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Kiselyov K, Schunn CD. Peer-reviewed presentation exchange in an undergraduate classroom. JOURNAL OF MICROBIOLOGY & BIOLOGY EDUCATION 2024; 25:e0006723. [PMID: 38661421 PMCID: PMC11044638 DOI: 10.1128/jmbe.00067-23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 12/06/2023] [Indexed: 04/26/2024]
Abstract
Reading, presenting, and discussing peer-reviewed scientific reports, case studies, and reviews are essential to modern biology education. These exercises model crucial aspects of students' future professional activities and introduce the students to the current scientific concepts and methodology, data analysis, and presentation. A common format for working with primary literature is a journal club: presenting and discussing research literature in front of peers, which has many merits. However, in large modern classrooms, this format is very time-consuming and stressful, especially since presenting is not a commonly taught skill. We argue that student groups for whom the current educational and professional paradigms present a challenge due to a historical lack of representation or wellness issues are deprived of a key educational opportunity. To solve this problem, we formulated an approach called Peer-Reviewed Presentation Exchange (PRPE), which focuses on collaborative analysis, presentation, and review of research literature that includes (i) voice-narrated research presentations by students, (ii) checklists generated by the instructor to establish expectations for an informative presentation or review, and (iii) presentation assignment and peer review process. We tested this approach in an undergraduate cell biology class over 3 years. Pre- and post-assessments show significant gains in self-efficacy and knowledge not only by students who presented but also by the students who reviewed the presentations; therefore, peer-reviewed presentations are an effective tool for learning. Exit surveys show that the approach is seen as beneficial by most students. Our approach allows every student to speak and ask questions in a low-stress creative environment. It is an excellent customizable, trackable, and scalable low-stakes assessment tool.
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Affiliation(s)
- Kirill Kiselyov
- Department of Biological Sciences, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Christian D. Schunn
- Learning Research and Development Center, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Arshad Z, Haq II, Martins A, Bhatia M. The impact of pre-operative mental health on outcomes of foot and ankle surgery: A scoping review. Foot Ankle Surg 2024; 30:165-173. [PMID: 37993358 DOI: 10.1016/j.fas.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/14/2023] [Accepted: 11/06/2023] [Indexed: 11/24/2023]
Abstract
BACKGROUND Evidence suggests that certain groups of orthopaedic patients have an increased prevalence of mental health disorders than the general population. This scoping review aims to evaluate the effect of pre-operative mental health on outcomes of foot and ankle surgery. METHODS A literature search was performed in four databases. Studies investigating a relationship between preoperative mental health and postoperative patient reported outcome measures (PROMs), complications, readmissions or reoperations were included. RESULTS Of the 19 studies investigating the effect of preoperative mental health on PROMs, 16 (84.2%) reported a significant relationship between poorer preoperative mental health and inferior postoperative PROMs. Poorer mental health was associated with an increased rate of complications, readmissions and/or reoperations in four studies. CONCLUSIONS Poorer preoperative mental health is associated with significantly inferior outcomes following foot and ankle surgery. Clinicians should evaluate mental health to stratify likely outcomes and aid in the management of patient expectations. LEVEL OF EVIDENCE Level IV: Scoping review of Level II-IV studies.
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Affiliation(s)
- Zaki Arshad
- University Hospitals of Leicester NHS Trust, Leicester, UK.
| | | | - Andre Martins
- University Hospitals of Leicester NHS Trust, Leicester, UK
| | - Maneesh Bhatia
- University Hospitals of Leicester NHS Trust, Leicester, UK
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Lee S, Xue Y, Petricca J, Kremic L, Xiao MZX, Pivetta B, Ladha KS, Wijeysundera DN, Diep C. The impact of pre-operative depression on pain outcomes after major surgery: a systematic review and meta-analysis. Anaesthesia 2024; 79:423-434. [PMID: 38050423 DOI: 10.1111/anae.16188] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2023] [Indexed: 12/06/2023]
Abstract
Symptoms of depression are common among patients before surgery. Depression may be associated with worse postoperative pain and other pain-related outcomes. This review aimed to characterise the impact of pre-operative depression on postoperative pain outcomes. We conducted a systematic review of observational studies that reported an association between pre-operative depression and pain outcomes after major surgery. Multilevel random effects meta-analyses were conducted to pool standardised mean differences and 95%CI for postoperative pain scores in patients with depression compared with those without depression, at different time intervals. A meta-analysis was performed for studies reporting change in pain scores from the pre-operative period to any time-point after surgery. Sixty studies (n = 501,962) were included in the overall review, of which 18 were eligible for meta-analysis. Pre-operative depression was associated with greater pain scores at < 72 h (standardised mean difference 0.97 (95%CI 0.37-1.56), p = 0.009, I2 = 41%; moderate certainty) and > 6 months (standardised mean difference 0.45 (95%CI 0.23-0.68), p < 0.001, I2 = 78%; low certainty) after surgery, but not at 3-6 months after surgery (standardised mean difference 0.54 (95%CI -0.06-1.15), p = 0.07, I2 = 83%; very low certainty). The change in pain scores from pre-operative baseline to 1-2 years after surgery was similar between patients with and without pre-operative depression (standardised mean difference 0.13 (95%CI -0.06-0.32), p = 0.15, I2 = 54%; very low certainty). Overall, pre-existing depression before surgery was associated with worse pain severity postoperatively. Our findings highlight the importance of incorporating psychological care into current postoperative pain management approaches in patients with depression.
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Affiliation(s)
- S Lee
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - Y Xue
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - J Petricca
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - L Kremic
- Temerty Faculty of Medicine, University of Toronto, Toronto, Canada
| | - M Z X Xiao
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - B Pivetta
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
| | - K S Ladha
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Canada
| | - D N Wijeysundera
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
- Department of Anesthesia, St Michael's Hospital, Toronto, Canada
| | - C Diep
- Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Canada
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Manz WJ, Fink J, Novack J, Jacobson J, Bariteau JT. Association of First Metatarsal Phalangeal Joint Fusion for Hallux
Rigidus With Patient-Reported Pain and Mental Health Outcomes in Patients Taking
Psychotropic Medications. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114231157731. [PMID: 36968813 PMCID: PMC10037740 DOI: 10.1177/24730114231157731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/25/2023] Open
Abstract
Background: Limited literature examines the relationship between surgical outcomes in
chronic foot and ankle conditions and concurrent psychiatric care. The
present study aimed to investigate patient-reported and surgical outcomes of
patients treated for a psychiatric disorder undergoing first
metatarsophalangeal (MTP) fusion for hallux rigidus. We hypothesized that
patients on psychotropic medications would have greater subjective pain
preoperatively and less improvement in physical and mental functionality
postoperatively when compared with nonmedicated patients. Methods: A single-center, retrospective review of prospectively collected data was
conducted on 92 patients undergoing first MTP fusion with a preoperative
diagnosis of hallux rigidus from 2015 to 2019. At their preoperative,
6-month postoperative, and 1-year postoperative visits, patients were
administered visual analog pain scale (VAS) and 36-Item Short Form Health
Survey (SF-36) functionality surveys. Patients were subsequently identified
by chronic use of psychotropic medication preoperatively and grouped for
analysis (MED, n = 42; NO MED, n = 50). Results: Postoperative mean VAS pain scores were lower for all studied patients at 6
months (VAS = 1.6 ± 2.3) and 1 year postoperatively (VAS = 1.1± 1.8)
relative to the preoperative visit (VAS = 4.7 ± 2.8)
(P ≤ .0001 and P ≤ .0001, respectively).
