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Takaya K, Sunohara A, Sakai S, Aramaki-Hattori N, Okabe K, Kishi K. Twist2 contributes to skin regeneration and hair follicle formation in mouse fetuses. Sci Rep 2024; 14:10854. [PMID: 38740788 PMCID: PMC11091223 DOI: 10.1038/s41598-024-60684-5] [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: 02/22/2024] [Accepted: 04/26/2024] [Indexed: 05/16/2024] Open
Abstract
Unlike adult mammalian wounds, early embryonic mouse skin wounds completely regenerate and heal without scars. Analysis of the underlying molecular mechanism will provide insights into scarless wound healing. Twist2 is an important regulator of hair follicle formation and biological patterning; however, it is unclear whether it plays a role in skin or skin appendage regeneration. Here, we aimed to elucidate Twist2 expression and its role in fetal wound healing. ICR mouse fetuses were surgically wounded on embryonic day 13 (E13), E15, and E17, and Twist2 expression in tissue samples from these fetuses was evaluated via in situ hybridization, immunohistochemistry, and reverse transcription-quantitative polymerase chain reaction. Twist2 expression was upregulated in the dermis of E13 wound margins but downregulated in E15 and E17 wounds. Twist2 knockdown on E13 left visible marks at the wound site, inhibited regeneration, and resulted in defective follicle formation. Twist2-knockdown dermal fibroblasts lacked the ability to undifferentiate. Furthermore, Twist2 hetero knockout mice (Twist + /-) formed visible scars, even on E13, when all skin structures should regenerate. Thus, Twist2 expression correlated with skin texture formation and hair follicle defects in late mouse embryos. These findings may help develop a therapeutic strategy to reduce scarring and promote hair follicle regeneration.
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Affiliation(s)
- Kento Takaya
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Ayano Sunohara
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Shigeki Sakai
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Noriko Aramaki-Hattori
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Keisuke Okabe
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan
| | - Kazuo Kishi
- Department of Plastic and Reconstructive Surgery, Keio University School of Medicine, 35 Shinanomachi, Shinjuku-Ku, Tokyo, 160-8582, Japan.
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2
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Janik PE, Opyrchał J, Ambroziak M, Noszczyk B, Paul MA. Polish Translation and Linguistic Validation of the SCAR-Q. Cureus 2024; 16:e52848. [PMID: 38406147 PMCID: PMC10885187 DOI: 10.7759/cureus.52848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/24/2024] [Indexed: 02/27/2024] Open
Abstract
Introduction Patient-reported outcome measurements (PROMs) are gaining considerable popularity as tools to assess the effectiveness of the treatment in plastic surgery, being a complement to surgical outcomes. The SCAR-Q questionnaire has been recently developed for patients with surgical, traumatic, and burn scars. Aim The study aims to describe the process of translation and linguistic validation of the scar questionnaire (SCAR-Q) for use in Polish patients undergoing scar treatment. Material and methods An official Polish translation and language validation of the SCAR-Q were done in adherence to International Society for Pharmacoeconomics and Outcomes Research (ISPOR) guidelines. The process consisted of four steps: two independent forward translations, a back translation, a review of the back translation, and cognitive participant interviews. Results The field-tested version of the SCAR-Q consisted of 29 items across three scales measuring appearance concerns, symptoms, and the psychosocial impact of the scar. The forward translation was done by two independent translators and revealed specific difficulties in translation to the Polish language (4/29 items). The back translation showed no significant differences compared to the original English version. Cognitive debriefing interviews involved nine Polish patients with postraumatic scars, burn scars, and scars after skin tumor resection. Participants have not reported any major difficulties in understanding the content of the questionnaire. Conclusions The ISPOR provides a straightforward and thorough guideline for the PROMs translation process. The new SCAR-Q is an accessible and efficient PROM that can be implemented in Polish patients to assess the effectiveness of scar treatment.
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Affiliation(s)
- Piotr E Janik
- Plastic Surgery, Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, POL
| | - Jakub Opyrchał
- Reconstructive Surgery, Maria Sklodowska-Curie Memorial Cancer Center and Institute of Oncology, Gliwice, POL
| | | | - Bartłomiej Noszczyk
- Plastic Surgery, Department of Plastic and Reconstructive Surgery, Centre of Postgraduate Medical Education, Prof. W. Orlowski Memorial Hospital, Warsaw, POL
| | - Marek A Paul
- Plastic and Reconstructive Surgery, Doc Paul Klinika, Bytom, POL
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Carrière ME, Tyack Z, Westerman MJ, Pleat J, Pijpe A, van Zuijlen PPM, de Vet HCW, Mokkink LB. From qualitative data to a measurement instrument: A clarification and elaboration of choices made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale (POSAS) 3.0. Burns 2023; 49:1541-1556. [PMID: 36914442 DOI: 10.1016/j.burns.2023.02.009] [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: 09/27/2022] [Revised: 02/05/2023] [Accepted: 02/19/2023] [Indexed: 02/24/2023]
Abstract
PURPOSE To clarify and elaborate on the choices that were made in the development of the Patient Scale of the Patient and Observer Scar Assessment Scale 3.0 (POSAS 3.0), based upon the rich information obtained from patients during focus groups and pilot tests. METHODS The discussions described in this paper are a reflection of the focus group study and pilot tests that were conducted in order to develop the Patient Scale of the POSAS3.0. The focus groups took place in the Netherlands and Australia and included 45 participants. Pilot tests were performed with 15 participants in Australia, the Netherlands, and the United Kingdom. RESULTS We discussed the selection, wording and merging of 17 included items. Additionally, the reason for exclusion of 23 characteristics are given. CONCLUSION Based upon the unique and rich material of patient input obtained, two versions of the Patient Scale of the POSAS3.0 were developed: the Generic version, and the Linear scar version. The discussions and decisions taken during the development are informative for a good understanding of the POSAS 3.0 and are indispensable as a background for future translations and cross-cultural adaptations.
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Affiliation(s)
- M E Carrière
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Association of Dutch Burn centers, Beverwijk, the Netherlands.
| | - Z Tyack
- Child Health Research Centre, University of Queensland, Brisbane, Australia
| | - M J Westerman
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Division of Life Science, Amsterdam UMC, VU University, Amsterdam, the Netherlands
| | - J Pleat
- Department of Plastic and Reconstructive Surgery, North Bristol NHS Trust, Bristol, United Kingdom
| | - A Pijpe
- Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Association of Dutch Burn centers, Beverwijk, the Netherlands
| | - P P M van Zuijlen
- Burn center and Department of Plastic, Reconstructive and Hand surgery, Red Cross Hospital, Beverwijk, the Netherlands; Department of Plastic, Reconstructive and Hand surgery, Amsterdam UMC (location VUmc), Amsterdam Movement Sciences, Amsterdam, the Netherlands; Pediatric Surgical Centre, Emma Children's Hospital, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
| | - H C W de Vet
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
| | - L B Mokkink
- Department of Epidemiology and Data Science, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Amsterdam Public Health research institute, Amsterdam, the Netherlands
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4
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Garg SP, Williams T, Taritsa IC, Wan R, Goel C, Harris R, Huffman K, Galiano RD. Evaluating skin colour diversity in the validation of scar assessment tools. Wound Repair Regen 2023; 31:731-737. [PMID: 37768279 DOI: 10.1111/wrr.13120] [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: 06/20/2023] [Revised: 08/23/2023] [Accepted: 09/13/2023] [Indexed: 09/29/2023]
Abstract
Across scar studies, there is a lack of dark-skinned individuals, who have a predisposition for keloid formation, altered pigmentation and poorer quality of life (QOL). There is a need for patients of colour to be included in scar scale development and validation. In this study, we evaluate the racial diversity of patients included in the validation of scar assessment scales. A systematic review was conducted for articles reporting on the validation of a scar assessment tool. Racial, ethnic and Fitzpatrick skin type (FST) data were extracted. Fifteen scar scale validation studies were included. Nine of the studies did not mention FST, race or ethnicity of the patients. Two of the studies that reported FST or race information only included White patients or included no FST V/VI patients: mapping assessment of scars (MAPS) and University of North Carolina '4P'. Only four studies included non-White patients or dark-skinned patients in the validation of their scar scale: the modified Vancouver Scar Scale (VSS), modified Patient and Observer Scar Assessment Scale (POSAS), acne QOL and SCAR-Q scales. The patients included in the modified VSS validation were 7% and 13% FST V/VI, 14% African in the modified POSAS and 4.5% FST V/VI in the SCAR-Q. We highlight the severe lack of diversity in scar scale validation, with only 4 out of 15 studies including dark-skinned patients. Given the susceptibility of darker-skinned individuals to have poorer scarring outcomes, it is critical to include patients of colour in the very assessment tools that determine their scar prognosis. Inclusion of patients of colour in scar scale development will improve scar assessment and clinical decision-making.
