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Rivera RJ, Karasavvidis T, Pagan C, Haffner R, Ast MP, Vigdorchik JM, Debbi EM. Functional assessment in patients undergoing total hip arthroplasty. Bone Joint J 2024; 106-B:764-774. [PMID: 39084648 DOI: 10.1302/0301-620x.106b8.bjj-2024-0142.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 08/02/2024]
Abstract
Aims Conventional patient-reported surveys, used for patients undergoing total hip arthroplasty (THA), are limited by subjectivity and recall bias. Objective functional evaluation, such as gait analysis, to delineate a patient's functional capacity and customize surgical interventions, may address these shortcomings. This systematic review endeavours to investigate the application of objective functional assessments in appraising individuals undergoing THA. Methods The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines were applied. Eligible studies of THA patients that conducted at least one type of objective functional assessment both pre- and postoperatively were identified through Embase, Medline/PubMed, and Cochrane Central database-searching from inception to 15 September 2023. The assessments included were subgrouped for analysis: gait analysis, motion analysis, wearables, and strength tests. Results A total of 130 studies using 15 distinct objective functional assessment methods (FAMs) were identified. The most frequently used method was instrumented gait/motion analysis, followed by the Timed-Up-and-Go test (TUG), 6 minute walk test, timed stair climbing test, and various strength tests. These assessments were characterized by their diagnostic precision and applicability to daily activities. Wearables were frequently used, offering cost-effectiveness and remote monitoring benefits. However, their accuracy and potential discomfort for patients must be considered. Conclusion The integration of objective functional assessments in THA presents promise as a progress-tracking modality for improving patient outcomes. Gait analysis and the TUG, along with advancing wearable sensor technology, have the potential to enhance patient care, surgical planning, and rehabilitation.
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Affiliation(s)
- Richard J Rivera
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
- University of South Florida Morsani College of Medicine, Tampa, Florida, USA
| | - Theofilos Karasavvidis
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Cale Pagan
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Rowan Haffner
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Michael P Ast
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Jonathan M Vigdorchik
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Eytan M Debbi
- Adult Reconstruction and Joint Replacement, Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
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Cattaneo A, Ghidotti A, Catellani F, Fiorentino G, Vitali A, Regazzoni D, Rizzi C, Bombardieri E. Motion acquisition of gait characteristics one week after total hip arthroplasty: a factor analysis. Arch Orthop Trauma Surg 2024; 144:2347-2356. [PMID: 38483620 PMCID: PMC11093841 DOI: 10.1007/s00402-024-05245-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 02/17/2024] [Indexed: 05/16/2024]
Abstract
INTRODUCTION Clinical gait analysis can be used to evaluate the recovery process of patients undergoing total hip arthroplasty (THA). The postoperative walking patterns of these patients can be significantly influenced by the choice of surgical approach, as each procedure alters distinct anatomical structures. The aim of this study is twofold. The first objective is to develop a gait model to describe the change in ambulation one week after THA. The secondary goal is to describe the differences associated with the surgical approach. MATERIALS AND METHODS Thirty-six patients undergoing THA with lateral (n = 9), anterior (n = 15), and posterior (n = 12) approaches were included in the study. Walking before and 7 days after surgery was recorded using a markerless motion capture system. Exploratory Factor Analysis (EFA), a data reduction technique, condensed 21 spatiotemporal gait parameters to a smaller set of dominant variables. The EFA-derived gait domains were utilized to study post-surgical gait variations and to compare the post-surgical gait among the three groups. RESULTS Four distinct gait domains were identified. The most pronounced variation one week after surgery is in the Rhythm (gait cycle time: + 32.9 % ), followed by Postural control (step width: + 27.0 % ), Phases (stance time: + 11.0 % ), and Pace (stride length: - 9.3 % ). In postsurgical walking, Phases is statistically significantly different in patients operated with the posterior approach compared to lateral (p-value = 0.017) and anterior (p-value = 0.002) approaches. Furthermore, stance time in the posterior approach group is significantly lower than in healthy individuals (p-value < 0.001). CONCLUSIONS This study identified a four-component gait model specific to THA patients. The results showed that patients after THA have longer stride time but shorter stride length, wider base of support, and longer stance time, although the posterior group had a statistically significant shorter stance time than the others. The findings of this research have the potential to simplify the reporting of gait outcomes, reduce redundancy, and inform targeted interventions in regards to specific gait domains.
