1
|
Athanatos L, Sandean DP, Burgula M, Lee B, Pandey R, Singh HP. Use of patient reported experience measure and patient reported outcome measures to evaluate differences in surgical or non-surgical management of humeral shaft fractures. Shoulder Elbow 2023; 15:140-150. [PMID: 37035617 PMCID: PMC10078821 DOI: 10.1177/17585732211050224] [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: 02/04/2021] [Revised: 09/12/2021] [Accepted: 09/13/2021] [Indexed: 11/15/2022]
Abstract
Background The aim of this study was to evaluate the use of patient reported experience measures (PREMs) in humeral shaft fractures managed with or without surgery against patient reported outcome measures (PROMs). Methods Adult patients treated for a humeral shaft fracture between June 2015 and August 2017 were included in non-surgery and surgery (early and late surgery) groups. The PREM questionnaire was based on patient and clinician feedback obtained during focus groups and was posted to patients. PROMs included the short form-12 (SF-12) and visual analogue scale (VAS) for pain, stiffness, function and satisfaction. Results Eighty-one patients responded, 54 patients were treated in a brace and 27 with surgery (13 early, 14 late). There was moderate positive correlation between PREM and VAS satisfaction and function and moderate negative correlation with VAS pain and stiffness. There was also moderate positive correlation between PREM and SF-12 mental and weak positive correlation with SF-12 physical. The late surgery group had poorer PREMs (expectations, p = 0.002 and friends & family test, p = 0.0001) and PROMs (VAS satisfaction, p = 0.005) compared to the early surgery group. Conclusions PREMs can be used in conjunction with PROMs to improve the patient's quality of care and as a means of identifying, at an early stage, those patients not doing well and to offer surgery.
Collapse
Affiliation(s)
| | - Darren P Sandean
- University Hospitals of Leicester NHS Trust, Leicester, England, UK
| | | | - Bethan Lee
- University Hospitals of Leicester NHS Trust, Leicester, England, UK
| | - Radhakant Pandey
- University Hospitals of Leicester NHS Trust, Leicester, England, UK
| | | |
Collapse
|
2
|
Ottenhoff JSE, van Laarhoven CMCA, van Heijl M, Schuurman AH, Coert JH, van der Heijden BEPA. Long-term follow-up of patients treated with pyrocarbon disc implant for thumb carpometacarpal osteoarthritis: the effect of disc position on outcomes measures. J Plast Surg Hand Surg 2023; 57:230-235. [PMID: 35244517 DOI: 10.1080/2000656x.2022.2044835] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Pyrocarbon disc interposition arthroplasty is an effective treatment for thumb base osteoarthritis. However, as with all implant techniques, the disc can (sub)luxate over time. The relationship between disc position, the experienced pain, and the necessity for revision surgery is not known. This study evaluated the effect of radiographic pyrocarbon disc position on the Michigan Hand Questionnaire (MHQ) outcome measurement. In addition, the correlation between disc position and other factors, including pain intensity, thumb strength, and occupation, was assessed. In this retrospective study, we included 136 patients (161 thumbs) with a mean follow-up of 6.7 years (range 3.3-11). Radiographs were scored on disc position and classified as 'well aligned' (Grade 1) up to 'luxated' (Grade 4). A database used for outcome measures included MHQ scores, pain intensity, satisfaction, thumb strength, range of motion, occupation, and hand dominance. In bivariate analyses, we assessed any association between disc position and outcome measurements. Eighty of the 136 implants (59%) were well-positioned (not displaced), 41% were (slightly) displaced (grade 2-3). No relationship existed between the degree of disc displacement and MHQ scores. Manual labor occupation was the only factor that correlated with more severe disc displacement. We could not detect any association between disc position and other outcome variables including pain intensity, thumb strength, or hand dominance. In conclusion, our study suggests that radiographic disc displacement has little clinical consequences. Future studies must assess if there is a causality between heavy mechanical stress to the CMC1 joint and luxation of the pyrocarbon disc over time.Level of evidence: IV Therapeutic-Retrospective case series.
