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Wänström J, Jonsson EÖ, Björnsson Hallgren H, Jorméus A, Adolfsson L. The minimal important difference and smallest detectable change of the Oxford elbow score, Quick disabilities of the arm shoulder and hand and single assessment numeric evaluation used for elbow trauma. JSES Int 2024; 8:897-902. [PMID: 39035650 PMCID: PMC11258825 DOI: 10.1016/j.jseint.2024.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/23/2024] Open
Abstract
Background The Minimal Important Difference (MID) and Smallest Detectable Change (SDC) are methods used to identify the smallest changes in Patient-Reported Outcome Measures (PROMs) that are of relevance to the patients. Data on these parameters is, however, limited for elbow conditions including traumatic injuries. The aim of this study was, therefore, to estimate the MID and SDC for three commonly used PROMs after elbow trauma; the Oxford Elbow Score (OES), Quick Disabilities of the Arm Shoulder and Hand (QuickDASH) and Single Assessment Numeric Evaluation (SANE). Methods One hundred patients, 67 females, aged ≥18 years (mean age 52.4 years (standard deviation, 18.2)), who had sustained a fracture, tendon rupture or dislocation affecting the elbow, completed the OES, QuickDASH, and SANE 3-5 months after injury (T1) and again after a minimum of 3 weeks (T2). A transition item with a 7-level scale, enquiring about the situation with the elbow, was also completed at T1 and T2. The difference in scores between T1 and T2 was calculated (change scores). The MID was assessed using the mean change method; a response of "slightly better" or "slightly worse" was defined as being a clinically significant change. The SDC was estimated by calculating the standard error of measurement based on 2 administrations (1- to 3-week interval) of PROMs in a separate group of patients who had sustained an elbow injury 1- 2 years previously. Results The most common diagnosis was fracture of the proximal radius (n = 33). Eighteen patients responded slightly better and 5 slightly worse on the transition item and had mean change scores of 7.9 (9.3) for the OES and -7.4 (11.4) for the QuickDASH. Assessment of SDC was based on 56 patients having sustained an elbow injury between September 2019 and October 2020. The SDC was: 12.1 for the OES, 11.4 for the QuickDASH, and 1.94 for the SANE. Conclusion Change scores need to exceed 12.1 points for the OES, 11.4 points for the QuickDASH, and 1.94 points for the SANE in order to measure change with clinical relevance and not due to measurement errors.
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Affiliation(s)
- Johan Wänström
- Department of Orthopaedics, Helsingborg Hospital, Helsingborg, Sweden
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Eythor Ö. Jonsson
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Hanna Björnsson Hallgren
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
| | - Albin Jorméus
- Department of Orthopaedics, Institute of Clinical Sciences, The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- Department of Orthopaedics, Sahlgrenska University Hospital, Mölndal, Sweden
| | - Lars Adolfsson
- Division of Orthopaedic Surgery, Department of Biomedical and Clinical Sciences, Linkoping University, Linkoping, Sweden
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Jonsson EÖ, Wänström J, Björnsson Hallgren H, Adolfsson L. The Oxford Elbow Score demonstrated good measurement properties when used with a shortened 7-day recall period. JSES Int 2023. [DOI: 10.1016/j.jseint.2022.12.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2023] Open
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Abbot S, Proudman S, Sim YP, Williams N. Psychometric properties of patient-reported outcomes measures used to assess upper limb pathology: a systematic review. ANZ J Surg 2022; 92:3170-3175. [PMID: 35959939 PMCID: PMC10087017 DOI: 10.1111/ans.17973] [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: 05/29/2022] [Revised: 07/18/2022] [Accepted: 07/28/2022] [Indexed: 12/31/2022]
Abstract
BACKGROUND With the continued development of patient-centred healthcare models, patient-reported outcome measures (PROMs) are increasingly used to evaluate outcomes in patients with upper limb pathology. The aim was to identify valid, reliable and responsive PROMs used to assess outcomes following upper limb pathology, and ascertain how their psychometric properties had been established. A secondary aim was to identify PROMs that have been validated to assess upper limb pathology in the paediatric population. METHODS A review of the Medline and EMBASE database was performed. Articles that analysed the validity of an established PROM used for upper limb pathology were included. Extracted study data included: author, country, PROM(s) investigated, year of publication, study type, sample size, demographics and duration of follow-up. RESULTS Twenty-five articles were included, which together investigated the psychometric properties of 23 different PROMs that have been used to assess outcomes in adults following upper limb pathology. No study evaluated the psychometric properties of PROMs used in the paediatric population. Among PROMs that have been used in adults, the Quick-Disabilities of the Arm, Shoulder and Hand (QuickDASH) had strong content- and construct-validity, reliability and responsiveness in comparison to others. CONCLUSION There are currently no studies that have analysed the content validity of PROMs used to assess upper limb pathology in the paediatric population. Prospective studies are required for the development of PROMs that can be utilized in children to assess upper limb pathology.