No differences in mean VAS pain scores nor SF-36 physical component summary
scores were detected at preoperative, 6-month, or 1-year visits between NO
MED and MED groups. Mean SF-36 mental component summary scores for those in
the MED group were lower at preoperative (NO MED = 83.8, MED = 71.8,
P = .006) and 6-month postoperative (NO MED = 86.1,
MED = 72.7, P = .037) visits than those in the NO MED
group, a trend not observed at the 1-year postoperative mark (NO MED = 84.1,
MED = 76.8, P = .228). There were no observed differences
in operative time (P = .219), tourniquet time
(P = .359), nor time to full weightbearing
(P = .512) between MED and NO MED groups. Additionally,
no differences in postoperative complication rates were observed between
groups. Conclusion: In patients treated with psychotropically active medications with hallux
rigidus, MTP Fusion appears to be a reasonable treatment choice with similar
outcomes for patients requiring psychotropically active medications to the
outcomes of those patients not requiring psychotropically active
medications. Level of Evidence: Level III, retrospective comparative study.
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Affiliation(s)
- Wesley J. Manz
- Emory University School of Medicine,
Atlanta, GA, USA
- Department of Orthopaedic Surgery,
Emory University School of Medicine, Atlanta, GA, USA
| | - Juliet Fink
- Emory University School of Medicine,
Atlanta, GA, USA
| | - Joseph Novack
- Emory University School of Medicine,
Atlanta, GA, USA
| | - Joseph Jacobson
- Emory University School of Medicine,
Atlanta, GA, USA
- Department of Orthopaedic Surgery,
Emory University School of Medicine, Atlanta, GA, USA
| | - Jason T. Bariteau
- Emory University School of Medicine,
Atlanta, GA, USA
- Department of Orthopaedic Surgery,
Emory University School of Medicine, Atlanta, GA, USA
- Jason T. Bariteau, MD, Emory University
Department of Orthopaedics, 59 Executive Park S, Atlanta, GA 30324, USA.
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Bernstein DN, Ramirez G, Thirukumaran CP, Samuel Flemister A, Oh IC, Ketz JP, Baumhauer JF. Clinical Improvement Following Operative Management of Ankle Fractures Among Patients With and Without Moderate to High Depressive Symptoms: An Analysis Using PROMIS. FOOT & ANKLE ORTHOPAEDICS 2023; 8:24730114221151077. [PMID: 36741681 PMCID: PMC9893091 DOI: 10.1177/24730114221151077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Background Understanding the recovery trajectory following operative management of ankle fractures can help surgeons guide patient expectations. Further, it is beneficial to consider the impact of mental health on the recovery trajectory. Our study aimed to address the paucity of literature focused on understanding the recovery trajectory following surgery for ankle fractures, including in patients with depressive symptoms. Methods From February 2015 to March 2020, patients with isolated ankle fractures were asked to complete Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), Pain Interference (PI), and Depression questionnaires as part of routine care at presentation and follow-up time points. Linear mixed effects regression models were used to evaluate the patient recovery pattern, comparing the preoperative time point to <3 months, 3-6 months, and >6 months across all patients. Additional models that included the presence of depression symptoms as a covariate were then used. Results A total of 153 patients met inclusion criteria. By 3-6 months, PROMIS PF (β: 9.95, 95% CI: 7.97-11.94, P < .001), PI (β: -10.30, 95% CI: -11.87 to -8.72, P < .001), and Depression (β: -5.60, 95% CI: -7.01 to -4.20, P < .001) improved relative to the preoperative time point. This level of recovery was sustained thereafter. When incorporating depressive symptoms into our model as a covariate, the moderate to high depressive symptoms were associated with significantly and clinically important worse PROMIS PF (β: -4.00, 95% CI: -7.00 to -1.00, P = .01) and PI (β: 3.16, 95% CI: -0.55 to 5.76, P = .02) scores. Conclusion Following ankle fracture surgery, all patients tend to clinically improve by 3-6 months postoperatively and then continue to appreciate this clinical improvement. Although patients with moderate to high depressive symptoms also clinically improve following the same trajectory, they tend to do so to a lesser level than those who have low depressive symptoms. Level of Evidence Level III, case-control study.
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Affiliation(s)
- David N. Bernstein
- Harvard Combined Orthopaedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
| | - Gabriel Ramirez
- Harvard Combined Orthopaedic Residency Program (HCORP), Massachusetts General Hospital, Boston, MA, USA
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Caroline P. Thirukumaran
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - A. Samuel Flemister
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Irvin C. Oh
- Department of Orthopaedics and Rehabilitation, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA
| | - John P. Ketz
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
| | - Judith F. Baumhauer
- Department of Orthopaedics & Physical Performance, University of Rochester Medical Center, Rochester, NY, USA
- University of Rochester School of Medicine and Dentistry, Rochester, NY, USA
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Shaw DB, Carreira DS. The Impacts of Anxiety and Depression on Outcomes in Foot and Ankle Surgery. Foot Ankle Int 2022; 43:1606-1613. [PMID: 36367127 DOI: 10.1177/10711007221132277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Thiyagarajan H, Lee M, Chen J, Meng NYE. Predictors of Patient Satisfaction in Hallux Valgus Surgery. J Foot Ankle Surg 2022; 61:1321-1324. [PMID: 35690528 DOI: 10.1053/j.jfas.2022.04.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 04/23/2022] [Accepted: 04/27/2022] [Indexed: 02/03/2023]
Abstract
This study aims to analyze a combination of preoperative biodata, radiological parameters, and validated functional scores to determine predictors for patient satisfaction in patients who have undergone Hallux abducto valgus (HAV) surgery at 2 years postoperatively. Data from 288 patients who had undergone HAV surgery and 373 cases were collected between 2007 and 2013. The study group measured the HAV angle (HVA), tibial sesamoid position (TSP), as well as inter-metatarsal angle (IMA) on both pre- and postoperative radiographs for all patients. Clinical outcomes such as the Visual Analogue Scale for pain, the American Orthopaedic Foot and Ankle Society (AOFAS) Hallux Metatarsophalangeal-Interphalangeal Scale (MTP-ITP) Scale, and Short Form 36 Health Survey's physical and mental component scores (PCS and MCS) were captured preoperatively and postoperatively. Univariate analysis was performed first to determine possible predictors of patient satisfaction and the results were then included in a binary logistic regression model. Independent predictors of patient satisfaction include higher preoperative AOFAS (p value = .028, 95% confidence interval [CI] 0.958, 0.998) and the 2 years postoperative AOFAS (p = .001, 95% CI 1.027, 1.114). We also found PCS and MCS scores at 2 years postoperatively to be independent predictors of patient satisfaction (p = .004, 95% CI 1.015, 1.086 and p = .045, 95% CI 1.001, 1.064 respectively). Predictors of patient satisfaction include subjective outcomes such as the AOFAS score and the Short Form 36 composite quality of life scales of PCS and MCS, rather than objective radiological outcomes such as HVA, IMA, and TSP.