Collapse
Affiliation(s)
- Janna S E Ottenhoff
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Cecile M C A van Laarhoven
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Erasmus Medical Center, Rotterdam, Netherlands
| | - Mark van Heijl
- Department of Surgery, Hand and Wrist Unit, Diakonessenhuis, Utrecht, Netherlands.,Department of Trauma Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Arnold H Schuurman
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - J Henk Coert
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, Netherlands
| | - Brigitte E P A van der Heijden
- Department of Plastic and Hand Surgery, Jeroen Bosch Hospital, 's-Hertogenbosch, Netherlands.,Department of Plastic, Reconstructive and Hand Surgery, Radboud University Nijmegen Medical Center, Nijmegen, Netherlands
| |
Collapse
|
3
|
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.
Collapse
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
| |
Collapse
|
4
|
Ottenhoff JS, Spaans AJ, Braakenburg A, Teunis T, van Minnen LP, Mink van der Molen AB. Joint Distraction for Thumb Carpometacarpal Osteoarthritis: 2-Year Follow-up Results of 20 Patients. J Wrist Surg 2021; 10:502-510. [PMID: 34881105 PMCID: PMC8635830 DOI: 10.1055/s-0041-1728806] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Accepted: 03/10/2021] [Indexed: 01/14/2023]
Abstract
Background Joint distraction is a fairly new treatment for patients with symptomatic thumb carpometacarpal osteoarthritis (CMC1 OA). A previous pilot study of five patients showed that CMC1 joint distraction is technically feasible. The current study presents the results of CMC1 joint distraction in 20 patients with a 2-year follow-up period. Purposes The primary study aim was to assess if patients with CMC1 OA have better physical function and less pain 2 years after CMC1 joint distraction. Second, we assessed the number of patients who achieved a minimal clinically important difference (MCID) in patient-reported outcome measures at each follow-up time point. Furthermore, this study sought differences on magnetic resonance imaging (MRI) of the CMC1 joint before and after distraction. Adverse events were noted and reported. Methods Twenty patients (median age of 54 years) with symptomatic CMC1 OA and an established indication for a trapeziectomy were enrolled. An external distractor device was placed over the CMC1 joint and left in situ for 8 weeks. Disabilities of the Arm, Shoulder, and Hand (DASH) score, Michigan Hand Outcome Questionnaire (MHQ), visual analogue scale (VAS), and grip strength were recorded preoperatively and at 3, 6, 12, and 24 months postoperatively. Results Two years after joint distraction, physical function and pain scores had improved significantly compared with baseline: DASH from 48 to 17, MHQ from 56 to 83, and VAS for pain from 50 to 18 mm. Fourteen of 19 patients (74%) reached an MCID in DASH and MHQ scores. One patient was not satisfied with treatment outcome and chose to proceed with a trapeziectomy 14 months after initial distraction therapy. Conclusions This study demonstrates that CMC1 joint distraction can postpone more invasive surgical interventions (e.g., trapeziectomy) for at least 2 years. Larger comparative studies are needed to assess the value of CMC1 joint distraction in the treatment of CMC1 OA. Level of Evidence This is a Level IV, prospective case series study.
Collapse
Affiliation(s)
- Janna S.E. Ottenhoff
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Anne J. Spaans
- Department of Orthopedic Surgery, Sint Maartenskliniek, Ubbergen, The Netherlands.
| | - Assa Braakenburg
- Department of Plastic, Reconstructive and Hand Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Teun Teunis
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - L. Paul van Minnen
- Department of Plastic Surgery, Royal Adelaide Hospital, Adelaide, Australia
| | - Aebele B. Mink van der Molen
- Department of Plastic, Reconstructive and Hand Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
- Department of Orthopedic Surgery, St. Antonius Hospital, Nieuwegein, The Netherlands
| |
Collapse
|
5
|
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.