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Affiliation(s)
- Samuel Abbot
- Department of Orthopaedics and Trauma, The Queen Elizabeth Hospital, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Department of Orthopaedics and Trauma, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Susanna Proudman
- Department of Orthopaedics and Trauma, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - Yih Ping Sim
- Department of Orthopaedics and Trauma, Lyell McEwin Hospital, Adelaide, South Australia, Australia
| | - Nicole Williams
- Department of Orthopaedics and Trauma, Women's and Children's Hospital, Adelaide, South Australia, Australia.,Centre for Orthopaedic and Trauma Research, University of Adelaide, South Australia, Australia
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Meijering D, Boerboom AL, Gerritsma CLE, de Vries AJ, Vegter RJK, Bulstra SK, Eygendaal D, Stevens M. Mid-term results of the Latitude primary total elbow arthroplasty. J Shoulder Elbow Surg 2022; 31:382-390. [PMID: 34619349 DOI: 10.1016/j.jse.2021.08.028] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 08/25/2021] [Accepted: 08/29/2021] [Indexed: 02/01/2023]
Abstract
BACKGROUND The Latitude total elbow prosthesis is a third-generation implant, developed to restore the natural anatomy of the elbow. Literature on this prosthesis is scarce. The aim of this study was to analyze the mid-term results of the Latitude total elbow prosthesis. METHODS We retrospectively evaluated 62 patients (21 men and 41 women). The mean age at the time of surgery was 65 years (range, 28-87 years). The main indication for surgery was inflammatory arthritis. The outcome measures were complications, reoperations, self-reported physical functioning, pain, satisfaction, objectively measured physical functioning, and radiologic signs of loosening. Kaplan-Meier survival analysis was used to determine survival with revision as the endpoint. RESULTS Sixty-nine primary Latitude prostheses were placed in 62 patients between 2008 and 2019. Six patients (7 prostheses) died, 3 elbows underwent revision, and 9 patients were lost to follow-up. A total of 44 patients (50 prostheses) were available for follow-up. The mean length of follow-up was 51 months (range, 10-144 months). Kaplan-Meier survival analysis showed a survival rate of 82% at 10 years after surgery. The main reason for revision was aseptic loosening. Radial head dissociation was seen in 8 patients (24%), but none had complaints. Self-reported and objectively measured physical functioning yielded good results, although 23 patients (46%) did show radiolucent lines on radiographs. CONCLUSION Latitude total elbow arthroplasty is considered a successful procedure with low pain scores, high patient satisfaction, and good physical functioning. Survival rates nonetheless remain low and complication rates remain high yet are comparable to those of other elbow arthroplasties. We recommend biomechanical studies to concentrate on specific postoperative loading instructions to minimize wear and consequent loosening.
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Affiliation(s)
- Daniëlle Meijering
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | | | - Astrid J de Vries
- Department of Orthopedic Surgery, Martini Hospital, Groningen, The Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands; Department of Orthopedic Surgery, Amsterdam University Medical Centers, Amsterdam, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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Giannaka M, Andrigiannakis A, Dimitriadis Z, Fandridis E, Kapreli E, Strimpakos N. Cross-cultural validation of the Oxford Elbow Score and Mayo Elbow Performance Score in Greek. Musculoskelet Sci Pract 2022; 57:102499. [PMID: 34999382 DOI: 10.1016/j.msksp.2021.102499] [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: 09/13/2021] [Revised: 12/21/2021] [Accepted: 12/25/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Oxford Elbow Score (OES) and Mayo Elbow Performance Score (MEPS) are two of the most commonly used instruments for the functional assessment of elbow joint. The aim of this study was to cross-culturally validate the OES and MEPS into Greek language and examine their convergent validity, internal consistency, test-retest reliability and floor and ceiling effects. METHODS The two instruments were translated into Greek with the back translation method. Their final Greek versions (OES-GR and MEPS-GR) were completed by 40 patients with elbow disorders. The patients completed also the Greek version of the Disabilities of the Arm Shoulder and Hand (DASH-GR). The patients re-completed the OES-GR after 24 h. RESULTS The OES-GR was found to have good internal consistency (Cronbach's α = 0.85, 95%CI = 0.74-0.92), in contrast to the MEPS-GR (Cronbach's α = 0.47, 95%CI = 0.15-0.70). Both instruments were found to have good convergent validity with the DASH-GR (for MEPS-GR rs = -0.64, 95% CI -0.79 to -0.41; for OES-GR rs = -0.84, 95%CI = -0.91 to -0.72). Good was also the convergent validity of the OES-GR with the MEPS-GR (rs = 0.71, 95%CI = 0.51 to 0.84). The test-retest reliability for each domain of the OES-GR was found good to excellent (total score ICC = 0.91, 95%CI = 0.83-0.95; pain ICC = 0.90, 95%CI = 0.81-0.95; function ICC = 0.81, 95%CI = 0.68-0.90; social-psychological ICC = 0.91, 95%CI = 0.84-0.95). CONCLUSION The findings about the internal consistency, test-retest reliability, convergent validity and ceiling/floor effects of the OES-GR suggest that it is a quite valid and reliable instrument which can be used with confidence in Greek patients with elbow disorders. LEVEL OF EVIDENCE N/A.
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Affiliation(s)
- Magdalene Giannaka
- Quality of Life and Health Assessment Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Andreas Andrigiannakis
- Quality of Life and Health Assessment Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Zacharias Dimitriadis
- Quality of Life and Health Assessment Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | | | - Eleni Kapreli
- Clinical Exercise Physiology and Rehabilitation Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece
| | - Nikolaos Strimpakos
- Quality of Life and Health Assessment Research Lab, Physiotherapy Department, School of Health Sciences, University of Thessaly, Lamia, Greece.
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Meijering D, Boerboom AL, Gerritsma CLE, The B, van den Bekerom MPJ, van der Pluijm M, Vegter RJK, Bulstra SK, Eygendaal D, Stevens M. Prospective cohort study comparing a triceps-sparing and triceps-detaching approach in total elbow arthroplasty: a protocol. BMJ Open 2021; 11:e046098. [PMID: 33952551 PMCID: PMC8103376 DOI: 10.1136/bmjopen-2020-046098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND New surgical approaches have been developed to optimise elbow function after total elbow arthroplasty (TEA). Currently, there is no consensus on the best surgical approach. This study aims to investigate the functional outcomes, prosthetic component position and complication rates after a triceps-sparing and a triceps-detaching approach in TEA. METHODS AND ANALYSIS A multicentre prospective comparative cohort study will be conducted. All patients with an indication for primary TEA will enrol in either the triceps-sparing or the triceps-detaching cohort. Primary outcome measure is elbow function, specified as fixed flexion deformity. Secondary outcome parameters are self-reported and objectively measured physical functioning, including triceps force, prosthetic component position in standard radiographs and complications. DISCUSSION The successful completion of this study will clarify which surgical approach yields better functional outcomes, better prosthetic component position and lower complication rates in patients with a TEA. ETHICS AND DISSEMINATION The Medical Ethics Review Board of University Medical Center Groningen reviewed the study and concluded that it is not clinical research with human subjects as meant in the Medical Research Involving Human Subjects Act (WMO), therefore WMO approval is not needed (METc2019/544). TRIAL REGISTRATION NUMBER NTR NL8488.