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Affiliation(s)
| | - Merrill Lee
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore
| | - Jerry Chen
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
| | - Nicholas Yeo Eng Meng
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore, Singapore; Duke-NUS Medical School, Singapore, Singapore
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Blouin C, Genet F, Denormandie P, Graff W, Perrier A. Development of a preoperative questionnaire to improve satisfaction with hallux valgus repair: A Delphi study. PLoS One 2022; 17:e0276303. [PMID: 36279269 PMCID: PMC9591061 DOI: 10.1371/journal.pone.0276303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2022] [Accepted: 10/05/2022] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND Satisfaction with hallux valgus repair is often poor, despite good surgical outcomes. Many tools have been developed to assess the outcome of the procedure; however none evaluate the association between the initial motive for repair and the reasons for post-surgical dissatisfaction. The aim of this study was to develop a new tool to analyse the subjective and objective expectations of individuals during a pre-operative consultation for hallux valgus repair in order to improve post-surgical satisfaction. METHODS We first collected the reasons for dissatisfaction with repair from the medical files of dissatisfied individuals. Then, a steering committee of 4 French experts in the management of hallux valgus designed a questionnaire based on the reasons for dissatisfaction. We then used the DELPHI method to validate the questionnaire: we submitted the questionnaire to a panel of 34 francophone experts in hallux valgus repair for rating in 4 rounds. RESULTS The medical files of 853 individuals were reviewed and a 52-item questionnaire relating to expectations from hallux valgus surgery was drafted. After the 4 rounds, a final 44 item questionnaire reached consensus. Thirteen items related to clinical and psychological profile, 5 to pain, 9 to physical activity, 4 to aesthetics and 13 to footwear. CONCLUSION This tool should facilitate gathering of individuals' expectations from hallux valgus repair to ensure realistic goals and reduce post-surgical dissatisfaction.
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Affiliation(s)
- Cédric Blouin
- UFR Simone Veil-Santé, UR2020 Erphan, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- ISPC Synergies, Paris, France
| | - François Genet
- ISPC Synergies, Paris, France
- Département PARASPORT-SANTE, Unité Péri Opératoire du Handicap, (UPOH-Perioperative Disability Unit), Service de Médecine Physique et de Réadaptation, Hôpital Raymond-Poincaré, Groupe Hospitalo-Universitaire APHP-Université PARIS SACLAY, Garches, France
- UFR Simone Veil-Santé, END: ICAP, Inserm U1179, Université Versailles Saint-Quentin-en-Yvelines (UVSQ), Montigny-le-Bretonneux, France
| | - Philippe Denormandie
- Service de Chirurgie Orthopédique, Hôpital Raymond Poincaré, APHP, Garches, France
- Groupe Mutuelle Nationale des Hospitaliers (MNH), Paris, France
| | - Wilfrid Graff
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
| | - Antoine Perrier
- Service de Chirurgie Orthopédique, Hôpital de la Croix-Saint-Simon, Groupe Hospitalier Diaconesses–Croix-Saint-Simon, Paris, France
- Laboratoire de Recherche Translationnelle et D’Innovation en Médecine et Complexité TIMC, CNRS, Grenoble, France
- Service de Diabétologie, Groupe Hospitalier Pitié-Salpêtrière, Paris, France
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Klein EE, Wirt C, Greenley R, Weil LS, Weil L, Fleischer AE. Do Patient Personality Traits and Self-Reported Physical and Psychosocial Symptoms Help to Predict Hallux Valgus Surgery Outcomes? J Foot Ankle Surg 2022; 61:950-956. [PMID: 34998678 DOI: 10.1053/j.jfas.2021.12.019] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2020] [Accepted: 12/07/2021] [Indexed: 02/03/2023]
Abstract
As many as 10% of patients remain unsatisfied after hallux valgus surgery. We explored the effects of patient personality traits and other preoperative patient characteristics on patient-reported outcomes following surgery. Eighty consecutive adult patients (mean age 45 ± 14 years, 91% female [73/80]) undergoing scarf bunionectomy at our practice were prospectively enrolled from January 2016 to January 2017 and followed for 12 months. Predictor variables included preoperative physical and psychosocial complaints (determined via Brief Battery for Health Improvement-2 questionnaire), patient aggression level, and personality traits (extraversion, agreeableness, conscientiousness, emotional stability and openness). Primary outcome measures included the Foot and Ankle Outcome Score (FAOS) with its 5 subscales, and patient satisfaction. Multiple multivariable regression models were used to determine preoperative patient characteristics associated with FAOS outcome and satisfaction at 12 months. Seventy subjects (70/80, 87.5%) completed the study. All patients experienced technically successful surgery. In the multivariable regression analyses, none of the combinations of potentially important predictor variables explained more than 19.8% of the variance in any of the 5 FAOS subscales at 12 months (range: 6.1%-19.8%). Furthermore, no predictor was associated with patient satisfaction in either the univariate or multivariable analyses. We conclude that patient personality traits, aggression level, and self-reported physical and psychological symptoms do very little to predict outcomes in hallux valgus surgery. As healthcare delivery in the United States has increasingly prioritized patient satisfaction, we will need to broaden the quest for predictors associated with our best (and worst) patient-reported outcomes after hallux valgus surgery.
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Affiliation(s)
- Erin E Klein
- Associate Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Craig Wirt
- Podiatrist, Northwestern Medicine Orthopaedics, Warrenville, IL
| | - Rachel Greenley
- Professor and Chair, Department of Psychology, Rosalind Franklin University of Medicine and Science, North Chicago, IL
| | - Lowell S Weil
- Founder, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Lowell Weil
- CEO, Weil Foot & Ankle Institute, Mount Prospect, IL
| | - Adam E Fleischer
- Director of Research, Weil Foot & Ankle Institute, Mount Prospect, IL; Professor, Dr. William M. Scholl College of Podiatric Medicine, Rosalind Franklin University of Medicine and Science, North Chicago, IL.