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Affiliation(s)
- Stuti P Garg
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Tokoya Williams
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Iulianna C Taritsa
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Rou Wan
- Division of Plastic & Reconstructive Surgery, Mayo Clinic Rochester, Rochester, Minnesota, USA
| | - Chirag Goel
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Raiven Harris
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Kristin Huffman
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
| | - Robert D Galiano
- Division of Plastic & Reconstructive Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois, USA
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Drake VE, Moyer JS. The Measure of a Scar: Patient Perceptions and Scar Optimization after Skin Cancer Reconstruction. Facial Plast Surg 2023; 39:501-507. [PMID: 37290453 DOI: 10.1055/s-0043-1769807] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/10/2023] Open
Abstract
In facial reconstruction after skin cancer resection, management and optimization of postoperative scar is a complex paradigm. Every scar is unique and presents a different challenge-whether due to anatomic, aesthetic, or patient-specific factors. This necessitates a comprehensive evaluation and an understanding of the tools at hand to improve its appearance. How a scar looks is meaningful to patients, and the facial plastic and reconstructive surgeon is tasked with its optimization. Clear documentation of a scar is critical to assess and determine optimal care. Scar scales such as the Vancouver Scar Scale, the Manchester Scar Scale, the Patient and Observer Assessment Scale, the Scar Cosmesis Assessment and Rating "SCAR" Scale, and FACE-Q, among others, are reviewed here in the context of evaluating postoperative or traumatic scar. Measurement tools objectively describe a scar and may also incorporate the patient's assessment of their own scar. In addition to physical exam, these scales quantify scars that are symptomatic or visually unpleasant and would be best served by adjuvant treatment. The current literature regarding the role of postoperative laser treatment is also reviewed. While lasers are an excellent tool to assist in blending of scar and decreasing pigmentation, studies have failed to evaluate laser in a consistent, standardized way that allows for quantifiable and predictable improvement. Regardless, patients may derive benefit from laser treatment given the finding of subjective improvement in their own perception of scar, even when there is not a significant change to the clinician's eye. This article also discusses recent eye fixation studies which demonstrate the importance of careful repair of large and central defects of the face, and that patients value the quality of the reconstruction.
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Affiliation(s)
- Virginia E Drake
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Livonia, Michigan
| | - Jeffrey S Moyer
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology - Head and Neck Surgery, University of Michigan, Livonia, Michigan
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Lassig AAD, Lindgren BR, Wilson AC, Joseph AM, Davison M, Yueh B. InCISE: Instrument for Comprehensive Incisional and Surgical Evaluation. Laryngoscope 2023; 133:2166-2173. [PMID: 36226730 PMCID: PMC10097828 DOI: 10.1002/lary.30439] [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: 06/08/2022] [Revised: 08/22/2022] [Accepted: 09/27/2022] [Indexed: 11/12/2022]
Abstract
OBJECTIVE The evaluation of healing after head and neck surgery is currently qualitative and non-standardized, limiting the quality of surgical healing assessments in clinical and research settings. We sought to develop an objective, standardized wound assessment score, and hypothesize that a reliable instrument can be developed to evaluate head and neck surgical wounds. METHODS A prospective cohort study was conducted in a tertiary-care, academic head and neck surgery practice. Patients undergoing head and neck surgery were enrolled. A digital photograph protocol was developed for evaluating healing surgical wounds. A panel of experts developed and refined a wound healing score and established reliability, reproducibility, internal consistency, and validity of the score. RESULTS InCISE: Instrument for comprehensive incisional and surgical evaluation was created. The utility of our wound healing score was assessed using classical test theory. We performed the major steps of establishing reliability in head and neck surgeons: (1) internal consistency (Cronbach's α = 0.81), (2) inter-observer reliability (intra-class correlation = 0.76), and (3) intra-rater reliability (intra-class correlation = 0.87), and content validity (through focus groups). Our composite measure was found to have strong internal consistency, inter-rater reliability, and intra-rater reliability. Preliminary work suggests criterion validity via associations with physical health related quality of life (SF-12). CONCLUSION A wound healing score for head and neck surgery, InCISE, has been developed and is reliable, reproducible, and consistent. Although content validity is present and criterion validity is suggested, work continues to establish validity in this instrument to allow for expanded clinical and research use. LEVEL OF EVIDENCE NA Laryngoscope, 133:2166-2173, 2023.
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Affiliation(s)
- Amy Anne D. Lassig
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin Healthcare Research Institute / Hennepin County Medical Center, Minneapolis, MN USA
| | - Bruce R. Lindgren
- Biostatistics and Bioinformatics Core, Masonic Cancer Center, University of Minnesota, Minneapolis, MN USA
| | - Anna C. Wilson
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, Hennepin Healthcare Research Institute / Hennepin County Medical Center, Minneapolis, MN USA
| | - Anne M. Joseph
- Department of Medicine, Division of General Internal Medicine, University of Minnesota, Minneapolis, MN USA
| | - Mark Davison
- Department of Education, University of Minnesota, Minneapolis, MN USA
| | - Bevan Yueh
- Department of Otolaryngology – Head and Neck Surgery, Division of Head and Neck Surgery, University of Minnesota, Minneapolis, MN USA
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Patient-reported Outcomes of Scar Impact: Comparing of Abdominoplasty, Breast Surgery, and Facial Surgery Patients. Plast Reconstr Surg Glob Open 2022; 10:e4574. [PMID: 36246077 PMCID: PMC9555912 DOI: 10.1097/gox.0000000000004574] [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: 01/03/2022] [Accepted: 08/11/2022] [Indexed: 11/06/2022]
Abstract
Scarring negatively impacts patient mental health, causing worsened self-confidence, body image, and social interactions, as well as anxiety and depression. The objective of this study is to evaluate the scarring impact after facial surgery, breast surgery, and full abdominoplasty for symptoms, appearance, psychosocial health, career, and sexual well-being using validated patient-reported outcome measures.
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8
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Basson R, Bayat A. Skin scarring: Latest update on objective assessment and optimal management. Front Med (Lausanne) 2022; 9:942756. [PMID: 36275799 PMCID: PMC9580067 DOI: 10.3389/fmed.2022.942756] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Accepted: 07/19/2022] [Indexed: 11/13/2022] Open
Abstract
Although skin scarring is considered by some to be a minor, unavoidable consequence in response to skin injury, for many patients, cosmetically unsightly scars may cause uncomfortable symptoms and loss of function plus significant psycho-social distress. Despite their high prevalence and commonality, defining skin scars and their optimal management has proven problematic. Therefore, a literature search to assess the current evidence-base for scarring treatment options was conducted, and only those deemed Levels of Evidence 1 or 2 were included. Understanding the spectrum of skin scarring in the first instance is imperative, and is mainly comprised of four distinct endotypes; Stretched (flat), Contracted, Atrophic, and Raised for which the acronym S.C.A.R. may be used. Traditionally, scar assessment and response to therapy has employed the use of subjective scar scales, although these are now being superseded by non-invasive, objective and quantitative measurement devices. Treatment options will vary depending on the specific scar endotype, but fall under one of 3 main categories: (1) Leave alone, (2) Non-invasive, (3) Invasive management. Non-invasive (mostly topical) management of skin scarring remains the most accessible, as many formulations are over-the-counter, and include silicone-based, onion extract-based, and green tea-based, however out of the 52 studies identified, only 28 had statistically significant positive outcomes. Invasive treatment options includes intralesional injections with steroids, 5-FU, PDT, and laser with surgical scar excision as a last resort especially in keloid scar management unless combined with an appropriate adjuvant therapy. In summary, scar management is a rapidly changing field with an unmet need to date for a structured and validated approach.
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Affiliation(s)
- Rubinder Basson
- Wound Healing Theme, NIHR Manchester Biomedical Research Centre, Centre for Dermatology Research, University of Manchester, Manchester, United Kingdom
| | - Ardeshir Bayat
- Wound Healing Theme, NIHR Manchester Biomedical Research Centre, Centre for Dermatology Research, University of Manchester, Manchester, United Kingdom,Wound Healing Unit, Medical Research Council (South Africa), Division of Dermatology, University of Cape Town, Cape Town, South Africa,*Correspondence: Ardeshir Bayat,
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Is massage an effective intervention in the management of post-operative scarring? A scoping review. J Hand Ther 2022; 35:186-199. [PMID: 35227556 DOI: 10.1016/j.jht.2022.01.004] [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: 07/01/2021] [Revised: 11/21/2021] [Accepted: 01/21/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND Scar massage is a widely used treatment modality in hand therapy. This intervention is thoroughly discussed in the literature relating to burns rehabilitation, however, the evidence for its use in treating linear scars following surgery is limited. PURPOSE OF STUDY To collate the empirical literature on scar massage for the treatment of postsurgical cutaneous scars. STUDY DESIGN Scoping review. METHODS Medline, EMBASE, CINAHL, AMED, Scopus, ProQuest Dissertations & Theses Global, and the Joanna Briggs Institute were searched from inception to December 2020. Two researchers used a data extraction tool to record key demographic, intervention and outcome data, and to apply the Oxford Levels of Evidence for each study. RESULTS Twenty-five studies met the inclusion criteria, reporting on a combined sample of 1515 participants. Only two papers addressed hand or wrist scars (92 participants). While all studies reported favorable outcomes for scar massage, there were 45 different outcome measures used and a propensity towards non-standardized assessment. Intervention protocols varied from a single session to three treatments daily for 6 months. The results from 13 studies were confounded by the implementation of additional rehabilitation interventions. CONCLUSIONS The overall findings suggest that while there may be benefits to scar massage in reducing pain, increasing movement and improving scar characteristics; there is a lack of consistent research methods, intervention protocols and outcome measures. This scoping review highlights the heterogenous nature of research into scar massage following surgery and supports the need for further research to substantiate its use in the clinical setting.