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Affiliation(s)
- Danielle Meijering
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Alexander L Boerboom
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | | | - Bertram The
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
| | - Michel P J van den Bekerom
- Department of Orthopedic Surgery, OLVG, Amsterdam, The Netherlands
- Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Marco van der Pluijm
- Department of Orthopedic Surgery, Sint Maartenskliniek, Nijmegen, The Netherlands
| | - Riemer J K Vegter
- Department of Human Movement Sciences, University of Groningen, Groningen, The Netherlands
| | - Sjoerd K Bulstra
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
| | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Department of Orthopedic Surgery, Amsterdam Universitair Medische Centra, Amsterdam, The Netherlands
| | - Martin Stevens
- Department of Orthopedic Surgery, University Medical Center Groningen, Groningen, The Netherlands
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7
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Padovani S, Capuzzo M, Massari L, Caruso G, Arrigoni P, Zaolino C, Cucchi D, Valpiani G, Colozza A. Validation of the cross-cultural adapted Italian version of the Oxford Elbow Score. JSES Int 2021; 5:328-333. [PMID: 33681858 PMCID: PMC7910718 DOI: 10.1016/j.jseint.2020.10.025] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
Background The Oxford Elbow Score (OES) is an English-language questionnaire specifically designed to evaluate surgical elbow outcomes. This scoring system has been translated into other languages. Given the lack of an Italian version of the OES, the present study was designed to establish, culturally adapt, and validate the Italian version. Methods The OES questionnaire was culturally adapted to Italian patients in accordance with the literature guidelines with a pilot phase including seven patients with elbow problems and seven healthy subjects. The study includes 110 participants from three hospitals, who underwent elbow surgery for acute (70%) or chronic diseases. At least one month after elbow surgery, at the “index visit”, the physician completed the Mayo Elbow Performance Index and patients completed the following questionnaires: the Italian OES, the shortened version of the Disability of Arm, Shoulder and Hand Questionnaire (QuickDASH) and the Short-Form 36 Health Survey. Internal consistency was evaluated using Cronbach's alpha. Reproducibility was assessed using the intraclass correlation coefficient in ten patients who completed the OES again two-three days after the index visit. Construct validity was assessed using Spearman correlation coefficients. Responsiveness was evaluated in 68 patients who answered the questionnaires four months after the index visit, using the Wilcoxon signed-rank test, the effect size and the standardized response mean calculation. Results Cronbach's alpha was excellent: 0.86 (0.82-0.90) for OES pain, 0.92 (0.90-0.94) for OES function, and 0.90 (0.87-0.93) for OES social/psychological. The intraclass correlation coefficient was 0.94 (0.78-0.98) for OES pain, 0.91 (0.71-0.97) for OES function, 0.95 (0.83-0.98) for OES social-psychological and 0.93 (0.76-0.98) for OES total. The Spearman ρ was >0.7 for OES pain and QuickDASH, for OES function and both QuickDASH and Mayo Elbow Performance Index, and for OES social-psychological and QuickDASH. Regarding responsiveness, the mean of the changes between the two visits ranged from 33.9 for OES pain, to 44 points for OES function and OES social/psychological. The effect size and the standardized response mean were >0.8 for all OES domains. Conclusion This study demonstrates that the Italian version of the OES, translated in accordance with the international standardized guidelines, is reliable, valid, and responsive in patients who have undergone elbow surgery.
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Affiliation(s)
- Sara Padovani
- Department of Orthopedics and Traumatology, Ospedale degli Infermi di Faenza, Faenza (RA), Italy.,Orthopedics and Traumatology Unit, Sant Anna University Hospital of Ferrara, Ferrara, Italy
| | - Maurizia Capuzzo
- Department of Morphology, Experimental Medicine and Surgery, Section of Anesthesia and Intensive Care, Azienda Ospedaliero-Universitaria S. Anna, Ferrara, Italy
| | - Leo Massari
- Orthopedics and Traumatology Unit, Sant Anna University Hospital of Ferrara, Ferrara, Italy
| | - Gaetano Caruso
- Orthopedics and Traumatology Unit, Sant Anna University Hospital of Ferrara, Ferrara, Italy
| | - Paolo Arrigoni
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy.,Laboratory of Applied Biomechanics, Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy.,Research Center for Adult and Pediatric Rheumatic Diseases (RECAP-RD), Department of Biomedical Sciences for Health, Università degli Studi di Milano, Milan, Italy
| | - Carlo Zaolino
- U.O.C. 1a Clinica Ortopedica, ASST Centro Specialistico Ortopedico Traumatologico Gaetano Pini-CTO, Milan, Italy
| | - Davide Cucchi
- Department of Orthopaedics and Trauma Surgery, Universitätsklinikum Bonn, Bonn, Germany
| | - Giorgia Valpiani
- Research Innovation Quality and Accreditation Unit, S. Anna University Hospital of Ferrara, Ferrara, Italy
| | - Alessandra Colozza
- Department of Orthopedics and Traumatology, Ospedale degli Infermi di Faenza, Faenza (RA), Italy
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Ngwayi JRM, Tan J, Liang N, Sita EGE, Porter DE. Cross-cultural adaptation and validity of the Chinese version of the Oxford elbow score. J Orthop Surg Res 2020; 15:562. [PMID: 33243269 PMCID: PMC7690016 DOI: 10.1186/s13018-020-02100-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2020] [Accepted: 11/19/2020] [Indexed: 12/02/2022] Open
Abstract
Background The Oxford Elbow score (OES) is a patient-reported outcome measure designed to evaluate patients before and after elbow surgery. Although various translated versions of the score are available, there is no Chinese mandarin version. The aim of this study was to develop a Chinese language version of the OES and evaluate its psychometric properties for clinical use. Methods The English version of the OES was forward translated into Chinese, followed by a backward translation into English. Then a final Chinese version was produced following expert committee discussions and pilot study of 11 patients. A smart device compatible electronic version of the OES was designed and completed by 70 patients with elbow pathology alongside the Quick-Dash and the SF-36. Reliability was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach’s alpha for internal consistency. Spearman’s correlation coefficient was used to test the construct validity. Confirmatory factor analysis (CFA) was performed to evaluate the 3-factor structure of the OES. Results The overall Cronbach’s α coefficient was 0.906 and for the 3 different domains Function, Pain, and Social-psychological was 0.806, 0.796, and 0.776 respectively. The overall intraclass correlation coefficient was 0.764 and for the three different domains Function, Pain, and Social-psychological was 0.764, 0.624, and 0.590 respectively. The Spearman’s coefficient for correlation, between the QuickDASH and OES domains Function, Pain, and Social-psychological, was − 0.824, − 0.734, and − 0.622 respectively, showing strong correlation (r > 0.5; p < 0.01). There were moderate correlations between OES domains and the physical functioning, role physical, and strong correlations with bodily pain subscales of the PCS domain of the SF-36; results were insignificant for all other subscales. Conclusion Our translated Chinese mandarin OES version (mainland) was reliable and valid, suitable for evaluating elbow disorders in the Chinese population. Reliability was measured using both the Cronbach’s α for internal consistency and the intraclass correlation. Results were classified as “excellent” and were similar to results from the original OES. Electronic PROMs were used instead of the traditional paper-based PROMs for collection of data which was well tolerated by patients.
