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Dhiman K, Hall M, Crump T, Hoens AM, Lacaille D, Rankin JA, Then KL, Hazlewood G, Barnabe C, Katz S, Sutherland J, Dempsey E, Barber CEH. Content validity testing of the INTERMED Self-Assessment in a sample of adults with rheumatoid arthritis and rheumatology healthcare providers. Health Expect 2024; 27:e13978. [PMID: 38366795 PMCID: PMC10873686 DOI: 10.1111/hex.13978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 01/10/2024] [Accepted: 01/12/2024] [Indexed: 02/18/2024] Open
Abstract
BACKGROUND Care complexity can occur when patients experience health challenges simultaneously with social barriers including food and/or housing insecurity, lack of transportation or other factors that impact care and patient outcomes. People with rheumatoid arthritis (RA) may experience care complexity due to the chronicity of their condition and other biopsychosocial factors. There are few standardised instruments that measure care complexity and none that measure care complexity specifically in people with RA. OBJECTIVES We assessed the content validity of the INTERMEDS Self-Assessment (IMSA) instrument that measures care complexity with a sample of adults with RA and rheumatology healthcare providers (HCPs). Cognitive debriefing interviews utilising a reparative framework were conducted. METHODS Patient participants were recruited through two existing studies where participants agreed to be contacted about future studies. Study information was also shared through email blasts, posters and brochures at rheumatology clinic sites and trusted arthritis websites. Various rheumatology HCPs were recruited through email blasts, and divisional emails and announcements. Interviews were conducted with nine patients living with RA and five rheumatology HCPs. RESULTS Three main reparative themes were identified: (1) Lack of item clarity and standardisation including problems with item phrasing, inconsistency of the items and/or answer sets and noninclusive language; (2) item barrelling, where items asked about more than one issue, but only allowed a single answer choice; and (3) timeframes presented in the item or answer choices were either too long or too short, and did not fit the lived experiences of patients. Items predicting future healthcare needs were difficult to answer due to the episodic and fluctuating nature of RA. CONCLUSIONS Despite international use of the IMSA to measure care complexity, patients with RA and rheumatology HCPs in our setting perceived that it did not have content validity for use in RA and that revision for use in this population under a reparative framework was unfeasible. Future instrument development requires an iterative cognitive debriefing and repair process with the population of interest in the early stages to ensure content validity and comprehension. PATIENT OR PUBLIC CONTRIBUTION Patient and public contributions included both patient partners on the study team and people with RA who participated in the study. Patient partners were involved in study design, analysis and interpretation of the findings and manuscript preparation. Data analysis was structured according to emergent themes of the data that were grounded in patient perspectives and experiences.
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Affiliation(s)
- Kiran Dhiman
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Marc Hall
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Trafford Crump
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Surgery, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Alison M Hoens
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Physical Therapy, University of British Columbia, Vancouver, British Columbia, Canada
- Arthritis Patient Advisory Board, Arthritis Research Canada, Vancouver, British Columbia, Canada
| | - Diane Lacaille
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- Department of Medicine, University of British Columbia, Vancouver, British Columbia, Canada
| | - James A Rankin
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Karen L Then
- Faculty of Nursing, University of Calgary, Calgary, Alberta, Canada
| | - Glen Hazlewood
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Cheryl Barnabe
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
| | - Steven Katz
- Department of Medicine, University of Alberta, Edmonton, Alberta, Canada
| | - Jason Sutherland
- Centre for Health Services and Policy Research, University of British Columbia, Vancouver, British Columbia, Canada
| | - Erika Dempsey
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
| | - Claire E H Barber
- Department of Medicine, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada
- Arthritis Research Canada, Vancouver, British Columbia, Canada
- McCaig Institute for Bone and Joint Health, Calgary, Alberta, Canada
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Pires Rodrigues GA, Vuistiner P, Burrus C, Konzelmann M, Léger B, Luthi F. Should we separately measure the pain parameter of the Constant-Murley score in patients with chronic shoulder pain? BMC Musculoskelet Disord 2023; 24:399. [PMID: 37202747 DOI: 10.1186/s12891-023-06441-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Accepted: 04/18/2023] [Indexed: 05/20/2023] Open
Abstract
BACKGROUND The Constant-Murley Score (CMS) is a relatively unique shoulder assessment tool because it combines patient-reported outcomes (pain and activity), performance measurement and clinician-reported outcomes (strength and mobility). With these characteristics, the effect of patient-related psychological factors on the CMS remains debated. We aimed to investigate which parameters of the CMS are influenced by psychological factors by assessing the CMS before and after rehabilitation for chronic shoulder pain. METHODS This retrospective study screened all patients (18-65 years old) who were admitted for interdisciplinary rehabilitation for chronic shoulder pain (≥ 3 months) between May 2012 and December 2017. Patients with unilateral shoulder injuries were eligible. Exclusion criteria were shoulder instability, concomitant neurological injuries, complex regional pain syndrome (including Steinbrocker syndrome), heavy psychiatric issues, and missing data. The Hospital Anxiety and Depression Scale, Pain Catastrophizing scale, and Tampa Scale of Kinesiophobia were administered before and after treatment. Regression models were used to estimate associations between psychological factors and the CMS. RESULTS We included 433 patients (88% male, mean age 47±11 years) with a median duration of symptoms of 392.2 days (interquartile range: 266.5-583.5). Rotator cuff issue was present in 71% of patients. During interdisciplinary rehabilitation, patients were followed for a mean of 33.6±7.5 days. The mean CMS at entry was 42.8 ±15.5. The mean gain in CMS after treatment was 10.6 ±10.9. Before treatment, psychological factors were significantly associated with only the pain CMS parameter: -0.37 (95% CI: -0.46 to -0.28), p <0.001. After treatment, psychological factors were associated with the evolution of the four CMS parameters: -0.12 (-0.23 to -0.01) to -0.26 (95% CI: -0.36 to -0.16), p<0.05. CONCLUSIONS This study raises the question of a distinct assessment of pain when assessing shoulder function with CMS in patients with chronic shoulder pain. The separation of the "pain parameter" from the overall CMS score seems illusory with this tool that is used worldwide. However, clinicians should be aware that psychological factors can negatively influence the evolution of all CMS parameters during follow-up, which argues for a biopsychosocial approach to patients with chronic shoulder pain.