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Ramanathan D, Chu S, Prendes M, Carroll BT. Validated Outcome Measures and Postsurgical Scar Assessment Instruments in Eyelid Surgery: A Systematic Review. Dermatol Surg 2021; 47:914-920. [PMID: 33988553 DOI: 10.1097/dss.0000000000003077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Determining which postsurgical scar assessment instruments, if any, cover important eyelid outcome measures can either attest to the strength of one or more instruments or reveal the need for a more comprehensive scale. OBJECTIVE To systematically review validated outcome measures after eyelid surgery and postsurgical scar assessment tools to see whether any individual or combination of 2 assessment tools encompass all relevant, validated eyelid outcome measures. METHODS Systematic reviews of validated eyelid outcome measures and postsurgical scar assessment tools were conducted using PubMed/MEDLINE and Ovid. Outcome measure papers that met inclusion criteria were sorted into 8 categories: Patient Subjective, Visual Function, Mechanical Function, Daily Activities, Adverse Effects, Aesthetic Quantitative: Clinical Measurements, Aesthetic Qualitative: Global, and Aesthetic Qualitative: Specific. Outcome measure papers were categorized into tiers of evidence support, and assessment tools were evaluated based on which outcome measures each covered. RESULTS No one or combination of 2 assessment tools covered all selected eyelid outcome measures. Although measures related to the subjective patient experience were included in several of the assessment scales, none covered measures of visual function or eyelid-specific clinical measurements. CONCLUSION There is currently no existing postsurgical scar assessment instrument that covers all important eyelid-specific outcome measures.
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Affiliation(s)
- Diya Ramanathan
- Case Western Reserve University School of Medicine, Cleveland, Ohio
| | - Sherman Chu
- Western University of Health Sciences, College of Osteopathic Medicine of the Pacific, Northwest, Lebanon, Oregon
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
| | - Mark Prendes
- Department of Ophthalmology and Visual Sciences, University Hospitals, Case Western
- Reserve University School of Medicine, Cleveland, Ohio
| | - Bryan T Carroll
- Case Western Reserve University School of Medicine, Cleveland, Ohio
- Department of Dermatology, University Hospitals Cleveland Medical Center, Cleveland, Ohio
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Choo AMH, Ong YS, Issa F. Scar Assessment Tools: How Do They Compare? Front Surg 2021; 8:643098. [PMID: 34250003 PMCID: PMC8260845 DOI: 10.3389/fsurg.2021.643098] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2020] [Accepted: 05/20/2021] [Indexed: 11/13/2022] Open
Abstract
Healing after dermal injury is a complex but imperfect process that results in a wide range of visible scars. The degree of disfigurement is not the sole determinant of a scar's effect on patient well-being, with a number of other factors being critical to outcome. These include cosmetic appearance, symptoms such as itch and pain, functional loss, psychological or social problems, and quality of life. An accurate assessment of these domains can help clinicians measure outcomes, develop, and evaluate treatment strategies. A PubMed literature search was performed up to 31st March 2020. Ten objective scar measurements, four Clinician-Reported Outcome Measures (CROMs), six Patient-Reported Outcome Measures (PROMs), and one combined measure were evaluated for their reliability, clinical relevance, responsiveness to clinical change, and feasibility. Many quantitative tools were limited in their clinical relevance and feasibility, whereas few qualitative CROMs and PROMs have undergone rigorous assessment. This review examines currently available assessment tools, focusing primarily on subjective scar measurements (CROMs, PROMs), and offers a perspective on future directions in the field.
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Affiliation(s)
| | - Yee Siang Ong
- Department of Plastics, Reconstructive and Aesthetic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Fadi Issa
- Department of Plastic Surgery and Burns, Buckinghamshire Healthcare NHS Trust, Aylesbury, United Kingdom.,Medical Sciences Division, Nuffield Department of Surgical Sciences, University of Oxford, Oxford, United Kingdom
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Daily Quality-of-life Impact of Scars: An Interview-based Foundational Study of Patient-reported Themes. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2021; 9:e3522. [PMID: 33868874 PMCID: PMC8049395 DOI: 10.1097/gox.0000000000003522] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2020] [Accepted: 01/07/2021] [Indexed: 11/26/2022]
Abstract
Background: Scars negatively impact mental health. Prior patient interview studies on cutaneous scars have elicited opinions pertaining to psychosocial effects, appearance, and symptoms. There remains a need for patient-reported opinions in broader contexts, including career and sexual well-being, to better understand patients’ experiences with their cutaneous scars. Methods: In this qualitative study, patients with cutaneous scars participated in semi-structured interviews. Transcripts were analyzed using a constant comparative approach using the data software QDAMiner, to generate a thematic framework encompassing patients’ experience with cutaneous scars. Results: In total, 37 patients aged 25–79 years (mean 45, SD 17.9) were interviewed. Patients presented with keloid (2/37, 5%), hypertrophic (5/37, 14%), atrophic (4/37, 11%), and linear surgical (18/37, 49%) scars. Opinions fell under 8 overarching themes. Patients spoke commonly about psychological and social well-being (references to the frequency of thinking about a scar and talking about scars with others were mentioned 56 times by 26 patients and 103 times by 29 patients, respectively, for example). Discussions of sexual well-being and career were elicited but rarer (references to feeling uncomfortable when naked and negative impacts on professional networking were mentioned 17 times by 7 patients and 5 times by 3 patients, respectively, for example). Conclusions: The relationship between determinants of patients’ opinions of their scars and their impact on quality-of-life is complex. These results expand upon the existing knowledge of the effects scars have on quality-of-life and can contribute to the development and validation of future scar outcome measures.
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13
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Armstrong EA, Ejaz A, Sarna A, Conteh L, Tsung A, Pawlik TM, Cloyd JM. A Cross-Sectional Evaluation of Quality of Life Among Patients with Hepatic Adenomas. J Gastrointest Surg 2020; 24:2862-2864. [PMID: 32865734 DOI: 10.1007/s11605-020-04780-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Affiliation(s)
- Emily A Armstrong
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, 410 W 10th Ave, N907 Doan Hall, Columbus, OH, 43210-1267, USA
| | - Aslam Ejaz
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, 410 W 10th Ave, N907 Doan Hall, Columbus, OH, 43210-1267, USA
| | - Angela Sarna
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, 410 W 10th Ave, N907 Doan Hall, Columbus, OH, 43210-1267, USA
| | - Lanla Conteh
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, 410 W 10th Ave, N907 Doan Hall, Columbus, OH, 43210-1267, USA
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, 410 W 10th Ave, N907 Doan Hall, Columbus, OH, 43210-1267, USA
| | - Timothy M Pawlik
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, 410 W 10th Ave, N907 Doan Hall, Columbus, OH, 43210-1267, USA
| | - Jordan M Cloyd
- Department of Surgery, Division of Surgical Oncology, The Ohio State University Wexner, 410 W 10th Ave, N907 Doan Hall, Columbus, OH, 43210-1267, USA.
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Grigoryan KV, Kampp JT. Summary and evidence grading of over‐the‐counter scar treatments. Int J Dermatol 2020; 59:1136-1143. [DOI: 10.1111/ijd.15060] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/11/2020] [Accepted: 06/18/2020] [Indexed: 11/30/2022]
Affiliation(s)
| | - Jeremy T. Kampp
- Division of Dermatology University of Washington Seattle WA USA
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Restrepo S, Rojas S, Sanabria A. Cross-cultural adaptation and psychometric validation of the Patient Scar Assessment Questionnaire to the Spanish language in head and neck surgery. Int Wound J 2019; 17:21-31. [PMID: 31680458 DOI: 10.1111/iwj.13218] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2019] [Accepted: 08/18/2019] [Indexed: 11/27/2022] Open
Abstract
External appearance is the main aesthetic outcome in patients who undergo surgical procedures. Scars located in exposed areas, such as the neck and face, are important for patients. There are at least eight instruments that are used to evaluate postoperative scars, but few fulfil standard methodological conditions. The Patient Scar Assessment Questionnaire (PSAQ) was designed and validated using psychometric methodology. However, this scale has not been translated or validated in the Spanish language. The aim of this study was to undergo a cross-cultural adaptation and psychometric validation of the PSAQ scale to the Spanish language in patients who underwent head and neck surgery. We followed The Professional Society for Health Economics and Outcomes Research (ISPOR) guidelines for the translation and validation of health-related scales. Forward and back translations were made by independent translators. We included adult patients who underwent thyroidectomy, parathyroidectomy, parotidectomy, and neck dissection. For the psychometric validation, we used a principal axis exploratory factor analysis with oblimin rotation. A reliability test involving Cronbachs alpha and the item-total correlation was performed and for the convergent/concurrent validity, we selected the Spanish version of the Vancouver Scar Scale. A total of 180 patients were recruited. Factor analysis showed a five-factor solution. Cronbachs alpha for the subscales was >0.7. The comparison between the PSAQ appearance subscale and the VSS demonstrated a high correlation (rho = - 0.89). In a sample of 62 patients, the test-retest evaluation showed high correlation (0.74-0.99). Our study supports the Spanish version of the PSAQ as a valid, reliable, and reproducible tool to assess the perception and impact of neck scars in Spanish-speaking patients who undergo head and neck surgery.
