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Porsius JT, Ter Stege MHP, Selles RW, Slijper HP. Driving Factors of Recommending a Hand Surgery Clinic After Surgery. J Hand Surg Am 2024; 49:114-123. [PMID: 38099875 DOI: 10.1016/j.jhsa.2023.11.010] [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: 08/30/2022] [Revised: 10/20/2023] [Accepted: 11/01/2023] [Indexed: 02/05/2024]
Abstract
PURPOSE Since a patient's recommendation of a clinic to others is an important indicator of patient experience, more insight is needed into the underlying factors that motivate such recommendations. This retrospective cohort study assessed the relative contribution of the following: (1) patient-related characteristics, (2) treatment outcome, (3) satisfaction with treatment outcome, and (4) patients' experience with the process of care to patients' recommendation of a specific clinic after elective surgery. METHODS Patients of specialized outpatient hand surgery clinics (N = 6,895) reported the likelihood of recommending the clinic to friends or family 3-5 months after surgery by filling in the Net Promoter Score. Potential predictors of the Net Promoter Score were preoperative patient characteristics, patient-reported treatment outcomes, satisfaction with treatment outcome, and experience with several health care delivery domains. Linear regression analyses were used to examine the contribution of the predictors. RESULTS Mean age of the patients was 53 (SD, 14) years, 62.5% were women, and 62.5% were employed. Preoperative patient characteristics explained 1% of the variance in clinic recommendations. An additional 6% was explained by the treatment outcome, 21.6% by satisfaction with treatment outcome, and 33.8% by patients' experience with care delivery (total explained variance was 62.3%). The strongest independent predictors of clinic recommendations were positive experiences with the quality of the facilities and the communication skills of the physician. CONCLUSIONS Patient recommendations are more strongly driven by patients' experience with care delivery than by treatment outcome and patient characteristics. CLINICAL RELEVANCE In elective surgery, improving patient experiences is pivotal in boosting patient recommendation of the clinic.
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Affiliation(s)
- Jarry T Porsius
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, the Netherlands
| | - Marloes H P Ter Stege
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Hand and Wrist Center, Xpert Clinics, the Netherlands.
| | - Ruud W Selles
- Department of Plastic, Reconstructive and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands; Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Sanjuan-Cervero R, Gomez-Herrero D, Peña-Molina F, de la Iglesia NH, Sanjuan-Arago A, Novoa-Parra CD. Patient Insight With Collagenase Treatment for Dupuytren: A Prospective Study. J Hand Surg Am 2023; 48:1274.e1-1274.e6. [PMID: 35718584 DOI: 10.1016/j.jhsa.2022.04.013] [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: 07/15/2021] [Revised: 03/08/2022] [Accepted: 04/22/2022] [Indexed: 02/02/2023]
Abstract
PURPOSE There appears to be controversy regarding differing patient and physician perceptions of adverse effects (AEs) in the treatment of Dupuytren disease with collagenase clostridium histolyticum (CCH). The aim of this study was to compare the number, type, and severity of AEs perceived and reported by patients and by their physician METHODS: To assess AEs following CCH injection in a standardized way, patients were given a list of predefined complications and asked to rate their severity on a 4-point Likert scale ranging from 1 (serious) to 4 (insignificant). RESULTS Eighty-five patients were included. Patients reported fewer AEs than their physician (mean, 1.48 vs 2.18). There was no agreement between physician- and patient-reported AEs except for skin lacerations, which showed fair agreement (κ = 0.257). CONCLUSIONS Patients and physicians differ in their evaluation of AEs due to CCH treatment in Dupuytren disease. A fair level of agreement was observed for skin lacerations. CLINICAL RELEVANCE Greater consensus is needed when defining AEs associated with CCH in the treatment of Dupuytren disease.