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Affiliation(s)
- Gil Augusto Pires Rodrigues
- Department for Musculoskeletal Rehabilitation, Department of Medical Research, Clinique Romande de Réadaptation SUVA, Avenue du Grand-Champsec 90, 1950, sion, Switzerland.
- Musculoskeletal Department, Orthopedics and Traumatology Department, Lausanne University Hospital, Lausanne, Switzerland.
| | - Philippe Vuistiner
- Department of Medical Research, Clinique Romande de Réadaptation SUVA, Avenue du Grand-Champsec 90, 1950, Sion, Switzerland
| | - Cyrille Burrus
- Department for Musculoskeletal Rehabilitation, Department of Medical Research, Clinique Romande de Réadaptation SUVA, Avenue du Grand-Champsec 90, 1950, sion, Switzerland
| | - Michel Konzelmann
- Department of Medical Research, Assessment and Consultation Center, Clinique Romande de Réadaptation SUVA, Avenue du Grand-Champsec 90, 1950, Sion, Switzerland
| | - Bertrand Léger
- Department of Medical Research, Clinique Romande de Réadaptation SUVA, Avenue du Grand-Champsec 90, 1950, Sion, Switzerland
| | - François Luthi
- Department for Musculoskeletal Rehabilitation, Department of Medical Research, Clinique Romande de Réadaptation SUVA, Avenue du Grand-Champsec 90, 1950, sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Lausanne University Hospital, Rue du Bugnon 46, 1011, Lausanne, Switzerland
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Naye F, Décary S, Houle C, LeBlanc A, Cook C, Dugas M, Skidmore B, Tousignant-Laflamme Y. Six Externally Validated Prognostic Models Have Potential Clinical Value to Predict Patient Health Outcomes in the Rehabilitation of Musculoskeletal Conditions: A Systematic Review. Phys Ther 2023; 103:7066982. [PMID: 37245218 DOI: 10.1093/ptj/pzad021] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Revised: 06/21/2022] [Accepted: 01/06/2023] [Indexed: 05/30/2023]
Abstract
OBJECTIVE The purpose of this systematic review was to identify and appraise externally validated prognostic models to predict a patient's health outcomes relevant to physical rehabilitation of musculoskeletal (MSK) conditions. METHODS We systematically reviewed 8 databases and reported our findings according to Preferred Reporting Items for Systematic Reviews and Meta-Analysis 2020. An information specialist designed a search strategy to identify externally validated prognostic models for MSK conditions. Paired reviewers independently screened the title, abstract, and full text and conducted data extraction. We extracted characteristics of included studies (eg, country and study design), prognostic models (eg, performance measures and type of model) and predicted clinical outcomes (eg, pain and disability). We assessed the risk of bias and concerns of applicability using the prediction model risk of bias assessment tool. We proposed and used a 5-step method to determine which prognostic models were clinically valuable. RESULTS We found 4896 citations, read 300 full-text articles, and included 46 papers (37 distinct models). Prognostic models were externally validated for the spine, upper limb, lower limb conditions, and MSK trauma, injuries, and pain. All studies presented a high risk of bias. Half of the models showed low concerns for applicability. Reporting of calibration and discrimination performance measures was often lacking. We found 6 externally validated models with adequate measures, which could be deemed clinically valuable [ie, (1) STart Back Screening Tool, (2) Wallis Occupational Rehabilitation RisK model, (3) Da Silva model, (4) PICKUP model, (5) Schellingerhout rule, and (6) Keene model]. Despite having a high risk of bias, which is mostly explained by the very conservative properties of the PROBAST tool, the 6 models remain clinically relevant. CONCLUSION We found 6 externally validated prognostic models developed to predict patients' health outcomes that were clinically relevant to the physical rehabilitation of MSK conditions. IMPACT Our results provide clinicians with externally validated prognostic models to help them better predict patients' clinical outcomes and facilitate personalized treatment plans. Incorporating clinically valuable prognostic models could inherently improve the value of care provided by physical therapists.
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Affiliation(s)
- Florian Naye
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Simon Décary
- Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Quebec, Canada
- Tier 1 Canada Research Chair in Shared Decision Making and Knowledge Translation, Centre de recherche sur les soins et les services de première ligne de l'Université Laval (CERSSPL-UL), Quebec, Quebec, Canada
| | - Catherine Houle
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Pavillon Ferdinand-Vandry, Université Laval, Quebec, Quebec, Canada
| | - Chad Cook
- Physical Therapy Division, Duke University, Durham, North Carolina, USA
| | - Michèle Dugas
- VITAM Research Center, Centre Intégré Universitaire de Santé et de Services Sociaux de la Capitale-Nationale, Quebec, Quebec, Canada
| | - Becky Skidmore
- Independent Information Specialist, Ottawa, Ontario, Canada
| | - Yannick Tousignant-Laflamme
- School of Rehabilitation, Faculty of Medicine and Health Sciences, Université de Sherbrooke, Sherbrooke, Quebec, Canada
- Clinical Research of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
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Bhashyam AR, Challa ST, Thomas H, Rodriguez EK, Weaver MJ. Clinic follow-up of orthopaedic trauma patients during and after the post-surgical global period: a retrospective cohort study. BMC Musculoskelet Disord 2023; 24:120. [PMID: 36782143 PMCID: PMC9926540 DOI: 10.1186/s12891-023-06218-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/06/2022] [Accepted: 02/02/2023] [Indexed: 02/15/2023] Open
Abstract
BACKGROUND Insurance status is important as medical expenses may decrease the likelihood of follow-up after musculoskeletal trauma, especially for low-income populations. However, it is unknown what insurance factors are associated with follow-up care. In this study, we assessed the association between insurance plan benefits, the end of the post-surgical global period, and follow-up after musculoskeletal injury. METHODS This is a retrospective cohort study of 394 patients with isolated extremity fractures who were treated at three level-I trauma centers over four months in 2018. Paired t-tests were utilized to assess the likelihood of follow-up in relation to the 90-day post-surgical global period. Regression analysis was used to assess factors associated with the likelihood of follow-up. Supervised machine learning algorithms were used to develop predictive models of follow-up after the post-surgical global period. RESULTS Our final analysis included 328 patients. Likelihood of follow-up did not significantly change while within the post-surgical global period. When comparing follow-up within and outside of the post-surgical global period, there was a 20.1% decrease in follow-up between the 6-weeks and 6-month time points (68.3% versus 48.2%, respectively; p < 0.0001). Medicaid insurance compared to Medicare (OR 0.27, 95% confidence interval (CI) = [0.09, 0.84], p = 0.02) was a predictor of decreased likelihood of follow-up at 6-months post-operatively. CONCLUSIONS Our study demonstrates a statistically significant decrease in follow-up for orthopaedic trauma patients after the post-surgical global period, particularly for patients with Medicaid or Private insurance.