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Affiliation(s)
- Santiago Restrepo
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Santiago Rojas
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia
| | - Alvaro Sanabria
- Department of Surgery, School of Medicine, Universidad de Antioquia, Medellín, Colombia.,Head and Neck Service, Fundación Colombiana de Cancerología-Clínica Vida, Medellín, Colombia.,Centro de Excelencia en Cirugía de Cabeza y Cuello, CEXCA, Medellín, Colombia
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The Brisbane Burn Scar Impact Profile (child and young person version) for measuring health-related quality of life in children with burn scars: A longitudinal cohort study of reliability, validity and responsiveness. Burns 2019; 45:1537-1552. [DOI: 10.1016/j.burns.2019.07.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2019] [Revised: 05/19/2019] [Accepted: 07/10/2019] [Indexed: 12/24/2022]
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Systematic Review on the Content of Outcome Measurement Instruments on Scar Quality. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2424. [PMID: 31741815 PMCID: PMC6799398 DOI: 10.1097/gox.0000000000002424] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2019] [Accepted: 07/09/2019] [Indexed: 12/02/2022]
Abstract
Supplemental Digital Content is available in the text. Measurements of scar quality are essential to evaluate the effectiveness of scar treatments and to monitor scars. A large number of scar scales and measurement devices have been developed, which makes instrument selection challenging. The aim of this study was to provide an overview of the content (ie, included items) of all outcome measurement instruments that measure scar quality in different types of scars (burn, surgical, keloid, and necrotizing fasciitis), and the frequency at which the instruments and included items are used.
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Matiasek J, Kienzl P, Unger LW, Grill C, Koller R, Turk BR. An intra-individual surgical wound comparison shows that octenidine-based hydrogel wound dressing ameliorates scar appearance following abdominoplasty. Int Wound J 2018; 15:914-920. [PMID: 29956471 DOI: 10.1111/iwj.12944] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 05/17/2018] [Accepted: 05/19/2018] [Indexed: 11/28/2022] Open
Abstract
Hypertrophic scar formation because of surgical procedures is associated with higher levels of pain, a lower quality of life, and poor cosmetic outcome and requires more resources in follow-up management. An octenidine-based hydrogel has been shown to modulate immunological function in an in vitro wound model, suggesting an improved scar formation. In this prospective, randomised, observer-blinded, and intra-patient-controlled study, 45 patients who underwent abdominoplasty or mastectomy with transverse rectus abdominis muscle (TRAM) flap reconstruction were given both a standard postoperative wound dressing on one wound side and an octenidine-based hydrogel with transparent film dressing, covered with standard postoperative dressing on the other side. Four instances of hypertrophia were reported in the gel side versus 12 in the standard dressing side. Visual Analogue Scale (VAS) pain scores taken during postoperative dressing changes showed reduced scores on the gel side at all time points. Vancouver Scar Scale (VSS) scores showed improvement in the gel side at 3, 6, and 12 months postoperatively. Skin distensibility measured using a cutometer showed significantly improved measures in gel-treated wounds, similar to measures of healthy skin. Trans-epidermal water loss (TEWL), measured using a tewameter, showed improved values on the gel side soon after surgery, with both the control and the gel side normalising after approximately 6 months. The octenidine-based wound dressing demonstrates improved wound healing associated with a lower incidence of hypertrophic scar formation.
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Affiliation(s)
- Johannes Matiasek
- Department of Plastic and Reconstructive Surgery, St. Josef Hospital, Vienna, Austria.,Department of Plastic, Aesthetic and Reconstructive Surgery, Wilhelminen Hospital, Vienna, Austria
| | - Philip Kienzl
- Department of Dermatology, Division of Immunology, Allergy and Infectious Diseases (DIAID), Medical University of Vienna, Vienna, Austria
| | - Lukas W Unger
- Department of Surgery, Division of Transplantation, Medical University of Vienna, Vienna, Austria
| | - Christoph Grill
- Department of Plastic, Aesthetic and Reconstructive Surgery, Wilhelminen Hospital, Vienna, Austria
| | - Rupert Koller
- Department of Plastic, Aesthetic and Reconstructive Surgery, Wilhelminen Hospital, Vienna, Austria
| | - Bela R Turk
- Department of Plastic and Reconstructive Surgery, St. Josef Hospital, Vienna, Austria.,Kennedy Krieger Institute, Johns Hopkins Medical Institutions, Baltimore, Maryland
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Development of a New Patient-reported Outcome Instrument to Evaluate Treatments for Scars: The SCAR-Q. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2018; 6:e1672. [PMID: 29876160 PMCID: PMC5977950 DOI: 10.1097/gox.0000000000001672] [Citation(s) in RCA: 53] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2017] [Accepted: 12/13/2017] [Indexed: 11/28/2022]
Abstract
Background: Every year millions of individuals acquire scars. A literature review of patient-reported outcome (PRO) instruments identified content limitations in existing scar-specific measures. The aim of this study was to develop a new PRO instrument called SCAR-Q for children and adults with surgical, traumatic, and burn scars. Methods: We performed a secondary analysis of the qualitative datasets used in the development of PRO instruments for plastic and reconstructive surgery, that is, BREAST-Q, FACE-Q, BODY-Q, and CLEFT-Q. The keyword “scar*” was used to extract scar-specific text. Data were analyzed to identify concepts of interest and to form a comprehensive item pool. Scales were developed and refined through multiple rounds of cognitive interviews with patients and with input from international clinical experts between July 2015 and December 2016. Results: A total of 52 children and 192 adults from the qualitative datasets provided between 1 and 34 scar-specific codes (n = 1,227). The analysis led to the identification of 3 key domains for which scales were developed: scar appearance (eg, size, color, contour), scar symptoms (eg, painful, tight, itchy), and psychosocial impact (eg, feeling self-conscious, bothered by scar). Cognitive interviews with 25 adults and 20 pediatric participants with scars, plus feedback from 27 clinical experts, led to rewording and removal of items, and new items added. These steps ensured content validity for SCAR-Q in a broad range of scars. Conclusions: The SCAR-Q is now being field-tested. Once completed, we anticipate SCAR-Q will be used in clinical practice and in clinical trials to test different scar therapies.
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Tyack Z, Kimble R, McPhail S, Plaza A, Simons M. Psychometric properties of the Brisbane Burn Scar Impact Profile in adults with burn scars. PLoS One 2017; 12:e0184452. [PMID: 28902874 PMCID: PMC5597202 DOI: 10.1371/journal.pone.0184452] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Accepted: 08/24/2017] [Indexed: 01/23/2023] Open
Abstract
Objective The aim of the study was to determine the longitudinal validity, reproducibility, responsiveness and interpretability of the adult version of the Brisbane Burn Scar Impact Profile, a patient-report measure of health-related quality of life. Methods A prospective longitudinal cohort study of patients with or at risk of burn scarring was conducted at three assessment points (at baseline around the time of wound healing, one to two weeks post-baseline and 1-month post-baseline). Participants attending a major metropolitan adult burn centre at baseline were recruited. Participants completed the Brisbane Burn Scar Impact Profile and the 36-item Short Form Health Survey and Patient Observer Scar Assessment Scale. Intraclass Correlation Coefficients (ICCs), smallest detectable change, percentage of those who improved, stayed the same or worsened and Area under the Receiver Operating Characteristic Curve (AUC) were used to test the aim. Results Data were included for 118 participants at baseline, 68 participants at one to two weeks and 57 participants at 1-month post-baseline. All groups of items had acceptable reproducibility, except for the overall impact of burn scars (ICC = 0.69), the impact of sensations which was not expected to be stable (ICC = 0.63), mobility and daily activities (ICC = 0.63, 0.67 respectively). The responsiveness of six out of seven groups of items able to be tested against external criterion was supported (AUC = 0.72–0.75). Hypothesised correlations of changes in the Brisbane Burn Scar Impact Profile items with changes in criterion measures generally supported longitudinal validity (e.g., nine out of thirteen hypotheses using the SF-36 as an external criterion were supported). Internal consistency estimates, item-total and inter-item correlations indicated there was likely redundancy of some groups of items, particularly in the relationships and social interaction, appearance and emotional reactions items (Chronbach’s alpha range = 0.94–0.95). Conclusion Support was found for the reproducibility, longitudinal validity, responsiveness and interpretability of most groups of Brisbane Burn Scar Impact Profile items and some individual items in the test population. Potential redundancy of items should be investigated further.