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Affiliation(s)
| | - Jie Tan
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China
| | - Ning Liang
- School of Clinical Medicine, Tsinghua University, Beijing, 100084, China
| | | | - Daniel Edward Porter
- Department of Orthopedics, Beijing Huaxin Hospital, Clinical Medicine School, Tsinghua University, Beijing, 100016, China
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9
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Ademola A, Hildebrand KA, Schneider PS, Mohtadi NGH, White NJ, Bosse MJ, Garven A, Walker REA, Sajobi TT. PrEvention of posttraumatic contractuRes with Ketotifen 2 (PERK 2) - protocol for a multicenter randomized clinical trial. BMC Musculoskelet Disord 2020; 21:123. [PMID: 32093652 PMCID: PMC7041204 DOI: 10.1186/s12891-020-3139-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 02/13/2020] [Indexed: 11/10/2022] Open
Abstract
Background Injuries and resulting stiffness around joints, especially the elbow, have huge psychological effects by reducing quality of life through interference with normal daily activities such as feeding, dressing, grooming, and reaching for objects. Over the last several years and through numerous research results, the myofibroblast-mast cell-neuropeptide axis of fibrosis had been implicated in post-traumatic joint contractures. Pre-clinical models and a pilot randomized clinical trial (RCT) demonstrated the feasibility and safety of using Ketotifen Fumarate (KF), a mast cell stabilizer to prevent elbow joint contractures. This study aims to evaluate the efficacy of KF in reducing joint contracture severity in adult participants with operately treated elbow fractures and/or dislocations. Methods/design A Phase III randomized, controlled, double-blinded multicentre trial with 3 parallel groups (KF 2 mg or 5 mg or lactose placebo twice daily orally for 6 weeks). The study population consist of adults who are at least 18 years old and within 7 days of injury. The types of injuries are distal humerus (AO/OTA type 13) and/or proximal ulna and/or proximal radius fractures (AO/OTA type 2 U1 and/or 2R1) and/or elbow dislocations (open fractures with or without nerve injury may be included). A stratified randomization scheme by hospital site will be used to assign eligible participants to the groups in a 1:1:1 ratio. The primary outcome is change in elbow flexion-extension range of motion (ROM) arc from baseline to 12 weeks post-randomization. The secondary outcomes are changes in ROM from baseline to 6, 24 & 52 weeks, PROMs at 2, 6, 12, 24 & 52 weeks and impact of KF on safety including serious adverse events and fracture healing. Descriptive analysis for all outcomes will be reported and ANCOVA be used to evaluate the efficacy KF over lactose placebo with respect to the improvement in ROM. Discussion The results of this study will provide evidence for the use of KF in reducing post-traumatic joint contractures and improving quality of life after joint injuries. Trial registration This study was prospectively registered (July 10, 2018) with ClinicalTrials.gov reference: NCT03582176.
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Affiliation(s)
- Ayoola Ademola
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada. .,Department of Community Health Sciences, University of Calgary, Calgary, Canada.
| | - Kevin A Hildebrand
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Prism S Schneider
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Nicholas G H Mohtadi
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Surgery, University of Calgary, Calgary, Canada
| | - Neil J White
- Department of Surgery, University of Calgary, Calgary, Canada
| | - Michael J Bosse
- Department of Orthopaedic Surgery, Carolinas Medical Center, Charlotte, USA
| | | | - Richard E A Walker
- McCaig Institute of Bone and Joint, University of Calgary, Calgary, Canada.,Department of Radiology, University of Calgary, Calgary, Canada
| | - Tolulope T Sajobi
- Department of Community Health Sciences, University of Calgary, Calgary, Canada
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10
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Is It the Surgery or the Block? Incidence, Risk Factors, and Outcome of Nerve Injury following Upper Extremity Surgery. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2458. [PMID: 31741818 PMCID: PMC6799396 DOI: 10.1097/gox.0000000000002458] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2019] [Accepted: 07/23/2019] [Indexed: 11/27/2022]
Abstract
Although numerous studies have addressed the topic of postoperative nerve injury, debate continues to exist on its exact incidence, risk factors, etiology, and functional outcome. The aim of this study is to investigate the incidence of nerve injury and to identify patient, anesthetic, and surgical factors pertaining to perioperative nerve injury. Also, long-term nerve injury outcomes were assessed in terms of functionality. Methods A total of 297 patients, scheduled for elective distal upper extremity surgery, were prospectively included. At various time points, patients were screened for new onset nerve injury by means of clinical examination and questionnaires (including the Quick Disabilities of the Arm, Shoulder and Hand functionality measure). Results New nerve injury was diagnosed in 14 patients [4.7% (95% CI, 2.8-7.8)], but no causative risk factors were identified. The exact origin of nerve injury is suspected to be surgical in 11 cases. At 4 years postoperatively, 5 of the 14 patients with nerve injury (36%) were still symptomatic and had reduced functionality relative to preoperative status. Conclusions This study demonstrates an incidence of all cause nerve injury of 4.7%. No specific patient, anesthetic, or surgical risk factors are identified and, importantly, patients who received regional anesthesia are not at more risk of nerve injury than those who received general anesthesia. The exact origin of nerve injury is very difficult to determine, but is suspected to be caused by direct surgical trauma in most cases. Four years following the nerve injury, approximately 40% of the patients with new onset nerve injury have reduced functionality.