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Affiliation(s)
| | - Diego Gomez-Herrero
- Pharmacy Department, Hospital Vithas 9 de Octubre, Valencia, Spain; Doctor of Pharmacy Program, University of Granada, Granada, Spain
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Winberg M, Turesson C. Patients' perspectives of collagenase injection or needle fasciotomy and rehabilitation for Dupuytren disease, including hand function and occupational performance. Disabil Rehabil 2023; 45:986-996. [PMID: 35261296 DOI: 10.1080/09638288.2022.2046188] [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] [Indexed: 11/03/2022]
Abstract
PURPOSE To describe patients' perspectives of collagenase injection or needle fasciotomy for Dupuytren disease (DD) including hand therapy, and their view of hand function and occupational performance. MATERIALS AND METHODS Interviews were performed with twelve patients who had undergone non-surgical treatment and rehabilitation for DD. Data was analysed using a problem-driven content analysis using the model of Patient Evaluation Process as a theoretical framework. RESULTS The participants' previous experiences influenced their expectations of the upcoming treatment and they needed information to be prepared for treatment. Treatment and rehabilitation had a positive impact on daily life and were regarded as effective and simple with quick recovery. However, there could be remaining issues with tenderness or stiffness. The participants expressed their belief in rehabilitation and how their own efforts could contribute to an improved result. Despite concerns about future recurrence participants described increased knowledge and sense of control regarding future needs. CONCLUSION Undergoing a non-surgical treatment and rehabilitation process for DD was regarded as quick and easy and can meet the need for improved hand function and occupational performance. Taking responsibility for one's own rehabilitation was considered to influence the outcome positively. The theoretical framework optimally supported the exploration of participants' perspective.Implications for rehabilitationTreatment of Dupuytren Disease (DD) with needle/collagenase combined with hand therapy was experienced as giving fast improvement in hand function and occupational performance.An individualized care process which satisfies the need for knowledge about the disease, prognosis, treatment options and rehabilitation can give individuals suffering from DD a sense of security.The need for active participation in the DD care process can vary and it is crucial to listen to individuals' opinions and needs.Individuals can take considerable responsibility for rehabilitation after non-surgical treatment for DD and regard it as important for the outcome.
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Affiliation(s)
- Madeleine Winberg
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns in Linköping, and Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
- Department of Health, Medicine and Caring Sciences (HMV), Linköping University, Linköping, Sweden
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De Ridder WA, Wouters RM, Hoogendam L, Vermeulen GM, Slijper HP, Selles RW. Which Factors Are Associated With Satisfaction With Treatment Results in Patients With Hand and Wrist Conditions? A Large Cohort Analysis. Clin Orthop Relat Res 2022; 480:1287-1301. [PMID: 34982052 PMCID: PMC9191327 DOI: 10.1097/corr.0000000000002107] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2021] [Accepted: 12/15/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Satisfaction with treatment results is an important outcome domain in striving for patient-centered and value-based healthcare. Although numerous studies have investigated factors associated with satisfaction with treatment results, most studies used relatively small samples. Additionally, many studies have only investigated univariable associations instead of multivariable associations; to our knowledge, none have investigated the independent association of baseline sociodemographics, quality of life, improvement in pain and function, experiences with healthcare delivery, and baseline measures of mental health with satisfaction with treatment results. QUESTIONS/PURPOSES (1) What factors are independently associated with satisfaction with treatment results at 3 months post-treatment in patients treated for common hand and wrist conditions? (2) What factors are independently associated with the willingness to undergo the treatment again at 3 months post-treatment in patients treated for common hand and wrist conditions? Among the factors under study were baseline sociodemographics, quality of life, improvement in pain and function, experiences with healthcare delivery, and baseline measures of mental health. METHODS Between August 2018 and May 2020, we included patients who underwent carpal tunnel release, nonsurgical or surgical treatment for thumb-base osteoarthritis, trigger finger release, limited fasciectomy for Dupuytren contracture, or nonsurgical treatment for midcarpal laxity in one of the 28 centers of Xpert Clinics in the Netherlands. We screened 5859 patients with complete sociodemographics and data at baseline. Thirty-eight percent (2248 of 5859) of these patients had complete data at 3 months. Finally, participants were eligible for inclusion if they provided a relevant answer to the three patient-reported experience