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Affiliation(s)
- Zephanie Tyack
- Centre for Children’s Burns and Trauma Research, Children’s Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- * E-mail:
| | - Roy Kimble
- Centre for Children’s Burns and Trauma Research, Children’s Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
| | - Steven McPhail
- Institute of Health and Biomedical Innovation and School of Public Health and Social Work, Queensland University of Technology, Kelvin Grove, Queensland, Australia
- Centre for Functioning and Health Research, Metro South Health, Buranda, Australia
| | - Anita Plaza
- Royal Brisbane and Women’s Hospital, Herston, Queensland, Australia
| | - Megan Simons
- Centre for Children’s Burns and Trauma Research, Children’s Health Research Centre, The University of Queensland, South Brisbane, Queensland, Australia
- Department of Occupational Therapy, Lady Cilento Children’s Hospital, South Brisbane, Queensland, Australia
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Mundy LR, Miller HC, Klassen AF, Cano SJ, Pusic AL. Patient-Reported Outcome Instruments for Surgical and Traumatic Scars: A Systematic Review of their Development, Content, and Psychometric Validation. Aesthetic Plast Surg 2016; 40:792-800. [PMID: 27357634 PMCID: PMC5505642 DOI: 10.1007/s00266-016-0642-9] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Accepted: 04/15/2016] [Indexed: 11/27/2022]
Abstract
BACKGROUND Patient-reported outcomes (PROs) are of growing importance in research and clinical care and may be used as primary outcomes or as compliments to traditional surgical outcomes. In assessing the impact of surgical and traumatic scars, PROs are often the most meaningful. To assess outcomes from the patient perspective, rigorously developed and validated PRO instruments are essential. METHODS The authors conducted a systematic literature review to identify PRO instruments developed and/or validated for patients with surgical and/or non-burn traumatic scars. Identified instruments were assessed for content, development process, and validation under recommended guidelines for PRO instrument development. RESULTS The systematic review identified 6534 articles. After review, we identified four PRO instruments meeting inclusion criteria: patient and observer scar assessment scale (POSAS), bock quality of life questionnaire for patients with keloid and hypertrophic scarring (Bock), patient scar assessment questionnaire (PSAQ), and patient-reported impact of scars measure (PRISM). Common concepts measured were symptoms and psychosocial well-being. Only PSAQ had a dedicated appearance domain. Qualitative data were used to inform content for the PSAQ and PRISM, and a modern psychometric approach (Rasch Measurement Theory) was used to develop PRISM and to test POSAS. Overall, PRISM demonstrated the most rigorous design and validation process, however, was limited by the lack of a dedicated appearance domain. CONCLUSIONS PRO instruments to evaluate outcomes in scars exist but vary in terms of concepts measured and psychometric soundness. This review discusses the strengths and weaknesses of existing instruments, highlighting the need for future scar-focused PRO instrument development. LEVEL OF EVIDENCE IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Lily R Mundy
- College of Physicians and Surgeons, Columbia University, 630 West 168th Street, New York, NY, USA
| | - H Catherine Miller
- School of Medicine, University of Washington, 4333 Brooklyn Avenue Northeast, Seattle, WA, USA
| | - Anne F Klassen
- Departments of Pediatrics and Clinical Epidemiology & Biostatistics, McMaster University, 1280 Main Street West, Hamilton, ON, Canada
| | - Stefan J Cano
- Clinical Neurology Research Group, Peninsula Schools of Medicine and Dentistry, Plymouth University, Drake Circus, Plymouth, Devon, UK
| | - Andrea L Pusic
- Plastic and Reconstructive Service, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10065, USA.
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Clinimetric properties and clinical utility in rehabilitation of postsurgical scar rating scales: a systematic review. Int J Rehabil Res 2016; 38:279-86. [PMID: 26426285 DOI: 10.1097/mrr.0000000000000134] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this study was to review and critically assess the most used and clinimetrically sound outcome measures currently available for postsurgical scar assessment in rehabilitation. We performed a systematic review of the Medline and Embase databases to June 2015. All published peer-reviewed studies referring to the development, validation, or clinical use of scales or questionnaires in patients with linear scars were screened. Of 922 articles initially identified in the literature search, 48 full-text articles were retrieved for assessment. Of these, 16 fulfilled the inclusion criteria for data collection. Data were collected pertaining to instrument item domains, validity, reliability, and Rasch analysis. The eight outcome measures identified were as follows: Vancouver Scar Scale, Dermatology Life Quality Index, Manchester Scar Scale, Patient and Observer Scar Assessment Scale, Bock Quality of Life (Bock QoL) questionnaire, Stony Brook Scar Evaluation Scale, Patient-Reported Impact of Scars Measure, and Patient Scar Assessment Questionnaire. Scales were examined for their clinimetric properties, and recommendations for their clinical or research use and selection were made. There is currently no absolute gold standard to be used in rehabilitation for the assessment of postsurgical scars, although the Patient and Observer Scar Assessment Scale and the Patient-Reported Impact of Scars Measure emerged as the most robust scales.
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Abstract
Introduction Scarring on visible areas such as the face is associated with negative psychological impact. Many patients with acne have clinically relevant scarring for which they seek treatment, implying that there is an impact on their lives. Currently there are no validated tools to assess the burden of atrophic acne scarring from the patient’s perspective or to assess treatment benefit. Methods Two patient-reported outcome measures, the self-assessment of clinical acne-related scars (SCARS) and the facial acne scar quality of life (FASQoL) tools, both specific to facial atrophic acne scarring, were developed according to Food and Drug Administration guidance methodology. Patient interviews were conducted first to elicit patient-important concepts about scarring, then to validate patients’ understanding of wording in the tools. These tools focus on symptoms (SCARS) and psychological and social well-being (FASQoL) and were designed to be suitable for self-completion and to be rapidly completed (2–5 min) within a clinical research setting. Results Concept elicitation interviews were conducted with 30 subjects and cognitive interviews with 20 subjects. With acne scarring, important concepts for patients included size, surface area affected, counts, and depth. The SCARS and FASQoL tools were shown to address relevant concepts that were easily understood by patients. Conclusion Two patient-reported measures, SCARS and FASQoL, have been developed to help clinicians assess the severity and impact of acne scars. Responsivity of these instruments to treatment will require further evaluation. Funding Galderma R&D, Sophia Antipolis, France. Electronic supplementary material The online version of this article (doi:10.1007/s13555-016-0098-5) contains supplementary material, which is available to authorized users.
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Patient experiences of burn scars in adults and children and development of a health-related quality of life conceptual model: A qualitative study. Burns 2016; 42:620-32. [PMID: 26803365 DOI: 10.1016/j.burns.2015.11.012] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2015] [Revised: 11/10/2015] [Accepted: 11/16/2015] [Indexed: 11/21/2022]
Abstract
PURPOSE The aim of this study was to understand the impact of burn scars on health-related quality of life (HRQOL) from the perspective of adults and children with burn scars, and caregivers to inform the development of a conceptual model of burn scar HRQOL. METHOD Twenty-one participants (adults and children) with burn scars and nine caregivers participated in semi-structured, face-to-face interviews between 2012 and 2013. During the interviews, participants were asked to describe features about their (or their child's) burn scars and its impact on everyday life. Two coders conducted thematic analysis, with consensus achieved through discussion and review with a third coder. The literature on HRQOL models was then reviewed to further inform the development of a conceptual model of burn scar HRQOL. RESULTS Five themes emerged from the qualitative data: 'physical and sensory symptoms', 'impact of burn scar interventions', 'impact of burn scar symptoms', 'personal factors' and 'change over time'. Caregivers offered further insights into family functioning after burn, and the impacts of burn scars and burn scar interventions on family life. In the conceptual model, symptoms (sensory and physical) of burn scars are considered proximal to HRQOL, with distal indicators including functioning (physical, emotional, social, cognitive), individual factors and the environment. Overall quality of life was affected by HRQOL. CONCLUSION Understanding the impact of burn scars on HRQOL and the development of a conceptual model will inform future burn scar research and clinical practice.
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Abstract
Nonsuicidal self-injury (NSSI) has emerged as a significant mental health concern over the past several years. Accordingly, it is imperative that mental health professionals be able to draw upon and use approaches that meet the needs of those who report NSSI enactment. Notwithstanding the utility inherent in published recommendations for NSSI assessment and intervention, the aspect of NSSI scarring and its potential impact on those who have self-injured seems to be largely overlooked. Indeed, there is emerging evidence that people's perceptions of their NSSI scars may thwart NSSI recovery. This commentary highlights what is currently known about NSSI scarring and its potential impact on individuals who have self-injured. From here, and based on the state of evidence in this nascent area, tentative albeit practical suggestions for assessment and intervention are presented.
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Tyack Z, Ziviani J, Kimble R, Plaza A, Jones A, Cuttle L, Simons M. Measuring the impact of burn scarring on health-related quality of life: Development and preliminary content validation of the Brisbane Burn Scar Impact Profile (BBSIP) for children and adults. Burns 2015; 41:1405-19. [PMID: 26421693 DOI: 10.1016/j.burns.2015.05.021] [Citation(s) in RCA: 69] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2015] [Revised: 05/29/2015] [Accepted: 05/29/2015] [Indexed: 12/26/2022]
Abstract
INTRODUCTION No burn-scar specific, health-related quality of life (HRQOL) measure exists. This study aimed to develop a patient-reported, evaluative HRQOL measure to assess the impact of burn scarring in children and adults. METHOD Semi-structured interviews, content validation surveys, and cognitive interviews were used to develop and test content validity of a new measure - the Brisbane Burn Scar Impact Profile (BBSIP). RESULTS Participants comprised Australian adults (n=23) and children (n=19) with burn scarring; caregivers of children with burn scarring (n=28); and international scar management experts (n=14). Items distinct from other burn scar measures emerged. Four versions of the BBSIP were developed; one for children aged 8-18 years, one for adults, one for caregivers (as proxies for children aged less than 8-years), and one for caregivers of children aged 8-18 years. Preliminary content validity of the BBSIP was supported. Final items covered physical and sensory symptoms; emotional reactions; impact on social functioning and daily activities; impact of treatment; and environmental factors. CONCLUSION The BBSIP was developed to assess burn-scar specific HRQOL and will be available at http://www.coolburns.com.au under a creative commons license. Further testing is underway.
