appearance and quality-of-life scores were of limited value in explaining satisfaction with treatment outcome. However, the postoperative FACE-Q appearance scale and the decision to undergo a blepharoplasty were strongly associated with satisfaction with treatment outcome.
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Affiliation(s)
- Kim Phi Luong
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Center, Velthuis Kliniek, Eindhoven, The Netherlands
| | - Lieke C. M. Vissers
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Center, Velthuis Kliniek, Eindhoven, The Netherlands
| | - Ileen Domela Nieuwenhuis
- Department of Plastic and Reconstructive Surgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lisa S. Hazenkamp
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Stefan Hummelink
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Harm P. Slijper
- Research Center, Velthuis Kliniek, Eindhoven, The Netherlands
- Department of Plastic and Reconstructive Surgery, Erasmus MC—University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dietmar J. O. Ulrich
- From the Department of Plastic and Reconstructive Surgery, Radboud University Medical Center, Nijmegen, The Netherlands
- Research Center, Velthuis Kliniek, Eindhoven, The Netherlands
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Ten Heggeler MA, Sun PO, Jansen MC, Walbeehm ET, Zuidam JM, Selles RW. Is the outcome of a revision carpal tunnel release as good as those of a primary release? A matched cohort study. J Plast Reconstr Aesthet Surg 2022; 75:4432-4440. [PMID: 36272920 DOI: 10.1016/j.bjps.2022.08.056] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2021] [Revised: 04/13/2022] [Accepted: 08/17/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE This study aimed to compare primary and revision carpal tunnel release outcomes in all patients with carpal tunnel syndrome and when corrected for baseline severity and demographics. METHODS A total of 903 hands of primary and 132 hands of revision patients underwent carpal tunnel release and patients completed online questionnaires on demographics, clinical severity, and satisfaction. The primary outcome measure, the Boston Carpal Tunnel Questionnaire (BCTQ), was administered at intake and six months after surgery. RESULTS The BCTQ total score at six months was better in primary (1.55±0.58) than revision patients (1.94±0.73, p=<0.001), and primary patients improved more on the BCTQ total score (1.10±0.71 vs. 0.90±0.72, p=0.003). In patients matched on similar baseline characteristics using propensity score matching, the BCTQ total score at six months was also better in primary patients (1.65±0.63) than in revision patients (1.92±0.73, p=0.002), and primary patients still had more improvement in BCTQ total score (1.18±0.73 vs. 0.89±0.73, p=0.004). CONCLUSIONS This study shows that the outcome after revision carpal tunnel release is only 16% worse compared to primary carpal tunnel release. Preoperative symptom severity, functional status, and demographics may play a role since correcting for these factors reduces the difference in outcome between primary and revision CTR.
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Affiliation(s)
- Maud A Ten Heggeler
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands.
| | - Pepijn O Sun
- Department of Plastic, Reconstructive and Hand Surgery, Isala Hospital, Zwolle, the Netherlands; Department of Plastic & Reconstructive Surgery, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Miguel C Jansen
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Erik T Walbeehm
- Department of Plastic, Reconstructive and Hand Surgery, Isala Hospital, Zwolle, the Netherlands; Department of Plastic & Reconstructive Surgery, Radboud University Medical Center Nijmegen, Nijmegen, the Netherlands
| | - Jelle M Zuidam
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinic, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Hoogendam L, Koopman JE, van Kooij YE, Feitz R, Hundepool CA, Zhou C, Slijper HP, Selles RW, Wouters RM. What Are the Minimally Important Changes of Four Commonly Used Patient-reported Outcome Measures for 36 Hand and Wrist Condition-Treatment Combinations? Clin Orthop Relat Res 2022; 480:1152-1166. [PMID: 34962496 PMCID: PMC9263468 DOI: 10.1097/corr.0000000000002094] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2021] [Accepted: 12/01/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are frequently used to assess treatment outcomes for hand and wrist conditions. To adequately interpret these outcomes, it is important to determine whether a statistically significant change is also clinically relevant. For this purpose, the minimally important change (MIC) was developed, representing the minimal within-person change in outcome that patients perceive as a beneficial treatment effect. Prior studies demonstrated substantial differences in MICs between condition-treatment combinations, suggesting that MICs are context-specific and cannot be reliably generalized. Hence, a study providing