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11
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Kerver N, Boeddha AV, Gerritsma-Bleeker CLE, Eygendaal D. Snapping of the annular ligament: a uncommon injury characterised by snapping or locking of the elbow with good surgical outcomes. Knee Surg Sports Traumatol Arthrosc 2019; 27:326-333. [PMID: 30073382 DOI: 10.1007/s00167-018-5076-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/07/2017] [Accepted: 07/19/2018] [Indexed: 11/30/2022]
Abstract
PURPOSE Snapping annular ligament is an uncommon cause of lateral elbow pain. The purpose of this case series was to evaluate the clinical presentation and surgical outcomes for snapping annular ligament. METHODS Included were 23 patients with snapping annular ligament who received surgical treatment between 2007 and 2016. There were two treatment groups with either resection (arthroscopic or open procedure, n = 15) or open annular ligament reconstruction (n = 8). Patients were assessed with the Mayo Elbow Performance Index and the Oxford Elbow Score. Preoperative and postoperative scores were compared with a paired t test. RESULTS Pain was located laterally in nine patients (39.1%), anteriorly in three patients (13.0%), anterolaterally in two patients (8.7%), and diffusely in nine patients (39.1%). In total, 16 patients (69.6%) experienced a snapping sensation and ten patients (43.5%) locking of the elbow. According to the patients' reported outcomes, their symptoms improved significantly after both procedures. CONCLUSIONS This is the largest case series in the literature on snapping annular ligament, an uncommon cause of lateral elbow pain. Good treatment results are expected with resection of the interpositioned part of the annular ligament or annular ligament reconstruction. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Nienke Kerver
- Department of Orthopedic Surgery, Martini Hospital, Postbus 30033, 9700 RM, Groningen, The Netherlands.
| | - Ashvin V Boeddha
- Department of Orthopedic Surgery, Martini Hospital, Postbus 30033, 9700 RM, Groningen, The Netherlands
| | | | - Denise Eygendaal
- Department of Orthopedic Surgery, Amphia Hospital, Breda, The Netherlands
- Amsterdam Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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12
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Bexkens R, van Bergen CJA, van den Bekerom MPJ, Kerkhoffs GMMJ, Eygendaal D. Decreased Defect Size and Partial Restoration of Subchondral Bone on Computed Tomography After Arthroscopic Debridement and Microfracture for Osteochondritis Dissecans of the Capitellum. Am J Sports Med 2018; 46:2954-2959. [PMID: 30141965 DOI: 10.1177/0363546518790455] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Arthroscopic debridement and microfracture are considered the primary surgical treatment for capitellar osteochondritis dissecans (OCD). Healing of the subchondral bone plays an essential role in cartilage repair, while lack of healing is related to the development of osteoarthritis. To date, it is unknown to what extent healing of the subchondral bone occurs after this technique in the elbow. PURPOSE To analyze defect size changes and subchondral bone healing with computed tomography (CT) after arthroscopic debridement and microfracture for advanced capitellar OCD. STUDY DESIGN Case series; Level of evidence, 4. METHODS Between 2009 and 2016, 67 patients underwent arthroscopic debridement and microfracture for advanced capitellar OCD. Fifty-four patients (81% follow-up rate) with CT scans were included (mean ± SD: preoperative, 4.0 ± 1.7 months; postoperative, 29 ± 9.0 months). OCD defect size was assessed by measuring the largest diameter in 3 directions: medial-lateral direction (coronal plane) and anterior-posterior direction and depth (both in sagittal plane). Healing of the OCD was divided into 3 categories: good-complete osseous union or ossification; fair-incomplete osseous union or ossification but improved; poor-no changes between pre- and postoperative scans. Postoperative clinical outcome was assessed with the Oxford Elbow Score (OES) at the same time as the postoperative CT scan. RESULTS There were 30 female and 24 male patients (age, 15.7 ± 3.2 years). Defect size decreased ( P < .001) in all 3 directions (medial-lateral × anterior-posterior × depth) at 29 ± 9.0 months: preoperatively, 7.9 ± 2.8 × 8.0 ± 3.2 × 4.1 ± 1.5 mm; postoperatively, 3.5 ± 3.3 × 4.0 ± 3.5 × 1.6 ± 1.4 mm. Healing of the subchondral bone was graded as good in 19 defects (35%), fair in 27 (50%), and poor in 8 (15%). The mean postoperative OES score was 40 ± 8.4. Neither postoperative defect size nor healing grade correlated with the OES ( P > .05). CONCLUSION Arthroscopic debridement and microfracture for advanced capitellar OCD result in improved (ie, decreased) defect size at a mean follow-up of 29 months, both in width and in depth. Healing of the subchondral bone was either good or fair in 85%. Interestingly, CT findings did not correlate with clinical outcomes.
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Affiliation(s)
- Rens Bexkens
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands.,Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Department of Orthopaedic Surgery, Sports Medicine Service, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Michel P J van den Bekerom
- Department of Orthopaedic Surgery, Shoulder and Elbow Unit, Onze Lieve Vrouwe Gasthuis, Amsterdam, the Netherlands
| | - Gino M M J Kerkhoffs
- Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands.,Academic Center for Evidence-Based Sports Medicine, Amsterdam, the Netherlands.,Amsterdam Collaboration on Health and Safety in Sports, AMC/VUmc IOC Research Center, Amsterdam, the Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Amphia Hospital, Breda, the Netherlands.,Department of Orthopaedic Surgery, Academic Medical Center, University of Amsterdam, Amsterdam Movement Sciences, Amsterdam, the Netherlands
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13
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Evans JP, Smith CD, Fine NF, Porter I, Gangannagaripalli J, Goodwin VA, Valderas JM. Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use. J Shoulder Elbow Surg 2018; 27:e98-e106. [PMID: 29444754 DOI: 10.1016/j.jse.2017.12.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards. METHODS A search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used. RESULTS We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score. CONCLUSIONS This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently.