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Affiliation(s)
- Abhiram R. Bhashyam
- grid.32224.350000 0004 0386 9924Department of Orthopaedic Surgery, Massachusetts General Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, 55 Fruit St, Boston, MA 02114 USA
| | - Sravya T. Challa
- grid.32224.350000 0004 0386 9924Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, MA USA
| | - Hannah Thomas
- grid.38142.3c000000041936754XHarvard Medical School, Boston, MA USA
| | - Edward K. Rodriguez
- grid.239395.70000 0000 9011 8547Department of Orthopaedic Surgery, Beth Israel Deaconess Medical Center, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA USA
| | - Michael J. Weaver
- grid.38142.3c000000041936754XDepartment of Orthopaedic Surgery, Brigham and Women’s Hospital, Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, MA USA
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Tousignant-Laflamme Y, Houle C, Cook C, Naye F, LeBlanc A, Décary S. Mastering Prognostic Tools: An Opportunity to Enhance Personalized Care and to Optimize Clinical Outcomes in Physical Therapy. Phys Ther 2022; 102:6535136. [PMID: 35202464 PMCID: PMC9155156 DOI: 10.1093/ptj/pzac023] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2021] [Revised: 11/19/2021] [Accepted: 02/21/2022] [Indexed: 12/14/2022]
Abstract
UNLABELLED In health care, clinical decision making is typically based on diagnostic findings. Rehabilitation clinicians commonly rely on pathoanatomical diagnoses to guide treatment and define prognosis. Targeting prognostic factors is a promising way for rehabilitation clinicians to enhance treatment decision-making processes, personalize rehabilitation approaches, and ultimately improve patient outcomes. This can be achieved by using prognostic tools that provide accurate estimates of the probability of future outcomes for a patient in clinical practice. Most literature reviews of prognostic tools in rehabilitation have focused on prescriptive clinical prediction rules. These studies highlight notable methodological issues and conclude that these tools are neither valid nor useful for clinical practice. This has raised the need to open the scope of research to understand what makes a quality prognostic tool that can be used in clinical practice. Methodological guidance in prognosis research has emerged in the last decade, encompassing exploratory studies on the development of prognosis and prognostic models. Methodological rigor is essential to develop prognostic tools, because only prognostic models developed and validated through a rigorous methodological process should guide clinical decision making. This Perspective argues that rehabilitation clinicians need to master the identification and use of prognostic tools to enhance their capacity to provide personalized rehabilitation. It is time for prognosis research to look for prognostic models that were developed and validated following a comprehensive process before being simplified into suitable tools for clinical practice. New models, or rigorous validation of current models, are needed. The approach discussed in this Perspective offers a promising way to overcome the limitations of most models and provide clinicians with quality tools for personalized rehabilitation approaches. IMPACT Prognostic research can be applied to clinical rehabilitation; this Perspective proposes solutions to develop high-quality prognostic models to optimize patient outcomes.
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Affiliation(s)
| | - Catherine Houle
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada,Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Chad Cook
- Physical Therapy Division, Duke University, Durham, North Carolina, USA,Department of Population Health Sciences, Duke University, Durham, North Carolina, USA,Duke Clinical Research Institute, Duke University, Durham, North Carolina, USA
| | - Florian Naye
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada,Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
| | - Annie LeBlanc
- Department of Family Medicine and Emergency Medicine, Université Laval, Quebec, Quebec, Canada
| | - Simon Décary
- School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Quebec, Canada,Research Center of the Centre Hospitalier Universitaire de Sherbrooke (CRCHUS), Sherbrooke, Quebec, Canada
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Duong HP, Garcia A, Hilfiker R, Léger B, Luthi F. Systematic Review of Biopsychosocial Prognostic Factors for Return to Work After Acute Orthopedic Trauma: A 2020 Update. FRONTIERS IN REHABILITATION SCIENCES 2022; 2:791351. [PMID: 36188871 PMCID: PMC9397710 DOI: 10.3389/fresc.2021.791351] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 12/17/2021] [Indexed: 06/16/2023]
Abstract
OBJECTIVE To provide updated evidence on prognostic factors for return to work (RTW) in the early and late phases after acute orthopedic trauma from a biopsychosocial perspective. METHODS A systematic review of articles indexed in the MEDLINE, CINAHL, and Embase databases between 2010 and 2020 was performed. The inclusion criteria were cohort studies of employed populations sustaining acute orthopedic trauma with follow-up data on RTW. Biopsychosocial prognostic factors for RTW must be reported in the multiple regression models and divided into early (≤ 6 months) and late phases (> 6 months) postinjury. Two reviewers performed study selection, assessed the risk of bias and quality using the Quality in Prognosis Studies (QUIPS) tool and the Newcastle-Ottawa Scale (NOS), and extracted data independently. RESULTS Thirty articles were included with a follow-up period of 1-58 months. Based on the QUIPS tool, 7 studies (23%) were considered to have a low risk of bias, and 21 studies (70%) were considered to have a moderate risk of bias. Based on the NOS, the quality was high in 87% of the included studies. The RTW rates ranged from 22% to 74% in the early phase and from 44% to 94% in the late phase. In the early phase, strong evidence was found for injury severity. In the late phase, strong evidence was found for age, injury severity, level of pain, self-efficacy, educational level, blue-collar work, and compensation status; moderate evidence was found for recovery expectations and physical workload. There was limited or inconsistent evidence for the other factors. CONCLUSION Based on the levels of evidence, injury severity should be considered as one of the key barriers to RTW in the early and late phases postinjury. This finding underlines the need for serious injury prevention efforts. Our results also emphasize the multifaceted actions of the biopsychosocial model to facilitate RTW: promoting policies for older injured workers, improving access to medical and rehabilitation facilities, and adapting physical workload. Multiple other factors are likely important but require additional high-quality studies to assess their role in the RTW process.