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Holt M, Swalwell CL, Silveira GH, Tippett V, Walsh TP, Platt SR. Pain catastrophising, body mass index and depressive symptoms are associated with pain severity in tertiary referral orthopaedic foot/ankle patients. J Foot Ankle Res 2022; 15:32. [PMID: 35524334 PMCID: PMC9074220 DOI: 10.1186/s13047-022-00536-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Accepted: 04/04/2022] [Indexed: 11/23/2022] Open
Abstract
Introduction Patients with chronic foot/ankle pain are often referred for orthopaedic assessment. Psychological vulnerabilities influence pain states (including foot and ankle), therefore this study aimed to establish the prevalence and relative importance of compromised psychological health to perceived foot/ankle pain severity in people referred to an orthopaedic foot and ankle clinic with non-urgent presentations. Methods Patients with triaged non-urgent foot/ankle referrals to the Department of Orthopaedics at Gold Coast University Hospital were recruited over a 12-month period and completed the Manchester-Oxford Foot and Ankle Questionnaire which was the primary measure. Participants also completed questionnaires assessing their anthropometric, demographic and health characteristics (Self-Administered Comorbidity Questionnaire) as well as measures of health-related quality of life (EuroQol-5-Dimensions-5-Level Questionnaire and EQ Visual Analogue Scale) and psychological health (Center for Epidemiological Studies-Depression scale, Pain Catastrophizing Scale and Central Sensitization Inventory). Descriptive statistics were used to summarise participant characteristics and a hierarchical multiple linear regression was employed to establish the extent to which psychological variables explain additional variance in foot/ankle pain severity beyond the effects of participant characteristics (age, sex, body mass index (BMI)). Results One hundred and seventy-two adults were recruited ((64.0% female), median (IQR) age 60.9 (17.7) years and BMI 27.6 (7.5) kg/m2). Specific psychological comorbidities were prevalent including depressive symptoms (48%), central sensitisation (38%) and pain catastrophising (24%). Age, sex and BMI accounted for 11.7% of the variance in MOXFQ-index and psychological variables accounted for an additional 28.2%. Pain catastrophising was the most significant independent predictor of foot/ankle pain severity (accounting for 14.4% of variance), followed by BMI (10.7%) and depressive symptoms (2.3%). Conclusions This study demonstrated that specific psychological comorbidities and increased BMI are common in this cohort and that these factors are associated with the symptoms for which patients are seeking orthopaedic assessment. This knowledge should prompt clinicians to routinely consider the psychosocial components of patient presentations and develop non-operative and pre-operative treatment strategies which consider these factors with the goal of improving overall patient outcomes.
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Affiliation(s)
- Matthew Holt
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, 4215, Australia.,Griffith University, School of Medicine, Southport, Queensland, 4215, Australia
| | - Caitlin L Swalwell
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, 4215, Australia.,Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Kelvin Grove, Queensland, 4059, Australia
| | - Gayle H Silveira
- Department of Orthopaedics & Trauma, Northern Adelaide Local Health Network, South Australia, 5112, Australia
| | - Vivienne Tippett
- Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Kelvin Grove, Queensland, 4059, Australia
| | - Tom P Walsh
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, 4215, Australia. .,Queensland University of Technology (QUT), Faculty of Health, School of Clinical Sciences, Kelvin Grove, Queensland, 4059, Australia.
| | - Simon R Platt
- Department of Orthopaedics, Gold Coast University Hospital, Southport, Queensland, 4215, Australia.,Griffith University, School of Medicine, Southport, Queensland, 4215, Australia
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11
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Hoch C, Pire J, Scott DJ, Gross CE. The Influence of Pain and Resiliency on Foot and Ankle Surgery Outcomes. FOOT & ANKLE ORTHOPAEDICS 2022; 7:24730114221108137. [PMID: 35770145 PMCID: PMC9234850 DOI: 10.1177/24730114221108137] [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] [Indexed: 11/16/2022] Open
Abstract
Background: Resilience is the ability to recover after stressful events and has been shown to correlate with surgical outcomes. However, there has been minimal research on the impact of patient resiliency on foot and ankle surgical outcomes. This study aims to determine the predictive value of preoperative resiliency scores on surgical outcomes and investigate how this compares with the predictive value of pain scores. Methods: We conducted a retrospective review of adult patients who completed a preoperative Brief Resilience Scale (BRS) and underwent surgery between November 2019 and November 2020 with a fellowship-trained foot and ankle surgeon (N=184). Data included demographics, comorbidities, surgical details, complication and reoperation rates, pre- and postoperative opioid and benzodiazepine use, and additional patient-reported outcome measures (ie, visual analog scale [VAS], Pain Catastrophizing Scale [PCS], Pain Disability Index [PDI], Foot and Ankle Outcome Score [FAOS] pain subscale). Mean follow-up duration was 4.49 (range, 1.10-14.17) months. Results: BRS weakly correlated with decreased postoperative benzodiazepine use ( P=.007). PCS magnification ( P=.050) and helplessness ( P=.047) subscales weakly correlated with increased follow-up duration. PDI total score and most subscores significantly correlated with an increase in at least 1 of the following: follow-up duration, or postoperative opioid or benzodiazepine use. Neither the VAS nor FAOS pain subscore correlated with any outcome. PDI total score was the strongest predictor of postoperative opioid (β=0.334) and benzodiazepine (β=0.315) use. Preoperative opioid users had significantly higher PDI total score (user=39.3, nonuser=24.9; P=.012) and subscores (ie, social activity, sexual behavior, self-care, life-support activities). Conclusion: BRS is an unreliable tool for predicting outcomes in foot and ankle surgery, as it only weakly correlated with decreased benzodiazepine use. Rather, given the PDI’s strong associations with postoperative measures in this study, physicians should consider the value of preoperative PDI completion when predicting how foot and ankle surgery recipients will fare postoperatively. Level of Evidence: Level III, retrospective cohort study.