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Affiliation(s)
- Jonathan P Evans
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Health Services and Policy Research Group, University of Exeter, Exeter, UK; National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK.
| | - Chris D Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nicola F Fine
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
| | | | - Victoria A Goodwin
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
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14
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Viveen J, Doornberg JN, Kodde IF, Goossens P, Koenraadt KLM, The B, Eygendaal D. Continuous passive motion and physical therapy (CPM) versus physical therapy (PT) versus delayed physical therapy (DPT) after surgical release for elbow contractures; a study protocol for a prospective randomized controlled trial. BMC Musculoskelet Disord 2017; 18:484. [PMID: 29166890 PMCID: PMC5700741 DOI: 10.1186/s12891-017-1854-0] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2017] [Accepted: 11/15/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND The elbow is prone to stiffness after trauma. To regain functional elbow motion several conservative- and surgical treatment options are available. Conservative treatment includes physical therapy, intra-articular injections with corticosteroids and a static progressive or dynamic splinting program. If conservative treatment fails, an operative release of the posttraumatic stiff elbow is often performed. The best Evidence-Based rehabilitation protocol for patients after an operative release is unknown to date and differs per surgeon, hospital and country. Options include early- or delayed motion supervised by a physical therapist, immediate continuous passive motion (CPM), (night) splinting and a static progressive or dynamic splinting program. METHODS/DESIGN The SET-Study (Stiff Elbow Trial) is a single-centre, prospective, randomized controlled trial. The primary objective of this study is to compare the active Range of Motion (ROM) (flexion arc and rotational arc) twelve months after surgery between three groups. The first group will receive in-hospital CPM in combination with early motion Physical Therapy (PT) supervised by a physical therapist, the second group will receive only in-hospital early motion PT supervised by a physical therapist and the third group will receive outpatient supervised PT from postoperative day seven till ten. Secondary outcome measures will be Patient Reported Outcome Measures (PROMs) including the Mayo Elbow Performance Score (MEPS), the Oxford Elbow Score (OES), the quick Disabilities of Arm, Shoulder and Hand (qDASH) score, Visual Analogue pain Scale in rest and activity (VAS), Pain Catastrophizing Scale (PCS), the Short Form (SF)-36, the Centre for Epidemiological Studies Depression Scale Revised (CESD-R) and the Work Rehabilitation Questionnaire (WORQ) for the upper limb. DISCUSSION A successful completion of this trial will provide evidence on the best rehabilitation protocol in order to (re)gain optimal motion after surgical release of the stiff elbow. TRIAL REGISTRATION The trial is registered at the Dutch Trial Register: NTR6067 , 31-8-2016.
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Affiliation(s)
- Jetske Viveen
- , Department of Orthopaedic Surgery, Amphia Hospital, PO box 90158, Molengracht 21, 4818, CK, Breda, The Netherlands.
| | - Job N Doornberg
- Department of Orthopaedic Surgery, Flinders University, Bedford Park SA, Adelaide, 5042, Australia
| | - Izaak F Kodde
- Department of Orthopaedic Surgery, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam-Zuidoost, The Netherlands
| | - Pjotr Goossens
- , Department of Orthopaedic Surgery, Amphia Hospital, PO box 90158, Molengracht 21, 4818, CK, Breda, The Netherlands
| | - Koen L M Koenraadt
- , Foundation for Orthopaedic Research, Care & Education, Amphia Hospital, 4818 , CK, Breda, The Netherlands
| | - Bertram The
- , Department of Orthopaedic Surgery, Amphia Hospital, PO box 90158, Molengracht 21, 4818, CK, Breda, The Netherlands
| | - Denise Eygendaal
- , Department of Orthopaedic Surgery, Amphia Hospital, PO box 90158, Molengracht 21, 4818, CK, Breda, The Netherlands.,Department of Orthopaedic Surgery, University of Amsterdam, Meibergdreef 9, 1105, AZ, Amsterdam-Zuidoost, The Netherlands
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15
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Iordens GIT, Den Hartog D, Tuinebreijer WE, Eygendaal D, Schep NWL, Verhofstad MHJ, Van Lieshout EMM. Minimal important change and other measurement properties of the Oxford Elbow Score and the Quick Disabilities of the Arm, Shoulder, and Hand in patients with a simple elbow dislocation; validation study alongside the multicenter FuncSiE trial. PLoS One 2017; 12:e0182557. [PMID: 28886018 PMCID: PMC5590744 DOI: 10.1371/journal.pone.0182557] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2016] [Accepted: 07/19/2017] [Indexed: 11/19/2022] Open
Abstract
Study design Validation study using data from a multicenter, randomized, clinical trial (RCT). Objectives To evaluate the reliability, validity, responsiveness, and minimal important change (MIC) of the Dutch version of the Oxford Elbow Score (OES) and the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) in patients with a simple elbow dislocation. Background Patient-reported outcome measures are increasingly important for assessing outcome following elbow injuries, both in daily practice and in clinical research. However measurement properties of the OES and Quick-DASH in these patients are not fully known. Methods OES and Quick-DASH were completed four times until one year after trauma. Mayo Elbow Performance Index, pain (VAS), Short Form-36, and EuroQol-5D were completed for comparison. Data of a multicenter RCT (n = 100) were used. Internal consistency was determined using Cronbach’s alpha. Construct and longitudinal validity were assessed by determining hypothesized strength of correlation between scores or changes in scores, respectively, of (sub)scales. Finally, floor and ceiling effects, MIC, and smallest detectable change (SDC) were determined. Results OES and Quick-DASH demonstrated adequate internal consistency (Cronbach α, 0.882 and 0.886, respectively). Construct validity and longitudinal validity of both scales were supported by >75% correctly hypothesized correlations. MIC and SDC were 8.2 and 12.0 point for OES, respectively. For Quick-DASH, these values were 11.7 and 25.0, respectively. Conclusions OES and Quick-DASH are reliable, valid, and responsive instruments for evaluating elbow-related quality of life. The anchor-based MIC was 8.2 points for OES and 11.7 for Quick-DASH.