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Affiliation(s)
- Hong Phuoc Duong
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Anne Garcia
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
| | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, Sion, Switzerland
| | - Bertrand Léger
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
| | - François Luthi
- Department of Medical Research, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation, Sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
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Benhissen Z, Konzelmann M, Vuistiner P, Leger B, Luthi F, Devilliers H, Hilfiker R, Benaim C. Development and validation of a short version of the French Hand Function Sort questionnaire in vocational rehabilitation. Ann Phys Rehabil Med 2021; 64:101533. [PMID: 33933688 DOI: 10.1016/j.rehab.2021.101533] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Revised: 02/27/2021] [Accepted: 03/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND The Hand Function Sort (HFS) is a pictorial self-administered questionnaire with 62 items. It is a valid and reliable scale focused on the physical function of the upper limbs. It is used to predict the return to work. OBJECTIVES We aimed to develop and validate a short version of the French version of the HFS (HFS-F) to simplify its use in clinical practice. METHODS We included patients with upper-limb chronic pain hospitalised for vocational rehabilitation from 2012 to 2019. Vocational rehabilitation aims to improve the autonomy of patients to regain their previous working capacity. The 62 items of the HFS-F were analysed in terms of patient and expert assessments, floor/ceiling effect, item-to-total correlation, principal component analysis, and Rasch analysis. A short HFS-F was developed. Thereafter, we assessed its internal consistency, test-retest reliability, criterion validity with the full-length HFS-F, construct validity with different scales (Disabilities of the Arm, Shoulder, and Hand [DASH]; Brief Pain Inventory [BPI]; Hospital Anxiety and Depression [HAD]), standard error of measurement (SEM), and minimal detectable change (MDC). RESULTS Six experts were consulted, 34 patients were interviewed, and 629 questionnaires were analysed. Among the items, 25 were selected after the final round with the six experts. The internal consistency and test-retest reliability were excellent (Cronbach α=0.95, intraclass correlation coefficient=0.92, 95% confidence interval [95% CI] 0.87 to 0.95). The correlation coefficient between scores of the short and full-length HFS-F was 0.841 (95% CI: 0.752 to 0.897, P<10-4), and those between the short HFS-F score and the DASH, BPI, HAD-Anxiety, and HAD-Depression scores were -0.816 (95% CI: -0.714 to -0.881, P<10-4), -0.529 (95% CI: -0.338 to -0.674, P<10-4), -0.451 (95% CI: -0.244 to 0.614, P=0.0001), and -0.360 (95% CI: -0.140 to -0.542, P=0.0018), respectively. The SEM and MDC values were estimated at 6/100 and 17/100, respectively. CONCLUSIONS A short version of the HFS-F was developed and validated. We named this questionnaire the 25 HFS-F.
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Affiliation(s)
- Zineb Benhissen
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland.
| | - Michel Konzelmann
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland; Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Philippe Vuistiner
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - Bertrand Leger
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland
| | - François Luthi
- Department of Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation Suva, Sion, Switzerland; Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland; Division of Physical Medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
| | | | - Roger Hilfiker
- School of Health Sciences, HES-SO Valais-Wallis, University of Applied Sciences and Arts Western Switzerland Valais, Sion, Switzerland
| | - Charles Benaim
- Department of Medical Research, Clinique Romande de Réadaptation Suva, Sion, Switzerland; Division of Physical Medicine and Rehabilitation, Lausanne University Hospital, Lausanne, Switzerland
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Paoloni-Giacobino A, Luthi F, Stenz L, Le Carré J, Vuistiner P, Léger B. Altered BDNF Methylation in Patients with Chronic Musculoskeletal Pain and High Biopsychosocial Complexity. J Pain Res 2020; 13:1289-1296. [PMID: 32581570 PMCID: PMC7276326 DOI: 10.2147/jpr.s251782] [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] [Subscribe] [Scholar Register] [Received: 03/03/2020] [Accepted: 05/07/2020] [Indexed: 12/22/2022] Open
Abstract
Purpose The INTERMED instrument, which was developed to measure patient's biopsychosocial (BPS) complexity, represents a powerful diagnostic and therapeutic tool. Epigenetic changes are the interface between signals from the environment and genetic modifications, affecting gene expression, in particular, by DNA methylation of CpG dinucleotides in promotor regions of the corresponding genes. The brain-derived neurotrophic factor (BDNF) gene plays a crucial role in the central sensitization (CS) of pain. In this study, we hypothesized that chronic pain modifies the methylation levels of the BDNF gene in a manner that is interconnected with the BPS status. Patients and Methods Fifty-eight chronic musculoskeletal pain patients (CMSP) were enrolled in the study. DNA was extracted from blood samples, the methylation levels of 13 CpG sites in the BDNF promoter were measured by pyrosequencing, and association studies with various patient parameters and the INTERMED scores were performed. Results Interestingly, a negative correlation (-0.40) was found between the total INTERMED scores and the average CpG methylation values of the BDNF gene, but no correlation was observed with the severity of pain, degree of anxiety, depression, or kinesiophobia and catastrophism. Moreover, the association was independent of age, sex and level of comorbidities. Conclusion This result shows that CMSP, in association with its biopsychosocial context, epigenetically decreases the degree of methylation of the BDNF promoter and should therefore increase the level of BDNF transcription. It also suggests a role of the INTERMED tool to detect a relationship between the BPS complexity and the epigenetic control of a target gene. The possible upregulation of BDNF expression might be, at least in part, the signal for chronic pain-induced central sensitization (CS). This could partly explain why patients with a higher level of complexity feel more pain than those with lower complexity.