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Affiliation(s)
- Andrea Cattaneo
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy.
| | - Anna Ghidotti
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy
| | | | | | - Andrea Vitali
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy
| | - Daniele Regazzoni
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy
| | - Caterina Rizzi
- Department of Information Management Engineering and Production Engineering, University of Bergamo, Via Galvani, 2, Dalmine, BG, Italy
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Iqbal N, Fletcher J, Bassett P, Hart A, Lung P, Tozer P. Exploring methods of improving patient understanding and communication in a complex anal fistula clinic: results from a randomized controlled feasibility study. Colorectal Dis 2024; 26:518-526. [PMID: 38235831 DOI: 10.1111/codi.16861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/31/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/19/2024]
Abstract
AIM Patient understanding of disease can guide decision-making in the management of anal fistula. This prospective feasibility study aimed to assess the acceptability and methods of assessing the impact of viewing realistic models on patients with anal fistula. METHODS New referrals to a tertiary clinic participated in this single-centre, parallel-group randomized controlled study. Baseline characteristics, Decisional Conflict Scale and understanding of disease were assessed pre-consultation. Participants were randomized to a standard consultation, where disease and treatment options were explained using magnetic resonance images and drawn diagrams, or a similar consultation supplemented with an appropriate generic three-dimensional (3D) printed model. Understanding of disease and proposed surgery, Decisional Conflict Scale and ratings of visual aids were assessed post-consultation, along with 3D model feedback. RESULTS All 52 patients who were approached agreed to be randomized (25 standard, 27 3D consultation). Understanding of disease increased post-consultation in both groups. Post-consultation decisional conflict (0, no; 100, high decisional conflict) was low (median 27 post-standard vs. 24 post-3D consultation). Patients scored highly on measures assessing understanding of proposed surgery. 3D models were rated highly, with 96% of patients wanting to see them again in future consultations. CONCLUSIONS Three-dimensional printed fistula models are a welcome addition to outpatient consultations with results suggesting that understanding of surgery is improved. A future trial should be powered to detect whether 3D models result in a significant improvement in understanding beyond traditional methods of explanation and explore the conditions in which models have their maximal utility. CLINICALTRIALS GOV REGISTRATION ID This study was registered on ClinicalTrials.gov (ID: NCT04069728). Registered on 23 August 2019.
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Affiliation(s)
- Nusrat Iqbal
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, Harrow, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jordan Fletcher
- Department of Surgery and Cancer, Imperial College London, London, UK
- Department of Colorectal Surgery, St Mark's Hospital, Harrow, UK
| | - Paul Bassett
- Statsconsultancy Ltd, Longwood Lane, Amersham, UK
| | - Ailsa Hart
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, Harrow, UK
- Department of Metabolism, Digestion and Reproduction, Imperial College London, London, UK
| | - Phillip Lung
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, Harrow, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Phil Tozer
- Robin Phillips' Fistula Research Unit, St Mark's Hospital, Harrow, UK
- Department of Surgery and Cancer, Imperial College London, London, UK
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Kushwaha NS, Kumar A, Shukla R, Kumar D, Yadav G, Sharma V, Abbas MZ, Parihar K. Functional Outcomes and Gait Analysis of Total Hip Arthroplasty Through Lateral Hardinge Approach and Gluteus Medius-Sparing Approach: A Prospective Study. Cureus 2024; 16:e54323. [PMID: 38500899 PMCID: PMC10944693 DOI: 10.7759/cureus.54323] [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] [Accepted: 02/12/2024] [Indexed: 03/20/2024] Open
Abstract
Background and objective Hip degenerative joint disease is a common and debilitating musculoskeletal disorder. Total hip arthroplasty (THA) is a reconstructive hip procedure to relieve this condition through various surgical approaches. This study aimed to compare the functional outcomes between patients undergoing THA using the lateral Hardinge approach and the lateral gluteus medius-sparing approach. Material and methods This prospective study was carried out at a tertiary care institution. Thirty patients with arthritic hip joints were managed with total hip replacement (THR). The patients were allocated into two treatment groups; in group A, 14 patients received a THR by the lateral Hardinge approach, whereas in group B, 16 patients were managed by the lateral gluteus medius-sparing approach. Functional outcomes were assessed by the Harris Hip Score (HHS), and gait analysis was performed. Results The mean age of group A was 39.79 ±14.01 years and that of group B was 37.00 ±14.81 years. The mean length of incision was significantly lower in group B (p=0.001), whereas the mean duration of surgery (p=0.018) and mean contralateral pelvic tilt were found to be significantly lower in group A (p=0.009). No significant difference was found in abductor muscle strength, limb length discrepancy, HHS, pelvic obliquity, and pelvic rotation. Conclusion While functional outcomes were similar in both groups, the group that underwent THA with the gluteus medius-sparing approach had better gait based on lower pelvic tilt.