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Affiliation(s)
- Gijs I. T. Iordens
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Wim E. Tuinebreijer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | - Niels W. L. Schep
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Michael H. J. Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M. M. Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
- * E-mail:
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16
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Yosmaoglu HB, Doğan D, Sonmezer E. The reliability and validity of the Turkish version of the Oxford Elbow Score. J Orthop Surg Res 2016; 11:95. [PMID: 27586810 PMCID: PMC5009656 DOI: 10.1186/s13018-016-0429-3] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/22/2016] [Accepted: 08/20/2016] [Indexed: 11/23/2022] Open
Abstract
Background Objective measures of outcome ensure reliable decisions with regard to treatment planning. Oxford Elbow Score (OES) is one of the common outcome measures used for assessing quality of life of patients with elbow disorders. OES consists of three domains: pain, elbow function and social/psychological. The aim of this study is to test the validity and reliability of the Turkish version of the OES. Methods The study’s sample includes 82 patients with elbow problems. The original version of the OES was translated into Turkish using the Isis Outcomes Translation and Linguistic Validation Process. The construct validity of the Turkish version of the OES was tested using a confirmatory factor analysis. For internal consistency, Cronbach’s alpha was calculated. A Pearson correlation and a dependent sample t test were utilised for reproducibility of the OES. For convergent validity, the correlation coefficients were calculated between the domains of the OES and Short Form 36 (SF36). An independent sample t test was calculated to determine if there was a significant difference between the scores of the participants from the upper and lower groups. Results Confirmatory factor analysis (CFA) indicates that the three-factor structure of the OES was confirmed. Most of the fit indices are at the expected level, except for a root mean square error of approximation and an adjusted goodness of fit index. Cronbach’s alpha was calculated as 0.91 for the whole scale. The results showed that there are positive and high correlations between the first and follow-up assessments (r = 0.89, p < 0.0001). The Turkish OES version and its dimensions have moderate and significant correlations with domains of SF36 in general. The test results indicated that the mean of each item on three domains of the OES was higher for the upper 27 %, and this difference was significant at the 0.01 level. Conclusions The Turkish version of the OES is a reliable, valid, reproducible and practical tool. It can be used for patients with elbow disorders and is recommended for clinician use.
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Affiliation(s)
- Hayri Baran Yosmaoglu
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Eskisehir Yolu 20, Baglıca, Ankara, Turkey.
| | - Deha Doğan
- Department of Measurement and Evaluation, Faculty of Educational Sciences, University of Ankara, Cebeci, Ankara, Turkey
| | - Emel Sonmezer
- Department of Physical Therapy and Rehabilitation, Faculty of Health Sciences, Baskent University, Eskisehir Yolu 20, Baglıca, Ankara, Turkey
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17
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Iordens GIT, Van Lieshout EMM, Schep NWL, De Haan J, Tuinebreijer WE, Eygendaal D, Van Beeck E, Patka P, Verhofstad MHJ, Den Hartog D. Early mobilisation versus plaster immobilisation of simple elbow dislocations: results of the FuncSiE multicentre randomised clinical trial. Br J Sports Med 2015; 51:531-538. [PMID: 26175020 DOI: 10.1136/bjsports-2015-094704] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/17/2015] [Indexed: 11/04/2022]
Abstract
BACKGROUND/AIM To compare outcome of early mobilisation and plaster immobilisation in patients with a simple elbow dislocation. We hypothesised that early mobilisation would result in earlier functional recovery. METHODS From August 2009 to September 2012, 100 adult patients with a simple elbow dislocation were enrolled in this multicentre randomised controlled trial. Patients were randomised to early mobilisation (n=48) or 3 weeks plaster immobilisation (n=52). Primary outcome measure was the Quick Disabilities of the Arm, Shoulder, and Hand (Quick-DASH) score. Secondary outcomes were the Oxford Elbow Score, Mayo Elbow Performance Index, pain, range of motion, complications and activity resumption. Patients were followed for 1 year. RESULTS Quick-DASH scores at 1 year were 4.0 (95% CI 0.9 to 7.1) points in the early mobilisation group versus 4.2 (95% CI 1.2 to 7.2) in the plaster immobilisation group. At 6 weeks, early mobilised patients reported less disability (Quick-DASH 12 (95% CI 9 to 15) points vs 19 (95% CI 16 to 22); p<0.05) and had a larger arc of flexion and extension (121° (95% CI 115° to 127°) vs 102° (95% CI 96° to 108°); p<0.05). Patients returned to work sooner after early mobilisation (10 vs 18 days; p=0.020). Complications occurred in 12 patients; this was unrelated to treatment. No recurrent dislocations occurred. CONCLUSIONS Early active mobilisation is a safe and effective treatment for simple elbow dislocations. Patients recovered faster and returned to work earlier without increasing the complication rate. No evidence was found supporting treatment benefit at 1 year. TRIAL REGISTRATION NUMBER NTR 2025.
