1
|
Andronic O, Lu V, Claydon-Mueller LS, Cubberley R, Khanduja V. Clinical Equipoise in the Management of Patients With Femoroacetabular Impingement Syndrome and Concomitant Tönnis Grade 2 Hip Osteoarthritis or Greater: An International Expert-Panel Delphi Study. Arthroscopy 2024; 40:2029-2038.e1. [PMID: 38158166 DOI: 10.1016/j.arthro.2023.12.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/27/2023] [Revised: 12/17/2023] [Accepted: 12/19/2023] [Indexed: 01/03/2024]
Abstract
PURPOSE To gather global-expert opinion on the management of patients with femoroacetabular impingement syndrome (FAIS) and Tönnis grade 2 hip osteoarthritis (OA) or greater. METHODS An internet-based modified Delphi methodology was used via an online platform (Online Surveys) using the CREDES (Conducting and Reporting Delphi Studies) guidelines. The expert panel comprised 27 members from 18 countries: 21 orthopaedic surgeons (78%), 5 physiotherapists (18%), and 1 dual orthopaedic surgeon-sport and exercise medicine physician (4%). Comments and suggestions were collected during each round, and amendments were performed for the subsequent round. Between each pair of rounds, the steering panel provided the experts with a summary of results and amendments. Consensus was set a priori as minimum agreement of 80%. RESULTS Complete participation (100%) was achieved in all 4 rounds. A final list of 10 consensus statements was formulated. The experts agreed that there is no single superior management strategy for FAIS with Tönnis grade 2 OA and that Tönnis grade 3 OA and the presence of bilateral cartilage defects (acetabular and femoral) is a contraindication for hip preservation surgery. Nonoperative management should include activity modification and physiotherapy with hip-specific strengthening, lumbo-pelvic mobility training, and core strengthening. There was no consensus on the need for 3-dimensional imaging for initial quantification of joint degeneration. CONCLUSIONS There is clinical equipoise in terms of the best management strategy for patients with FAIS and Tönnis grade 2 OA, and therefore, there is an urgent need to perform a randomized controlled trial for this cohort of patients to ascertian the best management strategy. LEVEL OF EVIDENCE Level V, expert opinion.
Collapse
Affiliation(s)
- Octavian Andronic
- Department of Orthopaedics, Balgrist University Hospital, University of Zürich, Zürich, Switzerland; Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England; Department of Trauma and Orthopaedics, Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Cambridge, England
| | - Victor Lu
- School of Clinical Medicine, University of Cambridge, Cambridge, England
| | | | - Rachael Cubberley
- Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England
| | - Vikas Khanduja
- Medical Technology Research Centre, Anglia Ruskin University, Chelmsford, England; Department of Trauma and Orthopaedics, Young Adult Hip Service, Addenbrooke's-Cambridge University Hospital, Cambridge, England.
| |
Collapse
|
2
|
Côté P, Negrini S, Donzelli S, Kiekens C, Arienti C, Ceravolo MG, Gross DP, Battel I, Ferriero G, Lazzarini SG, Dan B, Shearer HM, Wong JJ. Introduction to target trial emulation in rehabilitation: a systematic approach to emulate a randomized controlled trial using observational data. Eur J Phys Rehabil Med 2024; 60:145-153. [PMID: 38420907 PMCID: PMC10938938 DOI: 10.23736/s1973-9087.24.08435-1] [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: 01/22/2024] [Accepted: 01/26/2024] [Indexed: 03/02/2024]
Abstract
Rehabilitation providers and policymakers need valid evidence to make informed decisions about the healthcare needs of the population. Whenever possible, these decisions should be informed by randomized controlled trials (RCTs). However, there are circumstances when evidence needs to be generated rapidly, or when RCTs are not ethical or feasible. These situations apply to studying the effects of complex interventions, including rehabilitation as defined by Cochrane Rehabilitation. Therefore, we explore using the target trial emulation framework by Hernán and colleagues to obtain valid estimates of the causal effects of rehabilitation when RCTs cannot be conducted. Target trial emulation is a framework guiding the design and analysis of non-randomized comparative effectiveness studies using observational data, by emulating a hypothetical RCT. In the context of rehabilitation, we outline steps for applying the target trial emulation framework using real world data, highlighting methodological considerations, limitations, potential mitigating strategies, and causal inference and counterfactual theory as foundational principles to estimating causal effects. Overall, we aim to strengthen methodological approaches used to estimate causal effects of rehabilitation when RCTs cannot be conducted.
Collapse
Affiliation(s)
- Pierre Côté
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| | - Stefano Negrini
- Department of Biomedical, Surgical and Dentals Sciences, University "La Statale", Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
| | - Sabrina Donzelli
- Department of Orthopedics, University Medical Center, Utrecht, the Netherlands
- Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | | | | | - Maria G Ceravolo
- Department of Experimental and Clinical Medicine, Polytechnic University of Marche University, Ancona, Italy
| | - Douglas P Gross
- Department of Physical Therapy, University of Alberta, Edmonton, AB, Canada
| | - Irene Battel
- Department of Biomedical, Surgical and Dentals Sciences, University "La Statale", Milan, Italy -
| | - Giorgio Ferriero
- Department of Biotechnology and Life Sciences, University of Insubria, Varese, Italy
- Physical Rehabilitation Medicine Unit, Scientific Institute of Tradate IRCCS, Istituti Clinici Scientifici Maugeri, Tradate, Varese, Italy
| | | | - Bernard Dan
- Faculty of Psychology and Educational Sciences, Université Libre de Bruxelles, Brussels, Belgium
- Inkendaal Rehabilitation Hospital, Vlezenbeek, Belgium
| | - Heather M Shearer
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
- Division of Research, Canadian Memorial Chiropractic College, Toronto, ON, Canada
| | - Jessica J Wong
- Institute for Disability and Rehabilitation Research, Faculty of Health Sciences, Ontario Tech University, Oshawa, ON, Canada
| |
Collapse
|
3
|
Hedges K, Levitsky M, Marchand G, Morawska L, Bhérer L, Letellier MC. Medical Masks Versus N95 Respirators for Preventing COVID-19 Among Health Care Workers. Ann Intern Med 2023; 176:eL230076. [PMID: 37459626 DOI: 10.7326/l23-0076] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/20/2023] Open
Affiliation(s)
- Kevin Hedges
- Canadian Aerosol Transmission Coalition, Ottawa, Ontario, Canada
| | | | | | - Lidia Morawska
- International Laboratory for Air Quality and Health, Queensland University of Technology, Brisbane, Queensland, Australia
| | - Luc Bhérer
- CIUSSS de la Capitale-Nationale, Quebec City, Quebec, Canada
| | | |
Collapse
|