measure (PREM) items. A total of 424 patients did not do this because they answered "I don't know" or "not applicable" to a PREM item, leaving 31% (1824 of 5859) for inclusion in the final sample. A validated Satisfaction with Treatment Result Questionnaire was administered at 3 months, which identified the patients' level of satisfaction with treatment results so far on a 5-point Likert scale (research question 1, with answers of poor, moderate, fair, good, or excellent) and the patients' willingness to undergo the treatment again under similar circumstances (research question 2, with answers of yes or no). A hierarchical logistic regression model was used to identify whether baseline sociodemographics, quality of life, change in outcome (patient-reported outcome measures for hand function and pain), baseline measures of mental health (including treatment credibility [the extent to which a patient attributes credibility to a treatment] and expectations, illness perception, pain catastrophizing, anxiety, and depression), and PREMs were associated with each question of the Satisfaction with Treatment Result Questionnaire at 3 months post-treatment. We dichotomized responses to our first question as good and excellent, which were considered more satisfied, and poor, moderate, and fair, which were considered less satisfied. After dichotomization, 57% (1042 of 1824) of patients were classified as more satisfied with the treatment results. RESULTS The following variables were independently associated with satisfaction with treatment results, with an area under the curve of 0.82 (95% confidence interval 0.80 to 0.84) (arranged from the largest to the smallest standardized odds ratio [SOR]): greater decrease in pain during physical load (standardized odds ratio 2.52 [95% CI 2.18 to 2.92]; p < 0.001), patient's positive experience with the explanation of the pros and cons of the treatment (determined with the question: "Have you been explained the pros and cons of the treatment or surgery?") (SOR 1.83 [95% CI 1.41 to 2.38]; p < 0.001), greater improvement in hand function (SOR 1.76 [95% CI 1.54 to 2.01]; p < 0.001), patients' positive experience with the advice for at-home care (determined with the question: "Were you advised by the healthcare providers on how to deal with your illness or complaints in your home situation?") (SOR 1.57 [95% CI 1.21 to 2.04]; p < 0.001), patient's better personal control (determined with the question: "How much control do you feel you have over your illness?") (SOR 1.24 [95% CI 1.1 to 1.40]; p < 0.001), patient's more positive treatment expectations (SOR 1.23 [95% CI 1.04 to 1.46]; p = 0.02), longer expected illness duration by the patient (SOR 1.20 [95% CI 1.04 to 1.37]; p = 0.01), a smaller number of symptoms the patient saw as part of the illness (SOR 0.84 [95% CI 0.72 to 0.97]; p = 0.02), and less concern about the illness the patient experiences (SOR 0.84 [95% CI 0.72 to 0.99]; p = 0.04). For willingness to undergo the treatment again, the following variables were independently associated with an AUC of 0.81 (95% CI 0.78 to 0.83) (arranged from the largest to the smallest standardized OR): patient's positive experience with the information about the pros and cons (determined with the question: "Have you been explained the pros and cons of the treatment or surgery?") (SOR 2.05 [95% CI 1.50 to 2.80]; p < 0.001), greater improvement in hand function (SOR 1.80 [95% CI 1.54 to 2.11]; p < 0.001), greater decrease in pain during physical load (SOR 1.74 [95% CI 1.48 to 2.07]; p < 0.001), patient's positive experience with the advice for at home (determined with the question: "Were you advised by the healthcare providers on how to deal with your illness or complaints in your home situation?") (SOR 1.52 [95% CI 1.11 to 2.07]; p = 0.01), patient's positive experience with shared decision-making (determined with the question: "Did you decide together with the care providers which care or treatment you will receive?") (SOR 1.45 [95% CI 1.06 to 1.99]; p = 0.02), higher credibility the patient attributes to the treatment (SOR 1.44 [95% CI 1.20 to 1.73]; p < 0.001), longer symptom duration (SOR 1.27 [95% CI 1.09 to 1.52]; p < 0.01), and patient's better understanding of the condition (SOR 1.17 [95% CI 1.01 to 1.34]; p = 0.03). CONCLUSION Our findings suggest that to directly improve satisfaction with treatment results, clinicians might seek to: (1) improve the patient's experience with healthcare delivery, (2) try to influence illness perception, and (3) boost treatment expectations and credibility. Future research should confirm whether these suggestions are valid and perhaps also investigate whether satisfaction with treatment results can be predicted (instead of explained, as was done in this study). Such prediction models, as well as other decision support tools that investigate patient-specific needs, may influence experience with healthcare delivery, expectations, or illness perceptions, which in turn may improve satisfaction with treatment results. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Willemijn Anna De Ridder
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
- Center for Hand Therapy, Xpert Handtherapie, Utrecht, the Netherlands
| | - Robbert Maarten Wouters
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
| | - Lisa Hoogendam
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
| | | | - Harm Pieter Slijper