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Affiliation(s)
- Zephanie Tyack
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 4, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland 4006, Australia; Central Queensland Hospital and Health Service, East St, Rockhampton, Queensland 4700, Australia.
| | - Jenny Ziviani
- School of Health and Rehabilitation Sciences, The University of Queensland, St Lucia, Brisbane, Queensland 4067, Australia.
| | - Roy Kimble
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 4, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland 4006, Australia; Department of Paediatric Surgery, Urology, Neonatal Surgery, Burns and Trauma, Lady Cilento Children's Hospital, Brisbane, Queensland 4101, Australia; School of Medicine, The University of Queensland, St Lucia, Brisbane, Queensland 4067, Australia.
| | - Anita Plaza
- Physiotherapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, Queensland 4006, Australia.
| | - Amber Jones
- Occupational Therapy Department, Royal Brisbane and Women's Hospital, Butterfield St, Herston, Brisbane, Queensland 4006, Australia.
| | - Leila Cuttle
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 4, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland 4006, Australia.
| | - Megan Simons
- Centre for Children's Burns and Trauma Research, Child Health Research Centre, Level 4, Foundation Building, Royal Children's Hospital, Herston Rd, Herston, Brisbane, Queensland 4006, Australia; Department of Occupational Therapy, Lady Cilento Children's Hospital, 501 Stanley St, South Brisbane, Queensland 4101, Australia.
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Walton MK, Powers JH, Hobart J, Patrick D, Marquis P, Vamvakas S, Isaac M, Molsen E, Cano S, Burke LB. Clinical Outcome Assessments: Conceptual Foundation-Report of the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2015; 18:741-52. [PMID: 26409600 PMCID: PMC4610138 DOI: 10.1016/j.jval.2015.08.006] [Citation(s) in RCA: 176] [Impact Index Per Article: 19.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/07/2015] [Accepted: 08/07/2015] [Indexed: 05/06/2023]
Abstract
An outcome assessment, the patient assessment used in an endpoint, is the measuring instrument that provides a rating or score (categorical or continuous) that is intended to represent some aspect of the patient's health status. Outcome assessments are used to define efficacy endpoints when developing a therapy for a disease or condition. Most efficacy endpoints are based on specified clinical assessments of patients. When clinical assessments are used as clinical trial outcomes, they are called clinical outcome assessments (COAs). COAs include any assessment that may be influenced by human choices, judgment, or motivation. COAs must be well-defined and possess adequate measurement properties to demonstrate (directly or indirectly) the benefits of a treatment. In contrast, a biomarker assessment is one that is subject to little, if any, patient motivational or rater judgmental influence. This is the first of two reports by the ISPOR Clinical Outcomes Assessment - Emerging Good Practices for Outcomes Research Task Force. This report provides foundational definitions important for an understanding of COA measurement principles. The foundation provided in this report includes what it means to demonstrate a beneficial effect, how assessments of patients relate to the objective of showing a treatment's benefit, and how these assessments are used in clinical trial endpoints. In addition, this report describes intrinsic attributes of patient assessments and clinical trial factors that can affect the properties of the measurements. These factors should be considered when developing or refining assessments. These considerations will aid investigators designing trials in their choice of using an existing assessment or developing a new outcome assessment. Although the focus of this report is on the development of a new COA to define endpoints in a clinical trial, these principles may be applied more generally. A critical element in appraising or developing a COA is to describe the treatment's intended benefit as an effect on a clearly identified aspect of how a patient feels or functions. This aspect must have importance to the patient and be part of the patient's typical life. This meaningful health aspect can be measured directly or measured indirectly when it is impractical to evaluate it directly or when it is difficult to measure. For indirect measurement, a concept of interest (COI) can be identified. The COI must be related to how a patient feels or functions. Procedures are then developed to measure the COI. The relationship of these measurements with how a patient feels or functions in the intended setting and manner of use of the COA (the context of use) could then be defined. A COA has identifiable attributes or characteristics that affect the measurement properties of the COA when used in endpoints. One of these features is whether judgment can influence the measurement, and if so, whose judgment. This attribute defines four categories of COAs: patient reported outcomes, clinician reported outcomes, observer reported outcomes, and performance outcomes. A full description as well as explanation of other important COA features is included in this report. The information in this report should aid in the development, refinement, and standardization of COAs, and, ultimately, improve their measurement properties.
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Affiliation(s)
- Marc K Walton
- Janssen Research and Development, Titusville, NJ, USA.
| | - John H Powers
- Leidos Biomedical Research in support of the Division of Clinical Research, National Institutes of Health, Bethesda, MD, USA
| | - Jeremy Hobart
- Plymouth University Peninsula Schools of Medicine and Dentistry, Devon, UK
| | - Donald Patrick
- Seattle Quality of Life Group, Department of Health Services, University of Washington, Seattle, WA, USA
| | | | | | | | - Elizabeth Molsen
- International Society for Pharmacoeconomics and Outcomes Research, Lawrenceville, NJ, USA
| | | | - Laurie B Burke
- LORA Group, LLC, Royal Oak, MD, USA; Department of Health Services Research, University of Maryland School of Pharmacy, Baltimore, MD, USA
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Sidgwick GP, McGeorge D, Bayat A. A comprehensive evidence-based review on the role of topicals and dressings in the management of skin scarring. Arch Dermatol Res 2015; 307:461-77. [PMID: 26044054 PMCID: PMC4506744 DOI: 10.1007/s00403-015-1572-0] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2014] [Revised: 04/11/2015] [Accepted: 04/29/2015] [Indexed: 12/22/2022]
Abstract
Wound healing after dermal injury is an imperfect process, inevitably leading to scar formation as the skin re-establishes its integrity. The resulting scars have different characteristics to normal skin, ranging from fine-line asymptomatic scars to problematic scarring including hypertrophic and keloid scars. Scars appear as a different colour to the surrounding skin and can be flat, stretched, depressed or raised, manifesting a range of symptoms including inflammation, erythema, dryness and pruritus, which can result in significant psychosocial impact on patients and their quality of life. In this paper, a comprehensive literature review coupled with an analysis of levels of evidence (LOE) for each published treatment type was conducted. Topical treatments identified include imiquimod, mitomycin C and plant extracts such as onion extract, green tea, Aloe vera, vitamin E and D, applied to healing wounds, mature scar tissue or fibrotic scars following revision surgery, or in combination with other more established treatments such as steroid injections and silicone. In total, 39 articles were included, involving 1703 patients. There was limited clinical evidence to support their efficacy; the majority of articles (n = 23) were ranked as category 4 LOE, being of limited quality with individual flaws, including low patient numbers, poor randomisation, blinding, and short follow-up periods. As trials were performed in different settings, they were difficult to compare. In conclusion, there is an unmet clinical need for effective solutions to skin scarring, more robust long-term randomised trials and a consensus on a standardised treatment regime to address all aspects of scarring.
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Affiliation(s)
- G. P. Sidgwick
- />Plastic and Reconstructive Surgery Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN UK
| | - D. McGeorge
- />Grosvenor Nuffield Hospital, Wrexham Road, Chester, CH4 7QP England, UK
| | - A. Bayat
- />Plastic and Reconstructive Surgery Research, Institute of Inflammation and Repair, Faculty of Medical and Human Sciences, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester, M1 7DN UK
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Abstract
BACKGROUND Physical appearance influences nearly every aspect of human life-impacting how people are judged and subsequently treated by others. OBJECTIVE To summarize the literature that addresses the psychosocial impact of facial scarring, with a particular emphasis on scarring after skin cancer treatment. MATERIALS AND METHODS A comprehensive PubMed search was conducted to find articles related to scarring and appearance in the contexts of cutaneous oncology and surgical reconstruction. References from retrieved articles were also considered for review. RESULTS Scars, especially on the head and neck, change physical appearance and can negatively impact psychosocial functioning. Medical professionals may underestimate the importance of physical appearance for patients with skin cancer. Validated patient-reported outcome (PRO) tools may prove better than objective scar ratings to identify patients who may experience psychosocial impairment from scarring. CONCLUSION Scarring after skin cancer surgery can profoundly affect psychosocial functioning. Perioperative use of validated PRO tools can help to identify patients with scar concerns. Heightened awareness of patients' psychosocial status will allow practitioners to offer appropriate counseling or support.
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Klassen AF, Cano SJ, Schwitzer JA, Scott AM, Pusic AL. FACE-Q scales for health-related quality of life, early life impact, satisfaction with outcomes, and decision to have treatment: development and validation. Plast Reconstr Surg 2015; 135:375-386. [PMID: 25626785 DOI: 10.1097/prs.0000000000000895] [Citation(s) in RCA: 165] [Impact Index Per Article: 18.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND An ever-growing range of facial cosmetic products and treatments are available, but little clinical research is being performed to determine treatment outcomes from the patient's perspective. The FACE-Q is a patient-reported outcome instrument composed of more than 40 independently functioning scales and checklists. The aim of this article is to describe the development and psychometric evaluation of five new FACE-Q scales. METHODS FACE-Q scales were developed according to international guidelines for patient-reported outcome instrument development. The following FACE-Q scales and a single symptom checklist (Recovery Early Symptoms) were evaluated in this study: Psychological Wellbeing, Social Function, Satisfaction with Decision to Have Treatment, Satisfaction with Outcome of Treatment, and Early Life Impact of Treatment. Modern and traditional psychometric methods were used to examine reliability, validity, and responsiveness. RESULTS The sample included 702 participants from three studies. The FACE-Q scales were found to be reliable, valid, and responsive to clinical change. These findings were supported by Rasch measurement theory (e.g., overall chi-square values, p ≥ 0.06; Person Separation Index ≥0.81), traditional psychometric (e.g., Cronbach alpha values ≥0.90) and responsiveness (i.e., significant improvement following face lift and lip treatment) analysis. CONCLUSIONS The FACE-Q measures concepts and symptoms important to facial aesthetic patients. The five scales and single symptom checklist described here can be used to measure what patients think about cosmetic treatments in a scientifically sound manner. As the cosmetics industry continues to expand, the patient perspective of treatment outcomes should be measured and reported. CLINICAL QUESTION/LEVEL OF EVIDENCE Diagnostic, III.