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Affiliation(s)
- Ariane Paoloni-Giacobino
- Medicine Faculty, Department of Genetic Medicine and Development, Geneva University, Geneva, Switzerland
| | - François Luthi
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Musculoskeletal Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
| | - Ludwig Stenz
- Medicine Faculty, Department of Genetic Medicine and Development, Geneva University, Geneva, Switzerland
| | - Joane Le Carré
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Medical Research, Clinique romande de réadaptation, Sion, Switzerland
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Medical Research, Clinique romande de réadaptation, Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique romande de réadaptation, Sion, Switzerland.,Department of Medical Research, Clinique romande de réadaptation, Sion, Switzerland
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O’Hara NN, Isaac M, Slobogean GP, Klazinga NS. The socioeconomic impact of orthopaedic trauma: A systematic review and meta-analysis. PLoS One 2020; 15:e0227907. [PMID: 31940334 PMCID: PMC6961943 DOI: 10.1371/journal.pone.0227907] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2019] [Accepted: 01/02/2020] [Indexed: 02/06/2023] Open
Abstract
The overall objective of this study was to determine the patient-level socioeconomic impact resulting from orthopaedic trauma in the available literature. The MEDLINE, Embase, and Scopus databases were searched in December 2019. Studies were eligible for inclusion if more than 75% of the study population sustained an appendicular fracture due to an acute trauma, the mean age was 18 through 65 years, and the study included a socioeconomic outcome, defined as a measure of income, employment status, or educational status. Two independent reviewers performed data extraction and quality assessment. Pooled estimates of the socioeconomic outcome measures were calculated using random-effects models with inverse variance weighting. Two-hundred-five studies met the eligibility criteria. These studies utilized five different socioeconomic outcomes, including return to work (n = 119), absenteeism days from work (n = 104), productivity loss (n = 11), income loss (n = 11), and new unemployment (n = 10). Pooled estimates for return to work remained relatively consistent across the 6-, 12-, and 24-month timepoint estimates of 58.7%, 67.7%, and 60.9%, respectively. The pooled estimate for mean days absent from work was 102.3 days (95% CI: 94.8–109.8). Thirteen-percent had lost employment at one-year post-injury (95% CI: 4.8–30.7). Tremendous heterogeneity (I2>89%) was observed for all pooled socioeconomic outcomes. These results suggest that orthopaedic injury can have a substantial impact on the patient’s socioeconomic well-being, which may negatively affect a person’s psychological wellbeing and happiness. However, socioeconomic recovery following injury can be very nuanced, and using only a single socioeconomic outcome yields inherent bias. Informative and accurate socioeconomic outcome assessment requires a multifaceted approach and further standardization.
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Affiliation(s)
- Nathan N. O’Hara
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
- * E-mail:
| | - Marckenley Isaac
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Gerard P. Slobogean
- Department of Orthopaedics, University of Maryland School of Medicine, Baltimore, Maryland, United States of America
| | - Niek S. Klazinga
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, the Netherlands
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Bhashyam AR, McGovern MM, Mueller T, Heng M, Harris MB, Weaver MJ. The Personal Financial Burden Associated with Musculoskeletal Trauma. J Bone Joint Surg Am 2019; 101:1245-1252. [PMID: 31318803 DOI: 10.2106/jbjs.18.01114] [Citation(s) in RCA: 17] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Little is known about the effect of orthopaedic trauma on the financial health of patients. We hypothesized that some patients who sustain musculoskeletal trauma experience considerable financial hardship during treatment, and we also assessed for factors associated with increased personal financial burden. METHODS We surveyed 236 of 393 consecutive patients who were approached at 1 of 2 American College of Surgeons level-I trauma centers between 2016 and 2017 following the completion of treatment for a musculoskeletal injury (60% response rate). Two validated measures (financial burden composite score and dichotomized worry score) were used to assess the financial hardship that patients experienced with the injury. RESULTS There were 236 participants in the study, the mean age was 56.3 years (range, 19 to 94 years), and 48.7% of patients were male. Of the 236 patients, 97.9% had medical insurance, yet the mean financial burden composite score (and standard deviation) was 2.4 ± 2.2 (0 indicated low and 6 indicated high). In this study, 25.0% of patients had high levels of worry about financial problems that resulted from the injury. Fifty-four percent of patients used their savings to pay for their care, and 23% of patients borrowed money or took out a loan. Twenty-three percent of patients missed payment on other bills. Fifty-seven percent of patients were required to cut expenses in general. Patients with higher composite financial burden scores had a significantly increased likelihood of high financial worry (odds ratio [OR], 1.8 [95% confidence interval (CI), 1.5 to 2.2]; p < 0.001). Factors associated with increased financial hardship were high-deductible health plan insurance (coefficient, 0.3 [95% CI, 0.002 to 0.528]; p = 0.048), Medicaid insurance (coefficient, 0.6 [95% CI, 0.342 to 0.863]; p < 0.001), failure to complete high school (coefficient, 0.475 [95% CI, 0.033 to 0.918]; p = 0.035), increased number of surgical procedures (coefficient, 0.067 [95% CI, 0.005 to 0.129]; p = 0.035), and prior medical or student loans (coefficient, 0.769 [95% CI, 0.523 to 1.016]; p < 0.001). CONCLUSIONS Despite a high rate of insurance, patients with orthopaedic trauma in our study had high rates of worry and financial distress. Asking about financial hardship may help to identify those patients with a higher personal financial burden and may promote allocation of additional social support and services.