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Hand and Wrist Center, Xpert Clinics, the Netherlands
| | - Ruud Willem Selles
- Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
- Department of Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, the Netherlands
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Van Nuffel M, Meulyzer C, Gheysen B, Böhrer A, Anthonissen M, Van den Kerckhove E, Degreef I. Palmar skin elasticity measured by the Cutometer MPA 580 is decreased in mild Dupuytren's disease compared to healthy controls. HAND THERAPY 2022; 27:14-21. [PMID: 37904791 PMCID: PMC10584061 DOI: 10.1177/17589983211061616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2021] [Accepted: 11/04/2021] [Indexed: 11/01/2023]
Abstract
Introduction Involvement of the palmar skin is often seen in patients with Dupuytren's disease (DD) with severe finger contractures. However, skin elasticity may be already decreased earlier in the disease. The Cutometer MPA 580 could provide an objective skin measurement tool to assess this decrease in elasticity. Linking objective skin measurements to functional outcome measures could lead to better prediction of disease progression. We set up a study to investigate if the Cutometer was able to detect differences in skin elasticity between patients with mild Dupuytren's disease and healthy controls. Methods A cross-sectional analytical study was performed. Three assessors measured skin elasticity (palmar hand) on two sites using the Cutometer on 30 patients with mild DD and 30 healthy controls. Student's t-test was used to evaluate differences in skin elasticity and a linear model to evaluate interactions between the groups and sites. Results Significant differences in skin elasticity were found between DD patients and controls, as well as differences based on the location examined. Discussion Similar to other skin conditions, the Cutometer MPA 580 was able to demonstrate a significant lower elasticity in the palmar skin in DD patients compared to healthy controls. A decrease in skin elasticity in different locations of the hand correlated with areas that often pose problems in the treatment of more severe DD. The Cutometer could potentially be a tool to identify these areas earlier in the disease.
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Affiliation(s)
- Maarten Van Nuffel
- Department of Medical Sciences, KU Leuven-University of Leuven; Hand Unit, Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
| | - Caroline Meulyzer
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Britt Gheysen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Arne Böhrer
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
| | - Mieke Anthonissen
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
- Oscare, Organisation for Burns, Scar After-care and Research, Antwerp, Belgium
| | - Eric Van den Kerckhove
- Department of Rehabilitation Sciences, KU Leuven-University of Leuven; Department of Physical Medicine and Rehabilitation, University Hospitals Leuven, Leuven, Belgium
- Department of Plastic, Reconstructive and Hand Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Ilse Degreef
- Department of Medical Sciences, KU Leuven-University of Leuven; Hand Unit, Department of Orthopaedic Surgery, University Hospitals Leuven, Leuven, Belgium
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Turesson C, Kvist J, Krevers B. Experiences of men living with Dupuytren's disease-Consequences of the disease for hand function and daily activities. J Hand Ther 2021; 33:386-393. [PMID: 31477329 DOI: 10.1016/j.jht.2019.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2018] [Revised: 03/18/2019] [Accepted: 04/28/2019] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Qualitative descriptive. INTRODUCTION Dupuytren's disease (DD) is a chronic hand condition causing impairment in hand function. Research describing persons' experiences of living with DD is limited. Understanding the subjective experience of illness is valuable for planning and implementing health-care services. PURPOSE OF THE STUDY To explore experiences among men living with an impaired hand function due to DD and the consequences of the disease for daily activities. METHODS Interviews were conducted with 21 men before surgery. The model of the patient evaluation process guided data collection. Data were analyzed using problem-driven content analysis. RESULTS Participants described DD as a chronic disease caused by heredity, previous injury, hard work, or aging. DD was, according to the participants, an uncomfortable and sometimes painful condition, causing a feeling of constant stiffness in the affected hand. DD could cause participants to have fear of hurting the hand, feelings of shame or embarrassment, and a sense of being old. Participants handled the deteriorating hand function by avoiding or refraining from activities, adapting their performance, or performing activities with less quality. The ideal hand function was seen as being able to use the hands without effort. DISCUSSION The diverse experiences of DD and if the hand is experienced as something that causes distress can be understood further using body-self dialectic and Gadow's states of embodiment, as well as the process of adapting and learning to live with the functional limitations. CONCLUSIONS A clinical implication for hand therapy is to acknowledge patients' individual experiences and support self-modifications and development of new skills.