Collapse
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
| |
Collapse
|
6
|
Trapeziometacarpal (TMC) arthroplasty under Wide Awake Local Anesthesia with No Tourniquet (WALANT) versus Local Anesthesia with peripheral nerve blocks (LAPNV): Perioperative pain and early functional results in 30 patients. HAND SURGERY & REHABILITATION 2021; 40:453-457. [PMID: 33775887 DOI: 10.1016/j.hansur.2021.03.006] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/26/2020] [Revised: 02/25/2021] [Accepted: 03/21/2021] [Indexed: 12/28/2022]
Abstract
We hypothesized that WALANT would provide similar perioperative analgesic comfort compared to local anesthesia with peripheral nerve blocks (LAPNV). We analyzed whether the patient's active participation during surgery would improve its early functional results. We did a retrospective, single study in an outpatient surgery unit, comparing two types of surgery: trapeziometacarpal arthroplasty (TMCA) under LAPNV and TMCA under WALANT. Fifteen patients were included per group. Pain levels were determined during anesthesia induction, intraoperatively, postoperatively, at rest and during activity at the last follow-up visit. The overall satisfaction with the surgery and time to resume daily activities and work were documented. The statistical analysis was performed on SAS software with an ANOVA. The significance threshold was set at 0.05. The groups were comparable on age, sex, dominant side, and operated side. No patients were lost to follow-up. The mean follow-up was 4 months (2.3-11). The QuickDASH score was 4.93 for TMCA under WALANT vs. 13.47 for TMCA under LAPNV (p = 0.01). There was no loosening, dislocation, or major complication. Our study showed that TMCA performed with WALANT yields similar results to the same procedure with LAPNV for perioperative pain relief without additional complications. Functional scores seem to be slightly improved with WALANT compared to LAPNV, but these results should be confirmed with longer follow up.
Collapse
|
7
|
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.
Collapse
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
| |
Collapse
|
8
|
Ruettermann M. Changing surgical treatments of thumb carpometacarpal osteoarthritis. J Hand Surg Eur Vol 2020; 45:533-535. [PMID: 32281453 PMCID: PMC7787559 DOI: 10.1177/1753193420915800] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Affiliation(s)
- Mike Ruettermann
- Department of Plastic Surgery, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
- HPC, Oldenburg, Institute for Hand- and Plastic Surgery, Oldenburg, Germany
| |
Collapse
|
9
|
Liu X, Gao F, Wang W, Yan J. Expression of miR-204 in patients with osteoarthritis and its damage to chondrocytes. JOURNAL OF MUSCULOSKELETAL & NEURONAL INTERACTIONS 2020; 20:265-271. [PMID: 32481242 PMCID: PMC7288379] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To explore the expression of miR-204 in patients with Osteoarthritis (OA) and its effect on chondrocytes. METHODS Cartilage tissues of patients with OA, and normal cartilage tissues of patients receiving emergent traumatic amputation were collected. Polymerase chain reaction (PCR) was used to quantify the expressions of miRNAs. Chondrocytes of patients with OA were isolated, cultured, and transfected with miR-204 mimics or miR-204 inhibitor, and cell models of over-expression and knockdown of miR-204 were constructed. MTT assay, clone formation test, trypan blue staining, and TdT-mediated dUTP Nick-End Labeling (TUNEL) staining were used to detect the effect of overexpression or knockdown of miR-204 on viability, proliferation, survival rate and apoptosis of chondrocytes. RESULTS miR-204 expression increased significantly in cartilage tissue of patients with OA. Results of MTT assay, clone formation test, and trypan blue staining showed that the over-expression of miR-204 inhibited the viability, proliferation, and survival rate, as well as promoted the apoptosis of chondrocytes. Whereas the knockdown of miR-204 improved the viability, proliferation, and survival rate of chondrocytes. CONCLUSION The expression of miR-204 increased significantly in patients with OA and played a damaging role in chondrocytes. The knockdown of miR-204 may provide new approaches for clinical treatment of OA.
Collapse
Affiliation(s)
- Xiaodong Liu
- The 2nd Affiliated Hospital of Harbin Medical University, P.R. China
| | - Feng Gao
- The 2nd Affiliated Hospital of Harbin Medical University, P.R. China
| | - Weikang Wang
- The 2nd Affiliated Hospital of Harbin Medical University, P.R. China
| | - Jinglong Yan
- The 2nd Affiliated Hospital of Harbin Medical University, P.R. China,Corresponding author: Dr. Jinglong Yan, The 2nd Affiliated Hospital of Harbin Medical University, No.246 Xuefu Road, Harbin 150000, P.R. China E-mail:
| |
Collapse
|