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Affiliation(s)
- Caroline Hoch
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Jonathan Pire
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Daniel J. Scott
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
| | - Christopher E. Gross
- Department of Orthopaedics and Physical Medicine, Medical University of South Carolina, Charleston, SC, USA
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Association of Depression and Anxiety With Expectations and Satisfaction in Foot and Ankle Surgery. J Am Acad Orthop Surg 2021; 29:714-722. [PMID: 34142981 DOI: 10.5435/jaaos-d-20-01394] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 05/23/2021] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Mental health diagnoses involving depression or anxiety are common and can have a dramatic effect on patients with musculoskeletal pathologies. In orthopaedics, depression/anxiety (D/A) is associated with worse postoperative patient-reported outcomes. However, few studies have assessed the effect of D/A on expectations and satisfaction in foot and ankle patients. METHODS Adult patients undergoing elective foot and ankle surgery were prospectively enrolled. Preoperatively, patients completed the eight-item Patient Health Questionnaire Depression Scale, Generalized Anxiety Disorder Screener-7, Foot and Ankle Outcome Score (FAOS), and Expectations Survey. At 2 years postoperatively, surveys including satisfaction, improvement, and fulfillment of expectations were administered. Fulfillment of expectations (fulfillment proportion) and FAOS scores were compared between patients with D/A and non-D/A patients. RESULTS Of 340 patients initially surveyed, 271 (80%) completed 2-year postoperative expectations surveys. One in five patients had D/A symptoms. Preoperatively, D/A patients had greater expectations of surgery (P = 0.015). After adjusting for measured confounders, the average 2-year postoperative fulfillment proportion was not significantly lower among D/A compared with non-D/A (0.86 versus 0.78, P = 0.2284). Although FAOS scores improved postoperatively for both groups, D/A patients had significantly lower preoperative and postoperative FAOS scores for domains of symptoms, activity, and quality of life (P < 0.05 for all). D/A patients reported less improvement (P = 0.036) and less satisfaction (P = 0.005) and were less likely willing to recommend surgery to others (P = 0.011). DISCUSSION Patients with D/A symptoms had higher preoperative expectations of surgery. Although D/A patients had statistically similar rates of fulfillment of expectations compared with non-D/A patients, they had markedly lower FAOS scores for domains of symptoms, activity, and quality of life. D/A patients also perceived less improvement and were more often dissatisfied with their outcomes. These findings should not dissuade providers from treating these patients surgically but rather emphasize the importance of careful patient selection and preoperative expectation management. LEVEL OF EVIDENCE Level III; retrospective review of prospective cohort study.
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Goh GS, Thever Y, Tay AYW, Rikhraj IS, Koo K. Can patients with psychological distress achieve comparable functional outcomes and satisfaction after hallux valgus surgery? A 2-year follow-up study. Foot Ankle Surg 2021; 27:660-664. [PMID: 32917525 DOI: 10.1016/j.fas.2020.08.011] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Accepted: 08/25/2020] [Indexed: 02/04/2023]
Abstract
BACKGROUND This study assessed the influence of preoperative mental health on functional outcomes and satisfaction, and the change in mental health after hallux valgus surgery. METHODS 383 patients who underwent scarf osteotomy were analyzed. Visual analogue scale (VAS), American Orthopaedic Foot & Ankle Society score (AOFAS) and SF-36 were assessed at 6 months and 2 years. The cohort was stratified into patients with and without psychological distress (i.e. SF-36 Mental Component Summary [MCS] <50 vs ≥50). RESULTS After adjusting for demographics and baseline scores, VAS and AOFAS were poorer in the distressed group at 6 months. However, there was no difference in scores at 2 years and a similar proportion of patients were satisfied. SF-36 MCS in distressed patients significantly improved, but remained lower compared to non-distressed patients at follow-up. CONCLUSIONS Patients with psychological distress undergoing hallux valgus surgery had poorer short-term outcomes, but these differences resolved at 2 years.
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Affiliation(s)
- Graham S Goh
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore.
| | - Yogen Thever
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | - Adriel You Wei Tay
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
| | | | - Kevin Koo
- Department of Orthopaedic Surgery, Singapore General Hospital, Singapore
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14
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Au Yong PSA, Sim EYL, Ho CYX, He Y, Kwa CXW, Teo LM, Abdullah HR. Association of Multimorbidity With Frailty in Older Adults for Elective Non-Cardiac Surgery. Cureus 2021; 13:e15033. [PMID: 34150384 PMCID: PMC8200322 DOI: 10.7759/cureus.15033] [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] [Indexed: 11/29/2022] Open
Abstract
Introduction Frailty is associated with adverse surgical outcomes. While existing studies describe the prevalence of multimorbidity and frailty in the community, the surgical population may have more severe disease and significant surgical stress. This study aims to describe the distribution of frailty and multimorbidity in the older surgical population and examine if specific comorbidities are more strongly associated with frailty. Methods This is a single-centre retrospective cohort study using an electronic database in the preoperative evaluation clinic, conducted in Singapore General Hospital, Singapore. All patients above 70 years old going for elective non-cardiac surgery were included. Demographics and comorbidities were analysed for their association with frailty according to the Edmonton Frail Scale. Results A total of 1396 out of 1398 patients were analyzed. The overall incidence of frailty was 27.8% and multimorbidity was 63.4%. Factors independently associated with frailty were age (adjusted Odds Ratio [aOR] = 1.07), female gender (aOR = 1.67), type 2 diabetes mellitus (aOR = 1.69), chronic kidney disease (aOR = 1.47), end-stage renal failure (aOR = 3.58), history of cerebrovascular accident or transient ischemic attack (aOR = 1.87), moderate anaemia (aOR = 2.11), dementia (aOR = 6.38), depression (aOR = 3.82), and peptic ulcer disease (aOR = 1.98). The presence of multi-morbidity was significantly associated with frailty, with overall increasing strength of association. Conclusion As the number of comorbidities increases, the odds of frailty increase. Only a small proportion of those with multimorbidity accumulate enough biological deficits to develop frailty, putting them at higher risk than with solely multimorbidity or frailty. Dementia and depression are comorbidities with strong associations that have yet to see coordinated interventional efforts in the preoperative setting.
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Affiliation(s)
- Phui Sze Angie Au Yong
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Eileen Yi Lin Sim
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Collin Yih Xian Ho
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Yingke He
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Charlene Xian Wen Kwa
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Li Ming Teo
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
| | - Hairil Rizal Abdullah
- Division of Anaesthesiology and Perioperative Medicine, Singapore General Hospital, Singapore, SGP
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15
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The Impact of Multiple Comorbid Mental Health Disorders on Health-related Quality of Life Following ACDF. Clin Spine Surg 2020; 33:E472-E477. [PMID: 32149747 DOI: 10.1097/bsd.0000000000000957] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVE The goal was to determine whether comorbid depression and/or anxiety influence outcomes after anterior cervical discectomy and fusion (ACDF) for patients with degenerative cervical pathology. BACKGROUND DATA The role preoperative mental health has on patient reported outcomes after ACDF surgery is not well understood. METHODS Patients undergoing elective ACDF for degenerative cervical pathology were identified. Patients were grouped based on their preoperative mental health comorbidities, including patients with no history, depression, anxiety, and those with both depression and anxiety. All preoperative medical treatment for depression and/or anxiety was identified. Outcomes including Physical Component Score (PCS-12), Mental Component Score (MCS-12), Neck Disability Index (NDI), Visual Analogue Scale neck pain score (VAS Neck ), and Visual Analogue Scale arm pain score (VAS Arm) were compared between groups from baseline to postoperative measurements using multiple linear regression analysis-controlling for factors such as age, sex, and body mass index, etc. A P-value <0.05 was considered statistically significant. RESULTS A total of 264 patients were included in the analysis, with an average age of 53 years and mean follow-up of 19.8 months (19.0-20.6). All patients with a diagnosis of depression or anxiety also reported medical treatment for the disease. The group with no depression or anxiety had significantly less baseline disability than the group with 2 mental health diagnoses, in MCS-12 (P=0.009), NDI (P<0.004), VAS Neck (P=0.003), and VAS Arm (P=0.001) scores. Linear regression analysis demonstrated that increasing occurrence of mental health disorders was not a significant predictor of change over time for any of the outcome measures included in the analysis. CONCLUSIONS Despite more severe preoperative symptoms, patients with a preoperative mental health disorder(s) demonstrated significant improvement in postoperative outcomes after ACDF. No differences were identified in postoperative outcomes between each of the groups. LEVEL OF EVIDENCE Level III.