MICs for a wide diversity of condition-treatment combinations for hand and wrist conditions will contribute to more accurate treatment evaluations. QUESTIONS/PURPOSES (1) What are the MICs of the most frequently used PROMs for common condition-treatment combinations of hand and wrist conditions? (2) Do MICs vary based on the invasiveness of the treatment (nonsurgical treatment or surgical treatment)? METHODS This study is based on data from a longitudinally maintained database of patients with hand and wrist conditions treated in one of 26 outpatient clinics in the Netherlands between November 2013 and November 2020. Patients were invited to complete several validated PROMs before treatment and at final follow-up. All patients were invited to complete the VAS for pain and hand function. Depending on the condition, patients were also invited to complete the Michigan Hand outcomes Questionnaire (MHQ) (finger and thumb conditions), the Patient-rated Wrist/Hand Evaluation (PRWHE) (wrist conditions), or the Boston Carpal Tunnel Questionnaire (BCTQ) (nerve conditions). Additionally, patients completed the validated Satisfaction with Treatment Result Questionnaire at final follow-up. Final follow-up timepoints were 3 months for nonsurgical and minor surgical treatment (including trigger finger release) and 12 months for major surgical treatment (such as trapeziectomy). Our database included 55,651 patients, of whom we excluded 1528 who only required diagnostic management, 25,099 patients who did not complete the Satisfaction with Treatment Result Questionnaire, 3509 patients with missing data in the PROM of interest at baseline or follow-up, and 1766 patients who were part of condition-treatment combinations with less than 100 patients. The final sample represented 43% (23,749) of all patients and consisted of 36 condition-treatment combinations. In this final sample, 26% (6179) of patients were managed nonsurgically and 74% (17,570) were managed surgically. Patients had a mean ± SD age of 55 ± 14 years, and 66% (15,593) of patients were women. To estimate the MIC, we used two anchor-based methods (the anchor mean change and the MIC predict method), which were triangulated afterward to obtain a single MIC. Applying this method, we calculated the MIC for 36 condition-treatment combinations, comprising 22 different conditions, and calculated the MIC for combined nonsurgical and surgical treatment groups. To examine whether the MIC differs between nonsurgical and surgical treatments, we performed a Wilcoxon signed rank test to compare the MICs of all PROM scores between nonsurgical and surgical treatment. RESULTS We found a large variation in triangulated MICs between the condition-treatment combinations. For example, for nonsurgical treatment of hand OA, the MICs of VAS pain during load clustered around 10 (interquartile range 8 to 11), for wrist osteotomy/carpectomy it was around 25 (IQR 24 to 27), and for nerve decompression it was 21. Additionally, the MICs of the MHQ total score ranged from 4 (nonsurgical treatment of CMC1 OA) to 15 (trapeziectomy with LRTI and bone tunnel), for the PRWHE total score it ranged from 2 (nonsurgical treatment of STT OA) to 29 (release of first extensor compartment), and for the BCTQ Symptom Severity Scale it ranged from 0.44 (nonsurgical treatment of carpal tunnel syndrome) to 0.87 (carpal tunnel release). An overview of all MIC values is available in a freely available online application at: https://analyse.equipezorgbedrijven.nl/shiny/mic-per-treatment/. In the combined treatment groups, the triangulated MIC values were lower for nonsurgical treatment than for surgical treatment (p < 0.001). The MICs for nonsurgical treatment can be approximated to be one-ninth (IQR 0.08 to 0.13) of the scale (approximately 11 on a 100-point instrument), and surgical treatment had MICs that were approximately one-fifth (IQR 0.14 to 0.24) of the scale (approximately 19 on a 100-point instrument). CONCLUSION MICs vary between condition-treatment combinations and differ depending on the invasiveness of the intervention. Patients receiving a more invasive treatment have higher treatment expectations, may experience more discomfort from their treatment, or may feel that the investment of undergoing a more invasive treatment should yield greater improvement, leading to a different perception of what constitutes a beneficial treatment effect. CLINICAL RELEVANCE Our findings indicate that the MIC is context-specific and may be misleading if applied inappropriately. Implementation of these condition-specific and treatment-specific MICs in clinical research allows for a better study design and to achieve more accurate treatment evaluations. Consequently, this could aid clinicians in better informing patients about the expected treatment results and facilitate shared decision-making in clinical practice. Future studies may focus on adaptive techniques to achieve individualized MICs, which may ultimately aid clinicians in selecting the optimal treatment for individual patients.