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Affiliation(s)
- Anne F Klassen
- Hamilton, Ontario, Canada; Plymouth, United Kingdom; and New York, N.Y. From McMaster University; Plymouth University Peninsula Schools of Medicine and Dentistry; and Memorial Sloan Kettering Cancer Center
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Validity, reliability, and the questionable role of psychometrics in plastic surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2014; 2:e161. [PMID: 25289354 PMCID: PMC4174233 DOI: 10.1097/gox.0000000000000103] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2014] [Accepted: 04/03/2014] [Indexed: 11/26/2022]
Abstract
SUMMARY This report examines the meaning of validity and reliability and the role of psychometrics in plastic surgery. Study titles increasingly include the word "valid" to support the authors' claims. Studies by other investigators may be labeled "not validated." Validity simply refers to the ability of a device to measure what it intends to measure. Validity is not an intrinsic test property. It is a relative term most credibly assigned by the independent user. Similarly, the word "reliable" is subject to interpretation. In psychometrics, its meaning is synonymous with "reproducible." The definitions of valid and reliable are analogous to accuracy and precision. Reliability (both the reliability of the data and the consistency of measurements) is a prerequisite for validity. Outcome measures in plastic surgery are intended to be surveys, not tests. The role of psychometric modeling in plastic surgery is unclear, and this discipline introduces difficult jargon that can discourage investigators. Standard statistical tests suffice. The unambiguous term "reproducible" is preferred when discussing data consistency. Study design and methodology are essential considerations when assessing a study's validity.
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Joseph SP, Moore BT, Slayden G, Sorensen GB, Boettger C, Potter D, Margolin D, Brown K. Patient perception of single-incision laparoscopic cholecystectomy. JSLS 2014; 17:585-95. [PMID: 24398201 PMCID: PMC3866063 DOI: 10.4293/108680813x13693422520396] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Safety and relief of symptoms appeared to be most important to patients with gallbladder disease, whereas postprocedural aesthetics was less important. Background and Objectives: Single-incision laparoscopic cholecystectomy (SILC) is gradually being adopted into general surgical practice. The potential risks and benefits are still being studied, and little is known about how patients perceive this new surgical technique. Methods: After providing patients with basic educational materials on laparoscopic cholecystectomy (LC) and SILC, we administered a questionnaire exploring patients' perspectives of the importance of postoperative pain, scar appearance, risk of complications, and cost regarding their preference for SILC versus LC. Results: Among 100 patients (mean age, 43.3 years), the majority were women (85%), white (85%), college educated (77%), and privately insured (85%). Indications included biliary dyskinesia (43%), biliary colic (48%), and acute cholecystitis (9%). Patients stated that they would be somewhat or very interested in SILC if recommended by their surgeon (89%), although 35% were somewhat or very concerned about the lack of long-term results. The majority would accept no additional risk to undergo SILC. Scar appearance was somewhat or very important to <40% of patients, whereas pain was somewhat or very important to 79%. Only 27% of patients would spend >$100 to undergo SILC. When asked to rank pain, appearance, symptom resolution, personal cost, and risk of complications, 52% ranked symptom resolution, 20% ranked pain, and 19% ranked risk of complications as most important. Conclusions: Safety and relief of symptoms are most important to patients with gallbladder disease, whereas postprocedural esthetics was relatively unimportant and few would be willing to pay more for SILC versus LC. However, if the surgeon recommends SILC, most patients would trust this recommendation.
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Affiliation(s)
- Sigi P Joseph
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA; Saint Luke's Hospital of Kansas City, Kansas City, MO, USA; Bothwell Regional Hospital, 601 E 14th St, Sedalia, MO 65301, USA.
| | - B Todd Moore
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | | | - George B Sorensen
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | | | - David Potter
- Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - Daniel Margolin
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
| | - Kimberly Brown
- Department of Surgery, University of Missouri-Kansas City, Kansas City, MO, USA. Saint Luke's Hospital of Kansas City, Kansas City, MO, USA
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Junker JPE, Philip J, Kiwanuka E, Hackl F, Caterson EJ, Eriksson E. Assessing quality of healing in skin: Review of available methods and devices. Wound Repair Regen 2014; 22 Suppl 1:2-10. [DOI: 10.1111/wrr.12162] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 01/24/2014] [Indexed: 12/16/2022]
Affiliation(s)
- Johan P. E. Junker
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Justin Philip
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Elizabeth Kiwanuka
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Florian Hackl
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Edward J. Caterson
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
| | - Elof Eriksson
- Division of Plastic Surgery; Brigham and Women's Hospital; Harvard Medical School; Boston Massachusetts
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Costa FLDS, Tiussi LD, Nascimento MS, Corrêa ACDS, Yasojima EY, Pires CAA. Diclofenac topical gel in excisional wounds maintain heal quality and reduce phlogistic signals1. Acta Cir Bras 2014; 29:328-33. [DOI: 10.1590/s0102-86502014000500007] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2013] [Accepted: 03/19/2014] [Indexed: 11/22/2022] Open
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Quality of scar after total thyroidectomy: a single blinded randomized trial comparing octyl-cyanoacrylate and subcuticular absorbable suture. ISRN SURGERY 2013; 2013:270953. [PMID: 24324898 PMCID: PMC3845629 DOI: 10.1155/2013/270953] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/05/2013] [Accepted: 09/26/2013] [Indexed: 12/14/2022]
Abstract
Objective. To compare the quality of resulting scar at 6 weeks after total thyroidectomy with the use of the tissue adhesive octyl-cyanoacrylate or subcuticular absorbable suture for the closure of cervicotomy. Material and Methods. There are 50 patients undergoing a cervicotomy for total thyroidectomy. Twenty-five patients were randomly assigned to closure with tissue adhesive and 25 with subcuticular absorbable suture. At week 6 the scar was evaluated by blinded assessors with the Italian version of POSAS questionnaire, a validated wound scale composed of an observer's and a patient's subscale. Results. Assessment of scar appearance showed a statistically significant difference (p = 0. 038) in favor of subcuticular suture with respect to tissue adhesive on observer's assessment. The difference on patients' self-assessment was not significant. A multivariate analysis of six qualitative features of scars showed a significant influence on assessment for hyperpigmentation and relief of scar. The Italian version of POSAS proved to be reliable. Conclusion. Though tissue adhesive represents a valid method of skin closure, subcuticular absorbable suture provides a better aesthetic outcome in small cervical incisions in the early phase after thyroid surgery.
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The impact of Dupuytren disease on patient activity and quality of life. J Hand Surg Am 2013; 38:1209-14. [PMID: 23707018 DOI: 10.1016/j.jhsa.2013.03.036] [Citation(s) in RCA: 55] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2012] [Revised: 03/08/2013] [Accepted: 03/08/2013] [Indexed: 02/02/2023]
Abstract
PURPOSE To explore the impact of Dupuytren disease (DD) from the patients' perspective. METHODS Audio-recorded interviews were conducted for patients with Dupuytren disease (DD) attending outpatient clinics. The interviews were transcribed and subjected to content analysis. This analysis highlighted key impact areas and common themes in individuals' personal experiences. These were then allocated to categories specified by the World Health Organization International Classification of Functioning, Disability, and Health (impairments and activity limitations) and the needs-based model of quality of life (QoL). RESULTS Qualitative unstructured interviews were conducted with 34 patients (74% men; age, 41-80 y; mean [SD], 64 [13] y). The sample had a wide range of severity and duration of DD (range, 0.5-40; mean [SD], 13 [10] y). Nine hundred fifty-three statements relating to the impact of DD were identified from the interview transcripts. These statements fell into 2 major categories of impact: activity limitations (10 themes including problems with dressing, gripping, and personal care) and QoL (6 need categories: physiological, safety and security, social, affection, esteem, and cognitive needs). CONCLUSIONS Findings from the interviews suggest that DD affects both performance of activities and QoL. To determine accurately the effectiveness of DD interventions from the patients' perspective, it is important to determine their impacts on both activity limitations and QoL. We intend to develop valid, reproducible, and responsive DD-specific scales for this purpose. CLINICAL RELEVANCE The study identifies key issues specific to DD that influence patients' functioning and QoL. The information reported will form the basis of DD-specific patient-reported outcomes measures for use in clinical practice and evaluations of interventions.