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Agarwalla A, Lu Y, Chang E, Patel BH, Cancienne JM, Cole BJ, Verma N, Forsythe B. Influence of mental health on postoperative outcomes in patients following biceps tenodesis. J Shoulder Elbow Surg 2020; 29:2248-2256. [PMID: 32684282 DOI: 10.1016/j.jse.2020.03.020] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2019] [Revised: 03/16/2020] [Accepted: 03/20/2020] [Indexed: 02/05/2023]
Abstract
PURPOSE To evaluate the relationship between preoperative mental health measured by the Short-Form 12 health survey mental component score and outcomes after isolated biceps tenodesis. METHODS The American Shoulder and Elbow Surgeons form (ASES), Single Assessment Numeric Evaluation (SANE), Constant-Murley score (CMS), and visual analog scale (VAS) for pain were administered preoperatively and at 6 and 12 months postoperatively to consecutive patients undergoing isolated biceps tenodesis between 2014 and 2018. Minimal clinically important difference, substantial clinical benefit (SCB), patient-acceptable symptom state (PASS), and rates of achievement were calculated. Patients were stratified by mental health status based on preoperative scores on the Short-Form 12 health survey mental component score. Multivariate logistic regression was performed to evaluate preoperative mental health status on achievement of minimal clinically important difference, SCB, and PASS. RESULTS Patients demonstrated significant improvements in all outcome measures (P < .001). Patients with depression reported inferior postoperative scores on all patient-reported outcome measures. Low preoperative mental health score significantly predicted reduced likelihood to achieve SCB (odds ratio [OR]: 0.38, 95% confidence interval [CI]: 0.17-0.81, P = .01) and PASS (OR: 0.28, 95% CI: 0.12-0.65, P = .003) on the ASES form, SANE (OR: 0.24, 95% CI: 0.10-0.61, P = .003), CMS (OR: 0.25, 95% CI: 0.08-0.77, P = .016), and VAS pain (OR: 0.01, 95% CI: 0.00-0.31, P = .008). CONCLUSION Patients with depression reported inferior scores on all postoperative patient-reported outcome measures and demonstrated lower odds of achieving the SCB and PASS on the ASES form and PASS on the SANE, CMS, and VAS pain, compared with nondepressed patients.
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Affiliation(s)
- Avinesh Agarwalla
- Department of Orthopaedic Surgery, Westchester Medical Center, Valhalla, NY, USA
| | - Yining Lu
- Department of Orthopaedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Elizabeth Chang
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Bhavik H Patel
- Department of Orthopaedic Surgery, University of Illinois, Chicago, IL, USA
| | | | - Brian J Cole
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Nikhil Verma
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA
| | - Brian Forsythe
- Division of Sports Medicine, Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, IL, USA.
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Hernández-Castillejo LE, Martínez Vizcaíno V, Garrido-Miguel M, Cavero-Redondo I, Pozuelo-Carrascosa DP, Álvarez-Bueno C. Effectiveness of hallux valgus surgery on patient quality of life: a systematic review and meta-analysis. Acta Orthop 2020; 91:450-456. [PMID: 32408787 PMCID: PMC8023907 DOI: 10.1080/17453674.2020.1764193] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - The quality of life (QoL) of patients with hallux valgus (HV) usually improves postoperatively. Evidence regarding the effect of HV surgery on different domains of patient QoL remains inconclusive. This systematic review and meta-analysis estimates the effect of HV surgery on patient QoL through distinguishing effects on physical domains (comprising physical function and body pain domains) using the EuroQol-5D, short form (SF) health survey-12, and SF-36 QoL scales and a visual analogue scale (VAS) score and mental and social domains using QoL scales.Patients and methods - MEDLINE, EMBASE, Cochrane Library, and Web of Science databases were systematically searched from inception to March 2019 for studies on the effect of HV surgery on patient QoL. A standardized mean difference score was calculated for each specific QoL domain (mental, social, pain, physical, and VAS) using Cohen's d index. The pooled effect size (ES) was estimated using a random-effects model based on the DerSimonian and Laird method.Results - From 12 published studies selected, the estimated pooled ES for QoL was 1.01 (95% confidence interval [CI] 0.52-1.51; I2 = 87%) for body pain and 0.43 (CI 0.31-0.55, I2 = 35%) for physical function. Regarding the composite mental and social domains of QoL, the pooled ES estimates were 0.24 (CI 0.00-0.47, I2 = 80%) and 0.42 (CI 0.21-0.63, I2 = 6.4%), respectively. The pooled difference in means for the VAS score was -4.1 (CI -4.5 to -3.6, I2 = 90%).Interpretation - Our data showed that HV surgery decreased patients' perceptions regarding pain. Furthermore, the data confirmed that HV surgery increased patients' QoL, particularly concerning physical and social domains.