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Affiliation(s)
- Gijs I T Iordens
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Esther M M Van Lieshout
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Niels W L Schep
- Trauma Unit, Department of Surgery, Academic Medical Center, Amsterdam, The Netherlands
| | - Jeroen De Haan
- Department of Surgery, Westfriesgasthuis, Hoorn, The Netherlands
| | - Wim E Tuinebreijer
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Denise Eygendaal
- Department of Orthopaedic Surgery, Upper Limb Unit, Amphia Hospital, Breda, The Netherlands
| | - Ed Van Beeck
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Peter Patka
- Department of Emergency Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michael H J Verhofstad
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Dennis Den Hartog
- Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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18
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Celik D. Psychometric properties of the Mayo Elbow Performance Score. Rheumatol Int 2014; 35:1015-20. [PMID: 25549600 DOI: 10.1007/s00296-014-3201-1] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2014] [Accepted: 12/19/2014] [Indexed: 02/07/2023]
Abstract
To translate and culturally adapt the Mayo Elbow Performance Score (MEPS), a widely used instrument for evaluating disability associated with elbow injuries, into Turkish (MEPS-T) and to determine psychometric properties of the translated version. The MEPS was translated into Turkish using published methodological guidelines. The measurement properties of the MEPS-T (construct validity and floor and ceiling effects) were tested in 91 patients with elbow pathology. The reproducibility of the MEPS-T was tested in 59 patients over 7-14 days. The responsiveness of the MEPS-T was tested in a subgroup of 46 patients diagnosed with lateral epicondylitis and who received conservative treatment for 6 weeks. The interclass correlation coefficient (ICC) was used to estimate the test-retest reliability. The construct validity was analyzed with the disabilities of the arm, shoulder and hand (DASH), Visual Analog Scale (VAS) and the Short Form 36 (SF-36). Effect size (ES) was used to assess the responsiveness. The distribution of floor and ceiling effects was determined. The MEPS-T showed very good test-retest reliability (ICC 0.89). The correlation coefficients between the MEPS-T and DASH and VAS were -0.61 and -0.53, respectively (p < 0.001). The highest correlations were between the MEPS-T and the mental component summary (r = 0.47, p = 0.001) and role emotional (r = 0.45, p = 0.001). The MEPS-T ES, 0.50, was moderate (95% CI 0.33-0.62). We observed no ceiling or floor effects. The MEPS-T represents a valid, reliable and moderately responsive instrument for evaluating patients with elbow disease.
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Affiliation(s)
- Derya Celik
- Division of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Istanbul University, 34740, Bakırköy, Istanbul, Turkey,
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19
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Validity and cross-cultural adaptation of the persian version of the oxford elbow score. Int J Rheumatol 2014; 2014:381237. [PMID: 25214845 PMCID: PMC4158467 DOI: 10.1155/2014/381237] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 07/28/2014] [Indexed: 11/22/2022] Open
Abstract
Oxford Elbow Score (OES) is a patient-reported questionnaire used to assess outcomes after elbow surgery. The aim of this study was to validate and adapt the OES into Persian language. After forward-backward translation of the OES into Persian, a total number of 92 patients after elbow surgeries completed the Persian OES along with the Persian DASH and SF-36. To assess test-retest reliability, 31 randomly selected patients (34%) completed the Persian OES again after three days while abstaining from all forms of therapeutic regimens. Reliability of the Persian OES was assessed by measuring intraclass correlation coefficient (ICC) for test-retest reliability and Cronbach's alpha for internal consistency. Spearman's correlation coefficient was used to test the construct validity. Cronbach's alpha coefficient was 0.92 showing excellent reliability. Cronbach's alpha for function, pain, and social-psychological subscales was 0.95, 0.86, and 0.85, respectively. Intraclass correlation coefficient (ICC) was 0.85 for the overall questionnaire and 0.90, 0.76, and 0.75 for function, pain, and social-psychological subscales, respectively. Construct validity was confirmed as the Spearman correlation between OES and DASH was 0.80. Persian OES is a valid and reliable patient-reported outcome measure to assess postsurgical elbow status in Persian speaking population.
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20
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Bruinsma W, Kodde I, de Muinck Keizer RJO, Kloen P, Lindenhovius ALC, Vroemen JPAM, Haverlag R, van den Bekerom MPJ, Bolhuis HW, Bullens PHJ, Meylaerts SAG, van der Zwaal P, Steller PE, Hageman M, Ring DC, den Hartog D, Hammacher ER, King GJW, Athwal GS, Faber KJ, Drosdowech D, Grewal R, Goslings JC, Schep NWL, Eygendaal D. A randomized controlled trial of nonoperative treatment versus open reduction and internal fixation for stable, displaced, partial articular fractures of the radial head: the RAMBO trial. BMC Musculoskelet Disord 2014; 15:147. [PMID: 24885637 PMCID: PMC4109703 DOI: 10.1186/1471-2474-15-147] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2014] [Accepted: 04/30/2014] [Indexed: 12/11/2022] Open
Abstract
Background The choice between operative or nonoperative treatment is questioned for
partial articular fractures of the radial head that have at least 2
millimeters of articular step-off on at least one radiograph (defined as
displaced), but less than 2 millimeter of gap between the fragments (defined
as stable) and that are not associated with an elbow dislocation,
interosseous ligament injury, or other fractures. These kinds of fractures
are often classified as Mason type-2 fractures. Retrospective comparative
studies suggest that operative treatment might be better than nonoperative
treatment, but the long-term results of nonoperative treatment are very
good. Most experts agree that problems like reduced range of motion, painful
crepitation, nonunion or bony ankylosis are infrequent with both
nonoperative and operative treatment of an isolated displaced partial
articular fracture of the radial head, but determining which patients will
have problems is difficult. A prospective, randomized comparison would help
minimize bias and determine the balance between operative and nonoperative
risks and benefits. Methods/Design The RAMBO trial (Radial Head – Amsterdam – Amphia – Boston
- Others) is an international prospective, randomized, multicenter trial.
The primary objective of this study is to compare patient related outcome
defined by the ‘Disabilities of Arm, Shoulder and Hand (DASH)
score’ twelve months after injury between operative and nonoperative
treated patients. Adult patients with partial articular fractures of the
radial head that comprise at least 1/3rd of the articular
surface, have ≥ 2 millimeters of articular step-off but
less than 2 millimeter of gap between the fragments will be enrolled.
Secondary outcome measures will be the Mayo Elbow Performance Index (MEPI),
the Oxford Elbow Score (OES), pain intensity through the ‘Numeric
Rating Scale’, range of motion (flexion arc and rotational arc),
radiographic appearance of the fracture (heterotopic ossification,
radiocapitellar and ulnohumeral arthrosis, fracture healing, and signs of
implant loosening or breakage) and adverse events (infection, nerve injury,
secondary interventions) after one year. Discussion The successful completion of this trial will provide evidence on the best
treatment for stable, displaced, partial articular fractures of the radial
head. Trial registration The trial is registered at the Dutch Trial Register: NTR3413.
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Affiliation(s)
- Wendy Bruinsma
- Trauma Unit, Department of Surgery, Academic Medical Center, Meibergdreef 9, 1100 DD Amsterdam, The Netherlands.
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