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Rosengren H, Askew DA, Heal C, Buettner PG, Humphreys WO, Semmens LA. Does taping torso scars following dermatologic surgery improve scar appearance? Dermatol Pract Concept 2013; 3:75-83. [PMID: 23785651 PMCID: PMC3663392 DOI: 10.5826/dpc.0302a13] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 02/01/2013] [Indexed: 11/15/2022] Open
Abstract
Background: Studies show that patients are significantly less satisfied with torso scars than scars elsewhere. Though not an uncommon practice, it is unknown if application of adhesive tapes following dermatological surgery help improve cosmesis. Objective: To determine the effect of taping sutured torso wounds on overall scar appearance, scar width and patient satisfaction with the scar. Patients/Methods: Participants having elliptical torso skin excisions in a primary care setting in regional Australia were randomized in a single-blinded, controlled trial to 12 weeks taping (intervention) or usual care (control) following deep and subcuticular suturing. A blinded assessor reviewed scars at three and six months. Results: Of 195 participants recruited, 136 (63 taped, 73 controls) completed six months of follow-up. Independent blinded assessment of overall scar appearance was significantly better in taped participants (p= 0.004). Taping reduced median scar width by 1 mm (p=0.02) and when stratified by gender, by 3.0 mm in males (p=0.04) and 1.0 mm in females (p=0.2). High participant scar satisfaction was not further improved by taping. Conclusion: Taping elliptical torso wounds for 12 weeks after dermatologic surgery improved scar appearance at six months.
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Affiliation(s)
- Helena Rosengren
- School of Medicine, James Cook University, Townsville, Queensland, Australia
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38
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Ud-Din S, Bowring A, Derbyshire B, Morris J, Bayat A. Identification of steroid sensitive responders versus non-responders in the treatment of keloid disease. Arch Dermatol Res 2013; 305:423-32. [PMID: 23479004 DOI: 10.1007/s00403-013-1328-7] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2012] [Revised: 02/05/2013] [Accepted: 02/11/2013] [Indexed: 12/17/2022]
Abstract
Intralesional corticosteroid injection is a well-recognised treatment modality for keloid disease (KD). Approximately 50% of KD cases are considered non-responders (or steroid resistant) with no consensus or indicators in detecting steroid-sensitive cases. In view of the undesirable side effects, uncertainty in timing and regularity of steroid treatment, we planned to identify responders and non-responders to target treatment more effectively. A scar injection proforma was developed capturing a detailed history focusing on symptoms and signs (redness, appearance, contour, texture, distortion and severity) associated with KD. The cause, site, number of keloid scars and scar recurrence were recorded as the lesions were injected on a monthly basis. A detailed description of response to steroid injection was documented and photographs were taken. Demographic data were collected on 65 patients (11 to 74 years with mean age 34.7 years, 60% were females, 50% were Caucasian). 77% (n = 50) were classified as steroid responders and showed improvement in symptoms and signs within 3 months. There was a statistically significant correlation between patients with higher contour scores of KD prior to treatment (p = 0.013) and frequency of injections (p = 0.003). Thus, the odds of being a responder were greater for patients with more than one injection and with higher contour scores. This preliminary case series has provided early evidence in enabling identification of steroid responders versus non-responders within a 3-month period. Selection of KD non-responders to steroid treatment can avoid potentially painful injection, its subsequent side effects and unnecessary continuation of redundant therapy and follow-up.
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Affiliation(s)
- Sara Ud-Din
- Plastic and Reconstructive Surgery Research, Manchester Institute of Biotechnology, University of Manchester, 131 Princess Street, Manchester M1 7ND, UK
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Photodynamic therapy: an innovative approach to the treatment of keloid disease evaluated using subjective and objective non-invasive tools. Arch Dermatol Res 2012; 305:205-14. [DOI: 10.1007/s00403-012-1295-4] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2012] [Revised: 10/04/2012] [Accepted: 10/15/2012] [Indexed: 10/27/2022]
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Trickett RW, Mudge E, Price P, Pallister I. A qualitative approach to recovery after open tibial fracture: the road to a novel, patient-derived recovery scale. Injury 2012; 43:1071-8. [PMID: 22356720 DOI: 10.1016/j.injury.2012.01.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2011] [Revised: 01/11/2012] [Accepted: 01/26/2012] [Indexed: 02/02/2023]
Abstract
AIM The aim of this study was to describe how patients perceive their recovery following open tibial fractures using a qualitative approach. PATIENTS AND METHODS Following the appropriate ethical approval, adult patients with a diagnosis of open tibial fracture were recruited after completion of their surgical treatment and discharge from Morriston Hospital, a centre with orthoplastic surgical care. A purposive sampling method was employed to ensure that a range of injuries as well as clinical outcomes were included. All patients took part in an in-depth semi-structured interview, exploring aspects of their injury, treatment, rehabilitation and psychosocial and financial situations. Interviews were completed with two interviewers present and were recorded for verbatim transcription. Interview transcripts were analysed to identify items important to patients during their recovery. RESULTS Nine patients with a mean injury to interview interval of 2.3 years were interviewed. A total of 538 items were identified and subsequently mapped onto 18 categories: pain; mobility; flexibility; temperature (effects on symptoms); fear; appearance; sleep; diet/weight; employment; social; finance; impact on others; self-care; recovery (patient perceptions of recovery); frustration; goal setting (by patients and health-care providers); and adaptation (both physical and mental). CONCLUSION There is a wide range of factors that our cohort found important during their recovery from open tibial fracture. Despite being considered as 'healed' by the medical staff, patients did not report a corresponding full recovery and return to pre-injury normality. The categories identified will enable the development of a patient-reported recovery scale to be used in lower-limb trauma.
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Affiliation(s)
- R W Trickett
- Department of Trauma and Orthopaedics, Abertawe Bro Morgannwg University Health Board, Morriston Hospital, Swansea, SA6 6NL, UK.
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Abstract
PURPOSE OF REVIEW The mid-gestation fetus is capable of regenerative healing with wound healing indistinguishable from surrounding skin. This review aims to evaluate the current knowledge of how the mid-gestation fetus heals without scar and the implications of these findings in efforts to recapitulate the fetal regenerative phenotype in the postnatal environment. RECENT FINDINGS It has been over 30 years since the empirical observation that the fetus heals without scar; yet, the underlying mechanisms of this phenomenon have not been elucidated. Fetal wound healing is characterized by a distinct growth factor profile, an attenuated inflammatory response with an anti-inflammatory cytokine profile, an extracellular matrix rich in type III collagen and hyaluronan, attenuated biomechanical stress, and a potential role for stem cells. Current therapies to minimize scarring in postnatal wounds have attempted to recapitulate singular aspects of the fetal regenerative phenotype and have met with varying degrees of clinical success. We now have the molecular tools to more completely comprehend the fundamental mechanisms of fetal regenerative wound repair, which has the potential to provide insights into the identification of therapeutic targets to minimize the scar formation. SUMMARY Successful therapies that help minimize postnatal scar formation can be realized through understanding the cellular and molecular mechanisms of fetal regenerative wound healing. These insights will have implications not only for cutaneous wound healing, but also potentially for any disease process characterized by excessive fibroplasia.
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Prospective comparison of scar-related satisfaction and quality of life after laparoscopic versus open radical prostatectomy: no differences from patients’ point of view. World J Urol 2012; 31:389-93. [DOI: 10.1007/s00345-012-0862-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/02/2012] [Accepted: 03/15/2012] [Indexed: 11/26/2022] Open
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Frans FA, van Zuijlen PP, Griot JD, van Der Horst CM. Assessment of Scar Quality after Cleft Lip Closure. Cleft Palate Craniofac J 2012; 49:171-6. [DOI: 10.1597/10-254] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Objective To assess scar quality after cleft lip repair. Design The linear scars of patients with cleft lip with or without cleft palate were evaluated in a prospective study using the Patient and Observer Scar Assessment Scale. Linear regression was performed to identify which scar characteristics were important according to patients and observer. Setting Regular outpatient follow-up visit with the cleft palate teams of two tertiary centers. Patients All consecutive patients were asked to participate in this study after informed consent, minimally 1 year postsurgery. Main Outcome Measure Scar characteristics influencing patient and observer opinion after cleft lip repair. Results A total of 86 patients with cleft lip with or without cleft palate were included, resulting in evaluation of 99 scars. Two scar characteristics, itching and pain, were seldom a concern for the patients. Linear regression showed that scars assessed longer after surgery had a better outcome. Conclusion Scar itching and pain did not seem to have an effect on patient opinion of the quality of the scar, and the majority of the patients were more satisfied with the outcome of their scar than the observer was.
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Affiliation(s)
- Franceline A. Frans
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Paul P.M. van Zuijlen
- Department of Plastic, Reconstructive, and Hand Surgery, Academic Medical Center, Amsterdam, The Netherlands
- Department of Plastic, Reconstructive, and Hand Surgery, Red Cross Hospital, Beverwijk, The Netherlands; Department of Plastic, Reconstructive, and Hand Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands; and Association of Dutch Burn Centers, Beverwijk, The Netherlands
| | - J.P.W. Don Griot
- Department of Plastic, Reconstructive, and Hand Surgery, Vrije Universiteit Medical Center, Amsterdam, The Netherlands
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Patient assessments of scarring: patient-reported impact of scars measure or patient scar assessment questionnaire? Plast Reconstr Surg 2011; 127:1744-1745. [PMID: 21460690 DOI: 10.1097/prs.0b013e31820a667c] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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46
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Reply: Patient Assessments of Scarring: Patient-Reported Impact of Scars Measure or Patient Scar Assessment Questionnaire? Plast Reconstr Surg 2011. [DOI: 10.1097/prs.0b013e31820a65e0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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