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Affiliation(s)
| | - Madeline M McGovern
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Taina Mueller
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Marilyn Heng
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Mitchel B Harris
- Department of Orthopaedic Surgery, Massachusetts General Hospital, Boston, Massachusetts.,Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts
| | - Michael J Weaver
- Harvard Orthopaedic Trauma Initiative, Harvard Medical School, Boston, Massachusetts.,Department of Orthopaedic Surgery, Brigham and Women's Hospital, Boston, Massachusetts
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Ramakrishnan K, Murphy G, Middleton J, Cameron I. Early vocational rehabilitation for patients with spinal injury: a qualitative research study of service providers. INTERNATIONAL JOURNAL OF THERAPY AND REHABILITATION 2018. [DOI: 10.12968/ijtr.2018.25.10.505] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Kumaran Ramakrishnan
- Research Fellow, John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Australia
| | - Gregory Murphy
- Emeritus Professor, School of Psychology and Public Health, Latrobe University, Australia
| | - James Middleton
- Professor of Rehabilitation Medicine, John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Australia
| | - Ian Cameron
- Professor of Rehabilitation Medicine and Head, John Walsh Centre for Rehabilitation Research, Sydney Medical School Northern, The University of Sydney, Australia
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Luthi F, Vuistiner P, Favre C, Hilfiker R, Léger B. Avoidance, pacing, or persistence in multidisciplinary functional rehabilitation for chronic musculoskeletal pain: An observational study with cross-sectional and longitudinal analyses. PLoS One 2018; 13:e0203329. [PMID: 30180195 PMCID: PMC6122830 DOI: 10.1371/journal.pone.0203329] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2018] [Accepted: 08/17/2018] [Indexed: 01/05/2023] Open
Abstract
Background Three main activity patterns have been distinguished in describing chronic pain (avoidance, pacing and persistence). However, their influence on patient outcomes remains a question of debate. This observational study aimed to measure the associations between the avoidance, pacing, and persistence (labelled overdoing) scales of the Patterns of Activity Measure–Pain (POAM-P), self-reported outcomes (pain-interference, depression, functional ability), and observational outcomes (walking, lifting test, physical fitness). Methods We conducted an observational study with cross-sectional and longitudinal analyses. The data were collected prospectively before and after treatment, which was a 5-week functional rehabilitation including vocational aspects. In addition to self-reported and observational outcomes, patients were asked if they thought they would be able to return to work at 6 months. Analyses were conducted with treatment effect sizes, correlations, and multiple regression models. Results In this sample (891 patients), we found on average small to moderate improvements for pain-interference and observational outcomes (Cohen’s d: 0.37 to 0.64). According to the multivariable models, overdoing was associated with most of the beneficial psychosocial and observational outcomes (β -0.13 to 0.17; all p<0.01). Avoidance was related to negative psychosocial outcomes before treatment (β -0.09 to 0.17; all p<0.015). Pacing, which had moderate correlation with avoidance (r = 0.46), was not associated with most of the outcomes. The feeling that the goal of returning to work was attainable was associated with lower avoidance scores (adjusted OR 0.97; p = 0.024). Conclusions The overdoing POAM-P scale probably measures a task-contingent persistence, which appears appropriate in the setting of this study. Persistent behavior was indeed related to small or moderate positive biopsychosocial outcomes, before and after treatment. Moreover feeling able to return to work was related to lower avoidance. Further studies should test the efficacy of motivational strategies that may promote functional task-contingent persistence and reduce avoidance of painful tasks.
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Affiliation(s)
- François Luthi
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Orthopedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
- * E-mail:
| | - Philippe Vuistiner
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
| | - Christine Favre
- Unit of Psychosomatic Medicine, Clinique Romande de Réadaptation suva, Sion, Switzerland
| | - Roger Hilfiker
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
- School of Health Science, University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), Sion, Switzerland
| | - Bertrand Léger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suva, Sion, Switzerland
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13
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Illness Perceptions and Return to Work in Patients With Moderate to Severe Injuries. Rehabil Nurs 2018; 43:297-304. [DOI: 10.1097/rnj.0000000000000101] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Plomb-Holmes C, Hilfiker R, Leger B, Luthi F. Impact of a non-return-to-work prognostic model (WORRK) on allocation to rehabilitation clinical pathways: A single centre parallel group randomised trial. PLoS One 2018; 13:e0201687. [PMID: 30071081 PMCID: PMC6072039 DOI: 10.1371/journal.pone.0201687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2017] [Accepted: 07/16/2018] [Indexed: 11/22/2022] Open
Abstract
INTRODUCTION Stratified medicine might allow improvement of patient outcomes while keeping costs stable or even diminishing them. Our objective was to measure if a prediction model, developed to predict non-return to work (nRTW) after orthopaedic trauma, improves the allocation to various vocational pathways for use in clinical practice. MATERIAL AND METHODS Randomised-controlled trial on vocational inpatients after orthopaedic trauma (n = 280). In the intervention group, nRTW risk (estimated using the WORRK tool) was given to the clinician team before allocation of vocational pathways, while in the control group it was not. Three pathways were available: simple, coaching and evaluation (EP). Accompanying indications for interpretation of the nRTW risk were given. The primary outcome was the proportion of patients allocated to the EP. The secondary outcome was patients' and clinicians' satisfaction. RESULTS 450 patients were assessed for eligibility, 280 included, 139 randomized to the control group (mean age 42.3years) and 141 to the intervention group (43.2years). The two groups had a similar risk profile. The patients in the intervention group were more often referred to the EP compared to the control group, but not statistically significantly more (risk ratio 1.31 [95% CI 0.70-2.46]). The number needed to treat was 30. When considering patients transferred to different pathways during rehabilitation, more patients from the intervention group were transferred to the EP over the course of the rehabilitation, increasing the risk ratio to 1.57 [95% CI 0.89 to 2.74]. DISCUSSION The knowledge of the risk of nRTW has an influence, that is not however statistically significant and is without clinical importance as previously defined by our own power calculations (based on a 15% increase in referral to EP in the intervention group compared to the control group), on clinical decision making with regards to the allocation of patients to different physical and vocational rehabilitation programs after orthopaedic trauma. This influence is less than what was expected, possibly due to insufficient directive guidelines accompanying the WORRK model, or because clinicians associate less hours of therapy (as with certain rehabilitation programs) to disadvantaging the patient. These findings do, however, support the multi-factorial aspect of clinician decision-making.