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Affiliation(s)
- Christina Turesson
- Department of Hand Surgery, Plastic Surgery and Burns, Department of Clinical and Experimental Medicine, Linköping University, Linköping, Sweden; Division of Occupational Therapy, Department of Social and Welfare Studies, Linköping University, Norrköping, Sweden.
| | - Joanna Kvist
- Division of Physiotherapy, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden; Division of Physiotherapy, Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Barbro Krevers
- Division of Health Care Analysis, Department of Medical and Health Sciences, Linköping University, Linköping, Sweden
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Ashdown T, Hayter E, Morris JA, Clough OT, Little M, Hardman J, Anakwe RE. Repeat limited fasciectomy is a safe and effective treatment for recurrence of Dupuytren's disease. Bone Joint J 2021; 103-B:946-950. [PMID: 33934652 DOI: 10.1302/0301-620x.103b5.bjj-2020-1393.r2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The results of surgery for Dupuytren's disease can be compromised by the potential for disease recurrence and loss of function. Selecting which patients will benefit from repeat surgery, when to operate, and what procedure to undertake requires judgement and an understanding of patient expectations and functional needs. We undertook this study to investigate patient outcomes and satisfaction following repeat limited fasciectomy for recurrent Dupuytren's disease. METHODS We prospectively identified all patients presenting with recurrence of Dupuytren's disease who were selected for surgical treatment with repeat limited fasciectomy surgery between January 2013 and February 2015. Patients were assessed preoperatively, and again at a minimum of five years postoperatively. We identified 43 patients who were carefully selected for repeat fasciectomy involving 54 fingers. Patients with severe or aggressive disease with extensive skin involvement were not included; in our practice, these patients are instead counselled and preferentially treated with dermofasciectomy. The primary outcome measured was change in the Michigan Hand Outcomes Questionnaire (MHQ) score. Secondary outcomes were change in finger range of motion, flexion contracture, Semmes-Weinstein monofilament (SWM) values, and overall satisfaction. RESULTS There was a significant improvement in MHQ scores, across all domains, with a mean overall score increase of 24 points (p < 0.001). The summed flexion contracture across the metacarpophalangeal joint (MCPJ) and the proximal interphalangeal joint (PIPJ) reduced from means of 72.0° (SD 15.9°) to 5.6° (SD 6.8°) (p < 0.001). A significant increase in maximal flexion was seen at the MCPJ (p < 0.001) but not the PIPJ (p = 0.550). The mean overall satisfaction score from the visual analogue scale was 8.9 (7.9 to 10.0). Complications were uncommon although five fingers showed reduced sensibility at final follow-up. CONCLUSION Our study shows that repeat limited fasciectomy for selected patients presenting with recurrence of Dupuytren's disease can be an effective and safe treatment resulting in excellent patient-reported outcomes and levels of satisfaction. Cite this article: Bone Joint J 2021;103-B(5):946-950.
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Affiliation(s)
- Thomas Ashdown
- Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, London, UK
| | - Edward Hayter
- Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, London, UK
| | - James A Morris
- Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, London, UK
| | - Oliver T Clough
- Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, London, UK
| | - Maximillian Little
- Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, London, UK
| | - John Hardman
- Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, London, UK
| | - Raymond E Anakwe
- Department of Trauma and Orthopaedic Surgery, St Mary's Hospital, London, UK.,Department of Surgery and Cancer, Imperial College London, London, UK
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Blackburn J, van der Oest MJW, Chen NC, Feitz R, Duraku LS, Zuidam JM, Vranceanu AM, Selles RW. Are Patient Expectations and Illness Perception Associated with Patient-reported Outcomes from Surgical Decompression in de Quervain's Tenosynovitis? Clin Orthop Relat Res 2021; 479:1147-1155. [PMID: 33861217 PMCID: PMC8052037 DOI: 10.1097/corr.0000000000001577] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2020] [Accepted: 10/23/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Psychological factors such as depression, pain catastrophizing, kinesiophobia, pain anxiety, and more negative illness perceptions are associated with worse pain and function in patients at the start of treatment for de Quervain's tenosynovitis. Longitudinal studies have found symptoms of depression and pain catastrophizing at baseline were associated with worse pain after treatment. It is important to study patients opting for surgery for their condition because patients should choose surgical treatment based on their values rather than misconceptions. Psychological factors associated with worse patient-reported outcomes from surgery for de Quervain's tenosynovitis should be identified and addressed preoperatively so surgeons can correct any misunderstandings about the condition. QUESTION/PURPOSE What preoperative psychosocial factors (depression, anxiety, pain catastrophizing, illness perception, and patient expectations) are associated with pain and function 3 months after surgical treatment of de Quervain's tenosynovitis after controlling for demographic characteristics? METHODS This was a prospective cohort study of 164 patients who underwent surgery for de Quervain's tenosynovitis between September 2017 and October 2018 performed by 20 hand surgeons at 18 centers. Our database included 326 patients who underwent surgery for de Quervain's tenosynovitis during