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Affiliation(s)
- Lisa Hoogendam
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Xpert Clinics, Hand and Wrist Center, the Netherlands
| | - Jaimy Emerentiana Koopman
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Xpert Clinics, Hand and Wrist Center, the Netherlands
| | - Yara Eline van Kooij
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Xpert Clinics Hand Therapy, the Netherlands
| | - Reinier Feitz
- Xpert Clinics, Hand and Wrist Center, the Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Radboud University Medical Center, Radboud Institute for Health Sciences, Nijmegen, the Netherlands
| | - Caroline Anna Hundepool
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Chao Zhou
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Hospital, Maastricht, the Netherlands
| | | | - Ruud Willem Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Robbert Maarten Wouters
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC University Medical Center, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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9
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Teunissen JS, van der Oest MJW, Selles RW, Ulrich DJO, Hovius SER, van der Heijden B. Long-term outcomes after ulna shortening osteotomy: a mean follow-up of six years. Bone Jt Open 2022; 3:375-382. [PMID: 35514114 PMCID: PMC9134835 DOI: 10.1302/2633-1462.35.bjo-2022-0031.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Aims The primary aim of this study was to describe long-term patient-reported outcomes after ulna shortening osteotomy for ulna impaction syndrome. Methods Overall, 89 patients treated between July 2011 and November 2017 who had previously taken part in a routine outcome evaluation up to 12 months postoperatively were sent an additional questionnaire in February 2021. The primary outcome was the Patient-Rated Wrist and Hand Evaluation (PRWHE) total score. Secondary outcomes included patient satisfaction with treatment results, complications, and subsequent treatment for ulnar-sided wrist pain. Linear mixed models were used to compare preoperative, 12 months, and late follow-up (ranging from four to nine years) PRWHE scores. Results Long-term outcomes were available in 66 patients (74%) after a mean follow-up of six years (SD 1). The mean PRWHE total score improved from 63 before surgery to 19 at late follow-up (difference in means (Δ) 44; 95% confidence interval (CI) 39 to 50; p = <0.001). Between 12 months and late follow-up, the PRWHE total score also improved (Δ 12; 95% CI 6 to 18; p = < 0.001). At late follow-up, 14/66 of patients (21%) reported a PRWHE total score of zero, whereas this was 3/51 patients (6%) at 12 months (p = 0.039). In all, 58/66 patients (88%) would undergo the same treatment again under similar circumstances. Subsequent treatment (total n = 66; surgical n = 57) for complications or recurrent symptoms were performed in 50/66 patients (76%). The most prevalent type of reoperation was hardware removal in 42/66 (64%), and nonunion occurred in 8/66 (12%). Conclusion Ulna shortening osteotomy improves patient-reported pain and function that seems to sustain at late follow-up. While satisfaction levels are generally high, reoperations such as hardware removal are common. Cite this article: Bone Jt Open 2022;3(5):375–382.
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Affiliation(s)
- Joris S. Teunissen
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Mark J. W. van der Oest
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
- Department of Rehabilitation Medicine, Erasmus University Medical Centre, Rotterdam, Zuid-Holland, The Netherlands
| | - Dietmar J. O. Ulrich
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
| | - Steven E. R. Hovius
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Hand and Wrist Center, Xpert Clinics, Amsterdam, Noord-Holland, The Netherlands
| | - Brigitte van der Heijden
- Department of Plastic, Reconstructive and Hand Surgery, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, Gelderland, The Netherlands
- Department of Plastic, Reconstructive and Hand Surgery, Jeroen Bosch Ziekenhuis, 's-Hertogenbosch, Brabant, The Netherlands
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10
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Wouters RM, Jobi-Odeneye AO, de la Torre A, Joseph A, Hovius SER. A Standard Set for Outcome Measurement in Patients With Hand and Wrist Conditions: Consensus by the International Consortium for Health Outcomes Measurement Hand and Wrist Working Group. J Hand Surg Am 2021; 46:841-855.e7. [PMID: 34325941 DOI: 10.1016/j.jhsa.2021.06.004] [Citation(s) in RCA: 45] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2020] [Revised: 06/02/2021] [Accepted: 06/09/2021] [Indexed: 02/02/2023]
Abstract
PURPOSE To describe the principles, process, and results of creating the International Consortium for Health Outcomes Measurement (ICHOM) standard set for hand and wrist conditions. METHODS Following the standardized methods of ICHOM, an international working group of hand surgeons, therapists, and researchers was assembled to develop an evidence-based, patient-centered, standard set of outcome measures for patients with hand and wrist conditions. Multiple systematic reviews were performed to support our choices of outcome domains and tools for hand and wrist conditions. Fourteen video conferences were held between March 2018 and March 2020, and a modified Delphi process was used. RESULTS A consensus was reached on 5 measurement tracks: the thumb, finger, wrist, nerve, and severe hand trauma tracks, with a distinction between regular and extended tracks for which specific allocation criteria applied. The standard set contains a selection of outcome tools and predefined time points for outcome measurement. Additionally, we developed a hierarchy for using the tracks when there are multiple conditions, and we selected risk-adjustment, case-mix variables. CONCLUSIONS The global implementation of the ICHOM standard set for hand and wrist conditions may facilitate value-based health care for patients with hand and wrist conditions. CLINICAL RELEVANCE The ICHOM standard set for hand and wrist conditions can enable clinical decision making, quality improvement, and comparisons between treatments and health care professionals.