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Affiliation(s)
| | - Vicente Martínez Vizcaíno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; ,Facultad de Ciencias de la Salud, Universidad Autónoma de Chile, Talca, Chile; ,Correspondence:
| | - Miriam Garrido-Miguel
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain;
| | - Iván Cavero-Redondo
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; ,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
| | | | - Celia Álvarez-Bueno
- Health and Social Research Center, Universidad de Castilla La Mancha, Cuenca, Spain; ,Universidad Politécnica y Artística del Paraguay, Asunción, Paraguay
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18
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Kim TY, Lee HW, Jeong BO. Influence of Depressive Symptoms on the Clinical Outcomes of Total Ankle Arthroplasty. J Foot Ankle Surg 2020; 59:59-63. [PMID: 31882150 DOI: 10.1053/j.jfas.2019.07.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2019] [Revised: 03/18/2019] [Accepted: 07/07/2019] [Indexed: 02/03/2023]
Abstract
Many studies have reported the relevance of depression on clinical outcomes after knee or hip arthroplasty. However, no study has investigated this relationship in total ankle arthroplasty (TAA). This study aimed to study the relationship between depressive symptoms and clinical outcomes after TAA. This retrospective comparative study investigated 40 patients who underwent TAA for end-stage ankle arthritis. Depressive symptoms were evaluated using the Center for Epidemiologic Studies Depression Scale and Patient Health Questionnaire-9. Preoperative and postoperative clinical outcomes were compared using the visual analog scale (VAS) and American Orthopedic Foot and Ankle Society (AOFAS) ankle-hindfoot scores by classifying the subjects into depressive and nondepressive groups. The mean follow-up duration was 24.3 ± 7.3 (range 14 to 37) months. There were 13 and 27 subjects in the depressive and nondepressive groups, respectively. There were no significant differences in the baseline characteristics and preoperative VAS and AOFAS scores between them. The postoperative VAS score was significantly higher in the depressive group (3.1 ± 2.4) than in the nondepressive group (1.4 ± 2.3; p < .001). The postoperative AOFAS scores in the depressive and nondepressive groups were 89.3 ± 13.4 and 95.0 ± 8.1, respectively, showing a significantly superior result in the latter group (p < .001). The clinical outcomes after TAA were poorer in the patients with depressive symptoms than in those without. Depressive symptoms are patient-specific factors or independent predictors that show less improvement after TAA. Therefore, clinical considerations of these symptoms are essential before TAA.
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Affiliation(s)
- Tae Yong Kim
- Orthopaedic Doctor, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Hyun Woo Lee
- Orthopaedic Doctor, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea
| | - Bi O Jeong
- Orthopaedic Doctor, Department of Orthopaedic Surgery, College of Medicine, Kyung Hee University, Seoul, Korea.
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19
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Maidman SD, Nash AE, Fantry A, Tenenbaum S, Daoud Y, Brodsky J, Bariteau JT. Effect of Psychotropic Medications on Hammertoe Reconstruction Outcomes. FOOT & ANKLE ORTHOPAEDICS 2020; 5:2473011420944133. [PMID: 35097400 PMCID: PMC8697102 DOI: 10.1177/2473011420944133] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Background: Hammertoe deformities can seriously affect activity level and footwear. The use of prescription, mood-altering medications is very common, with some estimates as high as 25% of the population. Mood disorders, especially depression, negatively affect the results of medical and operative treatments. This study assessed the relationship of mood-altering medication use with the outcomes and complications of operative reconstruction of hammertoes. Methods: Data were prospectively collected from 116 patients who underwent hammertoe reconstruction, including demographic information, medical history, the use of mood-altering psychotropic medications (antidepressants, anxiolytics, hypnotics, and mood stabilizers), and postoperative complications. Preoperative patient-reported outcomes were measured using the visual analog scale (VAS) for pain and Short Form Health Survey (SF-36), which were repeated at 1-year follow-up. Results: A total of 36.2% of patients were taking psychotropic medications. Medication and nonmedication groups had similar pain VAS and SF-36 Physical Component Summary (PCS) scores before and after surgery. Compared with nonmedication patients, patients on psychotropic medications had significantly lower SF-36 Mental Component Summary (MCS) scores preoperatively (P = .001) and postoperatively (P = .006), but no significant difference in the change in MCS (ΔMCS) from preoperative to postoperative. Psychotropic medication use was associated with superficial wound infections (P = .048), but not other complications. Conclusions: Patients taking psychotropic medications were equally likely to benefit from forefoot reconstruction as nonmedication patients. Preoperative and postoperative PCS and VAS were not significantly different between medication and nonmedication groups. Although the medication group had lower absolute MCS, they reported the same magnitude of improvement in MCS (ΔMCS) as the nonmedication group. Level of Evidence: Level II, prospective cohort study.
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Affiliation(s)
| | - Amalie E Nash
- Emory University School of Medicine, Atlanta, GA, USA.,Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA
| | | | - Shay Tenenbaum
- Chaim Sheba Medical Center at Tel HaShomer, affiliated to Sackler Faculty of Medicine, Tel Aviv University, Ramat Gan, Israel
| | - Yahya Daoud
- Baylor University Medical Center, Dallas, TX, USA
| | | | - Jason T Bariteau
- Department of Orthopaedics, Emory University School of Medicine, Atlanta, GA, USA.,Emory Orthopaedics and Spine Center, Atlanta, GA, USA
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Abstract
Coronal malalignment is an important deformity parameter in hallux valgus feet. Approximately 90% of patients with hallux valgus have some degree of metatarsal pronation. In operated hallux valgus, persistent metatarsal pronation is an independent deformity relapse factor. Coronal malalignment can be identified through an anteroposterior (AP) weight-bearing foot radiograph and a weight-bearing forefoot scan. The AP foot view can identify 3 levels of rotation: mild, moderate and severe metatarsal pronation. Regarding the treatment options, some techniques are capable of rotational correction, such as the proximal rotational metatarsal osteotomy, Lapidus, dome osteotomy, and proximal oblique sliding closing wedge.
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Affiliation(s)
- Pablo Wagner
- Universidad de Desarrollo - Clinica Alemana de Santiago, Universidad de los Andes - Hospital Militar de Santiago, Vitacura 5951, Vitacura, Santiago, Chile.
| | - Emilio Wagner
- Universidad de Desarrollo - Clinica Alemana de Santiago, Vitacura 5951, Vitacura, Santiago, Chile
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21
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Abstract
Postoperative management of hallux valgus varies widely. Setting preoperative expectations is an important aspect of attaining a successful outcome, but this is not routinely reviewed in the literature. This chapter offers suggestions on successfully navigating this area of patient care. Current concepts focus on pain control, immobilization, and return to activities. This chapter also reviews the current literature in these areas and sets out the authors' preferred management in the postoperative setting.
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Affiliation(s)
- William A Hester
- Sidney Kimmel Medical College, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA
| | - David I Pedowitz
- Foot & Ankle Fellowship, Sidney Kimmel Medical College, Thomas Jefferson University, The Rothman Institute, 925 Chestnut Street, 5th Floor, Philadelphia, PA 19107, USA.