the study period. Of these, 62% (201 of 326) completed all baseline questionnaires and 50% (164 of 326) also completed patient-reported outcomes at 3 months postoperatively. We found no difference between those included and those not analyzed in terms of age, sex, duration of symptoms, smoking status, and workload. The mean ± SD age of the patients was 52 ± 14 years, 86% (141 of 164) were women, and the mean duration of symptoms was 13 ± 19 months. Patients completed the Patient-Rated Wrist Evaluation (PRWE), the VAS for pain and function, the Patient Health Questionnaire for symptoms of anxiety and depression, the Pain Catastrophizing Scale, the Credibility/Expectations Questionnaire, and the Brief Illness Perceptions questionnaire at baseline. Patients also completed the PRWE and VAS for pain and function at 3 months postoperatively. We used a hierarchical multivariable linear regression model to investigate the relative contribution of patient demographics and psychosocial factors to the pain and functional outcome at 3 months postoperatively. RESULTS After adjusting for demographic characteristics, psychosocial factors, and baseline PRWE score, we found that only the patient's expectations of treatment and how long their illness would last were associated with the total PRWE score at 3 months postoperatively. More positive patient expectations of treatment were associated with better patient-reported pain and function at 3 months postoperatively (ß = -2.0; p < 0.01), while more negative patient perceptions of how long their condition would last were associated with worse patient-reported pain and function (timeline ß = 2.7; p < 0.01). The final model accounted for 31% of the variance in the patient-reported outcome at 3 months postoperatively. CONCLUSION Patient expectations and illness perceptions are associated with patient-reported pain and functional outcomes after surgical decompression for de Quervain's tenosynovitis. Addressing misconceptions about de Quervain's tenosynovitis in terms of the consequences for patients and how long their symptoms will last should allow patients to make informed decisions about the treatment that best matches their values. Prospective studies are needed to investigate whether addressing patient expectations and illness perceptions, with decision aids for example, can improve patient-reported pain and function postoperatively in those patients who still choose surgery for de Quervain's tenosynovitis. LEVEL OF EVIDENCE Level III, therapeutic study.
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Affiliation(s)
- Julia Blackburn
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Mark J W van der Oest
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Neal C Chen
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Reinier Feitz
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Liron S Duraku
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - J Michiel Zuidam
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Ana-Maria Vranceanu
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
| | - Ruud W Selles
- J. Blackburn, N. C. Chen, Hand and Arm Center, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- J. Blackburn, M. J. W. van der Oest, A.-M. Vranceanu, Integrated Brain Health Clinical and Research Program, Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
- M. J. W. van der Oest, L. S. Duraku, J. M. Zuidam, R. W. Selles, Department of Plastic, Reconstructive, and Hand Surgery, Erasmus MC, Rotterdam, the Netherlands
- M. J. W. van der Oest, R. Feitz, Hand and Wrist Center, Xpert Clinic, the Netherlands
- M. J. W. van der Oest, R. W. Selles, Department of Rehabilitation Medicine, Erasmus MC, Rotterdam, the Netherlands
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9
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Selles RW, Wouters RM, Poelstra R, van der Oest MJW, Porsius JT, Hovius SER, Moojen TM, van Kooij Y, Pennehouat PY, van Huis R, Vermeulen GM, Feitz R, Slijper HP. Routine Health Outcome Measurement: Development, Design, and Implementation of the Hand and Wrist Cohort. Plast Reconstr Surg 2020; 146:343-354. [PMID: 32740587 DOI: 10.1097/prs.0000000000007008] [Citation(s) in RCA: 60] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Routine measurement of outcome of clinical care is increasingly considered important, but implementation in practice is challenging. This article describes (1) how the authors created and implemented a routine outcome measurement cohort of patients with hand and wrist conditions and (2) how these data are used to improve the quality of care and facilitate scientific research. Starting in 2011, routine outcome measurement was implemented at all practice sites (currently 22) of a specialized treatment center for hand and wrist conditions across The Netherlands. The authors developed five "measurement tracks," including measurements administered at predetermined time points covering all hand and wrist disorders and treatments. An online system automatically distributes measurements among patients, which can be accessed by health care professionals. Using this system, the total number of yearly assigned tracks increased up to over 16,500 in 2018, adding up to 85,000 tracks in 52,000 patients in total. All surgeons, therapists, and other staff have direct access to individual patient data and patients have access to their treatment information using a secure patient portal. The data serve as a basis for studies on, among others, comparative effectiveness, prediction modeling, and clinimetric analyses. In conclusion, the authors present the design and successful implementation of a routine outcome measurement system that was made feasible using a highly automated data collection infrastructure, tightly linked to the patient journey and the workflow of health care professionals. The system serves not only as a tool to improve care but also as a basis for scientific research studies.