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Affiliation(s)
- Chantal Plomb-Holmes
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation suvacare, Sion, Switzerland
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suvacare, Sion, Switzerland
| | - Roger Hilfiker
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suvacare, Sion, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), Sion, Switzerland
| | - Bertrand Leger
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suvacare, Sion, Switzerland
| | - François Luthi
- Department for Musculoskeletal Rehabilitation, Clinique Romande de Réadaptation suvacare, Sion, Switzerland
- Institute for Research in Rehabilitation, Clinique Romande de Réadaptation suvacare, Sion, Switzerland
- Department of Physical Medicine and Rehabilitation, Orthopaedic Hospital, Lausanne University Hospital, Lausanne, Switzerland
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15
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Abstract
Zusammenfassung. Reha-Forschung ist die Methode, um die Wirkung der diversen Interventionen, die in der Rehabilitation angewendet werden, zu testen. Um dieses anspruchsvolle Ziel zu erreichen, ist die muskuloskelettale Rehabilitation auf Grundlagenforschung, klinische Forschung und Versorgungsforschung angewiesen. Die Rehabilitationsforschung in der Schweiz sieht sich jedoch mit grossen Herausforderungen und mehreren Barrieren konfrontiert. Insgesamt lässt sich feststellen, dass es keine kohärenten und schweizweit akzeptierten Standards für die systematische Integration aktueller Forschungsergebnisse in die konkrete Reha-Praxis gibt. Als anwendungsbezogenen Handlungsbedarf in der Reha-Forschung in der Schweiz schlagen die Autoren u.a. die Entwicklung einer nationalen Agenda für Reha-Forschung und die Bildung von nationalen Forschungsnetzwerken unter Einbezug der Grundversorger, der Hochschulen, der Rehakliniken und Patientenorganisationen vor.
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Affiliation(s)
- Gere Luder
- 2 Massachusetts General Hospital (MGH), Institute for Health Professions, Rehabilitation Sciences Program, Boston, USA
| | - Martin L Verra
- 1 Institut für Physiotherapie, Inselspital, Universitätsspital Bern, Insel Gruppe
| | - Maurizio Trippolini
- 2 Massachusetts General Hospital (MGH), Institute for Health Professions, Rehabilitation Sciences Program, Boston, USA
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Plomb-Holmes C, Lüthi F, Vuistiner P, Leger B, Hilfiker R. A Return-to-Work Prognostic Model for Orthopaedic Trauma Patients (WORRK) Updated for Use at 3, 12 and 24 Months. JOURNAL OF OCCUPATIONAL REHABILITATION 2017; 27:568-575. [PMID: 28012065 PMCID: PMC5709449 DOI: 10.1007/s10926-016-9688-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/01/2023]
Abstract
Purpose Updating the Wallis Occupational Rehabilitation Risk (WORRK) model formula, predicting non-return to work (nRTW) at different time points (3 and 12 months) than in the validation study (2 years). Methods Secondary analysis of two samples was carried out (following orthopaedic trauma), including work status, the first at 3 months (428 patients) and the second at 12 months (431 patients) after discharge from rehabilitation. We used calibration (agreement between predicted probabilities and observed frequencies) and discrimination (area under the receiver operating characteristics curve) to assess performance of the model after fitting it in the new sample, then calculated the probabilities of nRTW based on the coefficients from the 2-year prediction. Finally, the intercepts were updated for both 3- and 12-month prediction models (re-calibration was necessary for the adjustment of these probabilities) and performance re-evaluated. Results Patient characteristics were similar in all samples (mean age 43 in both groups; 86% male at 3 months, 84% male at 12 months). The proportion of nRTW at 3 months was 63.8% and 53.4% at 12 months (50.36% at 2 years). Performance of the original WORRK for both 3- and 12-month prediction showed an AUC of 0.73, while statistically significant miscalibration was found for both time points (p < 0.001). After the updating of the intercept, calibration was improved and did not show significant miscalibration (p = 0.458 and 0.341). The AUC stayed at 0.73. Conclusion The WORRK model was successfully adapted by changing the intercept for 3- and 12-month prediction of nRTW, now available for use in clinical practice.
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Affiliation(s)
- Chantal Plomb-Holmes
- Department for Musculoskeletal Rehabilitation, Clinique romande de réadaptation suvacare, Sion, Switzerland.
- Institut de Recherche en Réadaptation, Clinique romande de réadaptation suvacare, Sion, Switzerland.
| | - François Lüthi
- Department for Musculoskeletal Rehabilitation, Clinique romande de réadaptation suvacare, Sion, Switzerland
- Institut de Recherche en Réadaptation, Clinique romande de réadaptation suvacare, Sion, Switzerland
- Département de l'Appareil Locomoteur, Hôpital Orthopédique, Lausanne University Hospital, Lausanne, Switzerland
| | - Philippe Vuistiner
- Department for Musculoskeletal Rehabilitation, Clinique romande de réadaptation suvacare, Sion, Switzerland
- Institute of Social and Preventive Medicine, Lausanne University Hospital, Lausanne, Switzerland
| | - Bertrand Leger
- Institut de Recherche en Réadaptation, Clinique romande de réadaptation suvacare, Sion, Switzerland
| | - Roger Hilfiker
- Institut de Recherche en Réadaptation, Clinique romande de réadaptation suvacare, Sion, Switzerland
- School of Health Sciences, University of Applied Sciences and Arts Western Switzerland Valais (HES-SO Valais-Wallis), Sion, Switzerland
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Kristman VL, Shaw WS, Boot CRL, Delclos GL, Sullivan MJ, Ehrhart MG. Researching Complex and Multi-Level Workplace Factors Affecting Disability and Prolonged Sickness Absence. JOURNAL OF OCCUPATIONAL REHABILITATION 2016; 26:399-416. [PMID: 27550629 PMCID: PMC5104770 DOI: 10.1007/s10926-016-9660-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
Purpose There is growing research evidence that workplace factors influence disability outcomes, but these variables reflect a variety of stakeholder perspectives, measurement tools, and methodologies. The goal of this article is to summarize existing research of workplace factors in relation to disability, compare this with employer discourse in the grey literature, and recommend future research priorities. Methods The authors participated in a year-long collaboration that ultimately led to an invited 3-day conference, "Improving Research of Employer Practices to Prevent Disability, held October 14-16, 2015, in Hopkinton, Massachusetts, USA. The collaboration included a topical review of the literature, group conference calls to identify key areas and challenges, drafting of initial documents, review of industry publications, and a conference presentation that included feedback from peer researchers and a question/answer session with a special panel of knowledge experts with direct employer experience. Results Predominant factors in the scientific literature were categorized as physical or psychosocial job demands, work organization and support, and workplace beliefs and attitudes. Employees experiencing musculoskeletal disorders in large organizations were the most frequently studied population. Research varied with respect to the basic unit of assessment (e.g., worker, supervisor, policy level) and whether assessments should be based on worker perceptions, written policies, or observable practices. The grey literature suggested that employers focus primarily on defining roles and responsibilities, standardizing management tools and procedures, being prompt and proactive, and attending to the individualized needs of workers. Industry publications reflected a high reliance of employers on a strict biomedical model in contrast to the more psychosocial framework that appears to guide research designs. Conclusion Assessing workplace factors at multiple levels, within small and medium-sized organizations, and at a more granular level may help to clarify generalizable concepts of organizational support that can be translated to specific employer strategies involving personnel, tools, and practices.