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22
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Palomo-López P, Becerro-de-Bengoa-Vallejo R, Losa-Iglesias ME, López-López D, Rodríguez-Sanz D, Romero-Morales C, Calvo-Lobo C, Mazoteras-Pardo V. Kinesiophobia and Pain Intensity Are Increased by a Greater Hallux Valgus Deformity Degree- Kinesiophobia and Pain Intensity in Hallux Valgus. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17020626. [PMID: 31963718 PMCID: PMC7013541 DOI: 10.3390/ijerph17020626] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Revised: 01/07/2020] [Accepted: 01/16/2020] [Indexed: 12/19/2022]
Abstract
Background: Hallux valgus (HV) has been previously associated with psychological disorders. Thus, the purposes of this study were to associate kinesiophobia and pain intensity with HV deformity degrees, as well as predict kinesiophobia and pain intensity based on HV deformity and demographic features. Methods: A cross-sectional study was carried out recruiting 100 subjects, who were divided into HV deformity degrees, such as I-no HV (n = 25), II-mild (n = 25), III-moderate (n = 25), and IV-severe (n = 25) HV. Kinesiophobia total and domains (activity avoidance and harm) scores and levels were self-reported by the Tampa Scale of Kinesiophobia (TSK-11). Pain intensity was self-reported by the numeric rating scale (NRS). Results: Statistically significant differences (p < 0.01; η2 = 0.132–0.850) were shown for between-groups comparison of kinesiophobia total and domain scores (activity avoidance and harm) and levels, as well as pain intensity among HV deformity degrees. Post hoc comparisons showed statistically significant differences with a large effect size (p < 0.05; d = 0.85–4.41), showing higher kinesiophobia symptoms and levels and pain intensity associated with greater HV deformity degrees, especially for III-moderate and/or IV-severe HV deformity degrees versus I-no HV and/or II-mild deformity degrees. Both statistically significant prediction models (p < 0.05) for kinesiophobia (R2 = 0.300) and pain intensity (R2 = 0.815) were predicted by greater HV deformity degree and age. Conclusions: Greater kinesiophobia symptoms and levels and pain were associated with higher HV deformity degrees, especially severe and/or moderate HV with respect to no and/or mild HV. The kinesiophobia and pain intensity were predicted by greater HV deformity degree and age.
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Affiliation(s)
| | - Ricardo Becerro-de-Bengoa-Vallejo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (D.R.-S.); (V.M.-P.)
| | | | - Daniel López-López
- Research, Health and Podiatry Group, Department of Health Sciences, Faculty of Nursing and Podiatry, Universidade da Coruña, 15403 Ferrol, Spain;
| | - David Rodríguez-Sanz
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (D.R.-S.); (V.M.-P.)
| | - Carlos Romero-Morales
- Faculty of Sport Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, 28670 Madrid, Spain;
| | - César Calvo-Lobo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (D.R.-S.); (V.M.-P.)
- Correspondence:
| | - Victoria Mazoteras-Pardo
- Facultad de Enfermería, Fisioterapia y Podología, Universidad Complutense de Madrid, 28040 Madrid, Spain; (R.B.-d.-B.-V.); (D.R.-S.); (V.M.-P.)
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Affiliation(s)
- Timothy R Daniels
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Mansur Halai
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
| | - Jacob Matz
- Division of Orthopaedic Surgery, St. Michael's Hospital and University of Toronto, Toronto, Ontario, Canada
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Martin RL, Christoforetti JJ, McGovern R, Kivlan BR, Wolff AB, Nho SJ, Salvo JP, Ellis TJ, Van Thiel G, Matsuda D, Carreira DS. The Impact of Depression on Patient Outcomes in Hip Arthroscopic Surgery. Orthop J Sports Med 2018; 6:2325967118806490. [PMID: 30480015 PMCID: PMC6240974 DOI: 10.1177/2325967118806490] [Citation(s) in RCA: 49] [Impact Index Per Article: 8.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023] Open
Abstract
Background: Mental health impairments have been shown to negatively affect preoperative self-reported function in patients with various musculoskeletal disorders, including those with femoroacetabular impingement. Hypothesis: Those with symptoms of depression will have lower self-reported function, more pain, and less satisfaction on initial assessment and at 2-year follow-up than those without symptoms of depression. Study Design: Cohort study; Level of evidence, 3. Methods: Patients who were enrolled in a multicenter hip arthroscopic surgery registry and had 2-year outcome data available were included in the study. Patients completed the 12-item International Hip Outcome Tool (iHOT-12), visual analog scale (VAS) for pain, and 12-item Short-Form Health Survey (SF-12) when consenting for surgery. At 2-year follow-up, patients were emailed the iHOT, the VAS, and a rating scale of surgical satisfaction. Initial SF-12 mental component summary (MCS) scores <46.5 and ≤36 were used to qualify symptoms of depression and severe depression, respectively, as previously described and validated. Repeated-measures analysis of variance was performed to compare preoperative and 2-year postoperative iHOT-12, VAS, and satisfaction scores between those with and without symptoms of depression. Results: A total of 781 patients achieved the approximate 2-year milestone (mean follow-up, 735 ± 68 days), with 651 (83%) having 2-year outcome data available. There were 434 (67%) female and 217 (33%) male patients, with a mean age of 35.8 ± 13.0 years and a mean body mass index of 25.4 ± 8.8 kg/m2. The most common procedures were femoroplasty (83%), followed by synovectomy (80%), labral repair (76%), acetabuloplasty (58%), acetabular chondroplasty (56%), femoral chondroplasty (23%), and labral reconstruction (19%). The mean initial SF-12 MCS score was 51.5 ± 10.3, with cutoff scores indicating symptoms of depression and severe depression in 181 (28%) and 71 (11%) patients, respectively. Patients with symptoms of depression scored significantly (P < .05) lower on the initial iHOT-12 and VAS and 2-year follow-up iHOT-12, VAS, and rating scale of surgical satisfaction. Conclusion: A large number of patients who underwent hip arthroscopic surgery presented with symptoms of depression, which negatively affected self-reported function, pain levels, and satisfaction on initial assessment and at 2-year follow-up. Surgeons who perform hip arthroscopic surgery may need to identify the symptoms of depression and be aware of the impact that depression can have on surgical outcomes.
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Affiliation(s)
- RobRoy L Martin
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA.,Center for Sports Medicine, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA
| | - John J Christoforetti
- Allegheny Orthopaedic Associates, Allegheny Health Network, Pittsburgh, Pennsylvania, USA.,Department of Orthopaedic Surgery, Drexel University College of Medicine, Philadelphia, Pennsylvania, USA
| | - Ryan McGovern
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Benjamin R Kivlan
- Rangos School of Health Sciences, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Andrew B Wolff
- Washington Orthopaedics & Sports Medicine, Washington, DC, USA
| | - Shane J Nho
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA
| | - John P Salvo
- Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Thomas J Ellis
- Orthopedic One, Columbus, Ohio, USA.,Ohio Orthopedic Surgery Institute, Columbus, Ohio, USA.,Dublin Methodist Hospital, Dublin, Ohio, USA
| | - Geoff Van Thiel
- Department of Orthopedic Surgery, Rush University Medical Center, Chicago, Illinois, USA.,OrthoIllinois, Rockford, Illinois, USA.,Chicago Blackhawks, Chicago, Illinois, USA
| | - Dean Matsuda
- DISC Sports & Spine Center, Marina del Rey, California, USA
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