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Affiliation(s)
- Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Department of Rehabilitation Medicine, Erasmus Medical Center, University Medical Center Rotterdam, Center for Hand Therapy, Handtherapie Nederland Hand and Wrist Center, Xpert Clinics, the Netherlands.
| | | | - Alethse de la Torre
- the International Consortium for Health Outcomes Measurement, London, United Kingdom
| | - Andria Joseph
- the International Consortium for Health Outcomes Measurement, London, United Kingdom
| | | | - Steven E R Hovius
- Hand and Wrist Center, Xpert Clinic, Department of Plastic Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
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11
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Koopman JE, van Kooij YE, Selles RW, Slijper HP, Smit JM, van Nieuwenhoven CA, Wouters RM. Determining the Minimally Important Change of the Michigan Hand outcomes Questionnaire in patients undergoing trigger finger release. J Hand Ther 2021; 36:139-147. [PMID: 34312042 DOI: 10.1016/j.jht.2021.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Revised: 06/01/2021] [Accepted: 06/18/2021] [Indexed: 02/03/2023]
Abstract
INTRODUCTION The Michigan Hand outcomes Questionnaire (MHQ) is a widely used instrument to evaluate treatment results for hand conditions. Establishing the Minimally Important Change (MIC) is essential for interpreting change in outcome that is clinically relevant. PURPOSE OF THE STUDY The purpose of this study was to determine the MIC of the MHQ total and subscale scores in patients undergoing trigger finger release. STUDY DESIGN This is a prospective cohort study conducted between December 2011 and February 2020. METHODS Patients completed the MHQ prior to surgery and 3 months postoperatively. The MIC of the MHQ was determined using 5 anchor-based methods (ie, 2 anchor mean change methods and 3 receiver operating characteristic methods). The median MIC value was determined to represent the triangulated MIC. RESULTS A total of 1814 patients were included. The MIC for the MHQ total score ranged from 7.7 to 10.9, with a triangulated estimate of 9.3. The MIC estimates for 5 of 6 of the MHQ subscales ranged from 7.7 to 20.0. No MICs could be determined for the MHQ subscale "aesthetics" due to low correlations between the anchor questions and MHQ change scores. CONCLUSIONS These MIC estimates can contribute to the interpretation of clinical outcomes following trigger finger release and for assessment of power in prospective trials.
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Affiliation(s)
- Jaimy E Koopman
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Centre, Xpert Clinic, Eindhoven, the Netherlands.
| | - Yara E van Kooij
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Centre for Hand Therapy, Handtherapie Nederland, Utrecht, the Netherlands
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Harm P Slijper
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Centre, Xpert Clinic, Eindhoven, the Netherlands
| | - Jeroen M Smit
- Hand and Wrist Centre, Xpert Clinic, Eindhoven, the Netherlands
| | - Christianne A van Nieuwenhoven
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands
| | - Robbert M Wouters
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Centre Rotterdam, Rotterdam, the Netherlands; Centre for Hand Therapy, Handtherapie Nederland, Utrecht, the Netherlands
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