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Affiliation(s)
- Vicki L Kristman
- Department of Health Sciences, Lakehead University, 955 Oliver Road, Thunder Bay, ON, P7B 5E1, Canada.
- Institute for Work and Health, Toronto, ON, Canada.
- Division of Human Sciences, Northern Ontario School of Medicine, Lakehead University, Thunder Bay, ON, Canada.
- Dalla Lana School of Public Health, University of Toronto, Toronto, ON, Canada.
| | - William S Shaw
- Liberty Mutual Research Institute for Safety, Hopkinton, MA, USA
- University of Massachusetts Medical School, Worcester, MA, USA
| | - Cécile R L Boot
- Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - George L Delclos
- Division of Epidemiology, Human Genetics, and Environmental Sciences, The University of Texas-Houston School of Public Health, Houston, TX, USA
- Center for Research in Occupational Health (CiSAL), Pompeu Fabra University, Barcelona, Spain
| | | | - Mark G Ehrhart
- Department of Psychology, San Diego State University, San Diego, CA, USA
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Clinician and Patient-reported Outcomes Are Associated With Psychological Factors in Patients With Chronic Shoulder Pain. Clin Orthop Relat Res 2016; 474:2030-9. [PMID: 27357692 PMCID: PMC4965376 DOI: 10.1007/s11999-016-4894-0] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 05/10/2016] [Indexed: 01/31/2023]
Abstract
BACKGROUND Validated clinician outcome scores are considered less associated with psychosocial factors than patient-reported outcome measurements (PROMs). This belief may lead to misconceptions if both instruments are related to similar factors. QUESTIONS We asked: In patients with chronic shoulder pain, what biopsychosocial factors are associated (1) with PROMs, and (2) with clinician-rated outcome measurements? METHODS All new patients between the ages of 18 and 65 with chronic shoulder pain from a unilateral shoulder injury admitted to a Swiss rehabilitation teaching hospital between May 2012 and January 2015 were screened for potential contributing biopsychosocial factors. During the study period, 314 patients were screened, and after applying prespecified criteria, 158 patients were evaluated. The median symptom duration was 9 months (interquartile range, 5.5-15 months), and 72% of the patients (114 patients) had rotator cuff tears, most of which were work injuries (59%, 93 patients) and were followed for a mean of 31.6 days (SD, 7.5 days). Exclusion criteria were concomitant injuries in another location, major or minor upper limb neuropathy, and inability to understand the validated available versions of PROMs. The PROMs were the DASH, the Brief Pain Inventory, and the Patient Global Impression of Change, before and after treatment (physiotherapy, cognitive therapy and vocational training). The Constant-Murley score was used as a clinician-rated outcome measurement. Statistical models were used to estimate associations between biopsychosocial factors and outcomes. RESULTS Greater disability on the DASH was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale combined coefficient, 0.64; 95% CI, 0.25-1.03; p = 0.002) and social factors (language, professional qualification combined coefficient, -6.15; 95% CI, -11.09 to -1.22; p = 0.015). Greater pain on the Brief Pain Inventory was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale combined coefficient, 0.076; 95% CI, 0.021-0.13; p = 0.006). Poorer impression of change was associated with psychological factors (Hospital Anxiety and Depression Scale, Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia coefficient, 0.93; 95% CI, 0.87-0.99; p = 0.026) and social factors (education, language, and professional qualification coefficient, 6.67; 95% CI, 2.77-16.10; p < 0.001). Worse clinician-rated outcome was associated only with psychological factors (Hospital Anxiety and Depression Scale (depression only), Pain Catastrophizing Scale, Tampa Scale of Kinesiophobia combined coefficient, -0.35; 95% CI, -0.58 to -0.12; p = 0.003). CONCLUSIONS Depressive symptoms and catastrophizing appear to be key factors influencing PROMs and clinician-rated outcomes. This study suggests revisiting the Constant-Murley score. LEVEL OF EVIDENCE Level III, prognostic study.
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Updating the Wallis Occupational Rehabilitation RisK (WORRK) model: Predictive values at 3 months and one year. Ann Phys Rehabil Med 2015. [DOI: 10.1016/j.rehab.2015.07.307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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Correction: predicting non return to work after orthopaedic trauma: the Wallis occupational rehabilitation risk (WORRK) model. PLoS One 2015; 10:e0119193. [PMID: 25742298 PMCID: PMC4351056 DOI: 10.1371/journal.pone.0119193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Trippolini MA, Dijkstra PU, Côté P, Scholz-Odermatt SM, Geertzen JH, Reneman MF. Can Functional Capacity Tests Predict Future Work Capacity in Patients With Whiplash-Associated Disorders? Arch Phys Med Rehabil 2014; 95:2357-66. [DOI: 10.1016/j.apmr.2014.07.406] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2014] [Revised: 06/30/2014] [Accepted: 07/16/2014] [Indexed: 11/17/2022]
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