Postoperative impact of daily life after primary treatment of proximal/distal tibiafracture with Ilizarov external fixation

Development of a patient-reported outcome measure in limb reconstruction : a pilot study assessing face validity

Aims

Patients undergoing limb reconstruction surgery often face a challenging and lengthy process to complete their treatment journey. The majority of existing outcome measures do not adequately capture the patient-reported outcomes relevant to this patient group in a single measure. Following a previous systematic review, the Stanmore Limb Reconstruction Score (SLRS) was designed with the intent to address this need for an effective instrument to measure patient-reported outcomes in limb reconstruction patients. We aim to assess the face validity of this score in a pilot study.

Methods

The SLRS was designed following structured interviews with several groups including patients who have undergone limb reconstruction surgery, limb reconstruction surgeons, specialist nurses, and physiotherapists. This has subsequently undergone further adjustment for language and clarity. The score was then trialled on ten patients who had undergone limb reconstruction surgery, with subsequent structured questioning to understand the perceived suitability of the score.

Results

Ten patients completed the score and the subsequent structured interview. Considering the tool as a whole, 100% of respondents felt the score to be comprehensible, relevant, and comprehensive regarding the areas that were important to a patient undergoing limb reconstruction surgery. For individual questions, on a five-point Likert scale, importance/relevance was reported as a mean of 4.78 (4.3 to 5.0), with ability to understand rated as 4.92 (4.7 to 5.0) suggesting high levels of relevance and comprehension. Flesch-Kincaid reading grade level was calculated as 5.2 (10 to 11 years old).

Conclusion

The current SLRS has been shown to have acceptable scores from a patient sample regarding relevance, comprehensibility, and comprehensiveness. This suggests face validity, however further testing required and is ongoing in a larger cohort of patients to determine the reliability, responsiveness, precision, and criterion validity of the score in this patient group.

Cite this article: Bone Jt Open 2021;2(9):705–709.

Assessment of the quality of life in patients with varying degrees of equalization of lower limb length discrepancy treated with Ilizarov method

BACKGROUND

Inequalities in leg length result in functional disorders, as they impair the biomechanics of the musculoskeletal system, significantly reducing the quality of life (QoL). This study used the WHOQoL-BREF questionnaire in patients with varying degrees of lower leg shortness who had undergone treatment by the Ilizarov method, compared to a healthy control group.

METHODS

Fifty-eight patients treated with the Ilizarov method for discrepancies in lower limb length were grouped by degree of limb equalization (group 1, 37 treated individuals with limb length discrepancy < 1 cm; group 2, 21 individuals with discrepancy ≥ 1 cm but not more than 4 cm). The control group 3 contained 61 healthy individuals. Patient quality of life (QoL) was assessed using a shortened version of the WHOQoL-BREF questionnaire, at least 24 months after the end of Ilizarov therapy.

RESULTS

Control subjects obtained higher scores in all domains than subjects in both treatment groups, as well as significantly higher self-assessed QoL, and health, in the physical, psychological, social, and general lifestyle domains, as compared to those with inequalities ≥ 1 cm. Furthermore, patients with inequalities ≥ 1 cm had higher odds ratios of low self-assessment (3.28 times; p = 0.043), low self-assessment of health (4. 09 times; p = 0.047), and low physical and psychological domains (respectively 6.23 times; p = 0.005 and 8.46 times, p = 0.049) compared with patients with inequality < 1 cm. The shortened version of the WHOQoL questionnaire was used.

CONCLUSIONS

After at least 24 months of treatment with the Ilizarov method, patients with limb length discrepancy < 1 cm did not differ significantly from healthy individuals in the WHOQoL self-assessment of mental functioning, social, or life satisfaction.

The physical impact of long bone fractures on adults in KwaZulu-Natal

BACKGROUND

Limb fractures are increasingly common in low-income and middle-income countries due to an increase in motor vehicle and other accidents. Fractures may often lead to physical impairment that affects an individual's ability to carry out tasks.

OBJECTIVES

To assess the physical impact of long bone fractures on adults in KwaZulu-Natal.

METHOD

A standardised questionnaire pertaining to activities at home and leisure was used to establish patient-reported outcomes at nine public hospitals. English-speaking and isiZulu-speaking participants who had sustained a single long bone fracture in the preceding 4 to 12 weeks at the time of data collection were included. The following activities were evaluated: walking, running, exercising, driving, performing household chores, writing, answering telephones, texting on a cell phone, bathing, using crockery and preparing meals.

RESULTS

A total of 821 participants completed the questionnaire. Ninety-three per cent had closed long bone fractures and 69 per cent were lower limb fractures. Fifty-seven per cent of the fractures were caused by a fall. Female participants (p = 0.19) with lower limb fractures were more likely to have greater difficulty in performing tasks and participants 60 years of age and older (p = 0.001) were significantly more likely to have difficulty performing tasks.

CONCLUSION

These findings illustrate the daily limitations in patients' everyday activities at home, leisure and in activities such as driving.

CLINICAL IMPLICATIONS

This study highlights the difficulty that some individuals, particularly women and individuals 60 years of age and older, face in performing daily tasks after experiencing a long bone fracture.

Factors influencing self-care in outpatients with external fixation in China

Objective

This study was performed to investigate factors influencing self-care agency in outpatients with external fixation support.

Methods

Using a cross-sectional study approach, 110 outpatients with external fixation from a single Chinese hospital were evaluated from May 2018 to October 2018. Consecutive sampling was performed, and variables included demographic data, health knowledge regarding external fixation, and self-care skills. Open and closed survey questions were used.

Results

The mean self-care agency score was 101.70 ± 20.14, with 36 (35.3%) outpatients scoring high. Demographic variables did not significantly influence the self-care level. However, health knowledge was significantly correlated with self-care skills, indicating that knowledgeable outpatients were more likely to be better at self-care.

Conclusions

Outpatients with external fixation support need higher levels of health knowledge. The level of self-care agency in the present study was in the moderate range. Outpatients with external fixation support with higher health knowledge are more likely to have higher self-care skills.

A Systematic Review of Patient-reported Outcome Measures Used in Circular Frame Fixation

Introduction

Clinical studies in orthopedics are using patient-reported outcome measures (PROMs) increasingly. PROMs are often being designed for a specific disease or an area of the body with the aim of being patient centered. As yet, none exists specifically for treatment with circular ring external fixation devices.

Aim

The purpose of this study is to provide a comprehensive systematic review of the published literature related to the use of PROMs in patients that underwent treatment with circular frames (Ilizarov or Hexapod Type Fixators).

Methods

An online literature search was conducted for English language articles using the Scopus.

Results

There were 534 published articles identified. After initial filtering for relevance and duplication, this figure reduced to 17, with no further articles identified through searching the bibliographies. Exclusion criteria removed two articles resulting in 15 articles included in the final review. Out of the 15 studies identified, a total of 10 different scoring measures where used. The majority of studies used a combination of joint/limb-specific and generic health PROMs with an average of 2.5 per study. No paper specifically discussed all eight PROMs criteria when justifying which PROMs they used.

Conclusion

Our findings indicate that none of the PROMs analyzed in this systematic review are truly representative of the health outcomes specific to this patient group and, therefore, propose that a PROM specific to this patient group needs to be developed.

How to cite this article

Antonios T, Barker A, Ibrahim I, et al. A Systematic Review of Patient-reported Outcome Measures Used in Circular Frame Fixation. Strategies Trauma Limb Reconstr 2019;14(1):34–44.