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Affiliation(s)
- Ruud W Selles
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Robbert M Wouters
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Ralph Poelstra
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Mark J W van der Oest
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Jarry T Porsius
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Steven E R Hovius
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Thybout M Moojen
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Yara van Kooij
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Pierre-Yves Pennehouat
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Rob van Huis
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Guus M Vermeulen
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Reinier Feitz
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
| | - Harm P Slijper
- From the Departments of Plastic, Reconstructive, and Hand Surgery and Rehabilitation Medicine, Erasmus MC, University Medical Center Rotterdam; the Department of Hand and Wrist Surgery, Xpert Clinic; the Center for Hand Therapy, Handtherapie Nederland; and the Department of Plastic Surgery, Radboud University Medical Center
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10
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Tsehaie J, van der Oest MJW, Poelstra R, Selles RW, Feitz R, Slijper HP, Hovius SER, Porsius JT. Positive experience with treatment is associated with better surgical outcome in trapeziometacarpal osteoarthritis. J Hand Surg Eur Vol 2019; 44:714-721. [PMID: 31154893 PMCID: PMC6696737 DOI: 10.1177/1753193419851777] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The aim of this study was to investigate the association between patients' experiences with trapeziometacarpal arthroplasty and treatment outcomes in terms of patient-reported outcome measures, grip and pinch strength. We included 233 patients who received a Weilby procedure for trapeziometacarpal osteoarthritis. Before surgery and 12 months after surgery, patients completed the Michigan Hand Outcomes Questionnaire, and their pinch and grip strengths were measured. At 3 months after surgery, a patient-reported experience measure was completed. Using regression analysis, significantly positive associations were found between the Michigan Hand questionnaire and the patient-reported experience measure, with the strongest significant associations being for patients' experiences with information provision. No significant associations were found between the patients' experience and strength outcomes. The results highlight the potential importance of positive experience with the treatment process to improve treatment outcomes in patients undergoing surgery for trapeziometacarpal osteoarthritis. Level of evidence: IV.
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Affiliation(s)
- Jonathan Tsehaie
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands,Jonathan Tsehaie, Erasmus MC Rotterdam, Dr.
Molewaterplein 50, Room EE 15.91b, 3015 GE Rotterdam, The Netherlands.
| | - Mark J. W. van der Oest
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands
| | - Ralph Poelstra
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands
| | - Ruud W. Selles
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands
| | - Reinier Feitz
- Hand and Wrist Surgery, Xpert Clinic,
The Netherlands
| | | | - Steven E. R. Hovius
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands
| | - Jarry T. Porsius
- Department of Plastic, Reconstructive
and Hand Surgery, Erasmus MC Rotterdam, The Netherlands,Hand and Wrist Surgery, Xpert Clinic,
The Netherlands,Department of Rehabilitation Medicine,
Erasmus MC Rotterdam, The Netherlands
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11
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Better Patient-Reported Experiences with Health Care Are Associated with Improved Clinical Outcome after Carpal Tunnel Release Surgery. Plast Reconstr Surg 2019; 143:1677-1684. [DOI: 10.1097/prs.0000000000005516] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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