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Affiliation(s)
| | - Ashish Kumar
- Department of Orthopaedics, King George's Medical University, Lucknow, IND
| | - Rohit Shukla
- Department of Orthopaedics, King George's Medical University, Lucknow, IND
| | - Dharmendra Kumar
- Department of Orthopaedics, King George's Medical University, Lucknow, IND
| | - Ganesh Yadav
- Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | - Vineet Sharma
- Department of Physical Medicine and Rehabilitation, King George's Medical University, Lucknow, IND
| | - Mohammad Z Abbas
- Department of Orthopaedics, King George's Medical University, Lucknow, IND
| | - Kishore Parihar
- Department of Orthopaedics, King George's Medical University, Lucknow, IND
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Çakmak MF, Bayram S, Birişik F, Ayik Ö, Şahinkaya T, Ergin ÖN, Öztürk İ. The effects of modified hardinge approach on hip muscle strength in patients with primary hip arthroplasty: a patient evaluation with isokinetic strength test and gait analyses. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2024; 34:1209-1218. [PMID: 38010444 DOI: 10.1007/s00590-023-03778-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/16/2023] [Accepted: 11/01/2023] [Indexed: 11/29/2023]
Abstract
OBJECTIVE Numerous factors affect abductor strength after Total hip arthroplasty (THA), including surgical technique, prosthesis type, postoperative rehabilitation program, and preoperative patient condition. We prospectively investigated the effects of the modified Hardinge approach on hip muscle strength, which was evaluated using the isokinetic test, functional results, and gait function of patients who underwent primary THA. METHODS The hip muscles strength were measured using an isokinetic dynamometer. The primary outcomes of the present study were measurement of isokinetic strength of hip abductor muscle strengths using an isokinetic evaluator and gait analyses preoperatively and at 6 months postoperatively in 27 patients. RESULTS Isokinetic muscle strength test, abductor and other hip circumference groups achieved the preoperative muscle strength at 3 months postoperatively, and the postoperative sixth month values showed a statistically significant improvement compared with the preoperative and third month values. In gait analyze, our temporospatial data showed a slight regression at postoperative 3 months but reached the same values at 6 months postoperatively. Kinematic data showed a significant regression, but the data were not compared with those in the preoperative period. CONCLUSIONS Adequate muscle strength and physiological gait pattern, similar to the preoperative status, can be achieved at 6 months postoperatively. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Mehmet Fevzi Çakmak
- Department of Orthopedics and Traumatology, Faculty of Medicine, Kırşehir Ahi Evran University, Kırşehir, Turkey
| | - Serkan Bayram
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey.
| | - Fevzi Birişik
- Department of Orthopaedics and Traumatology, Istanbul Research and Training Hospital University of Health Sciences, Istanbul, Turkey
| | - Ömer Ayik
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey
| | - Türker Şahinkaya
- Department of Sports Medicine, Faculty of Medicine, Istanbul University, Istanbul, Turkey
| | - Ömer Naci Ergin
- Department of Orthopedics and Traumatology, Istanbul Faculty of Medicine, Istanbul University, 34050, Çapa Fatih Istanbul, Turkey
| | - İrfan Öztürk
- Department of Orthopedics and Traumatology, Istanbul Florence Nightingale Hospital, Istanbul, Turkey
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Yang M, Yao M, Chu K, Wei C, Li Z, Huo J, Liu S, Li H. Efficacy of Direct Anterior Approach Versus Posterior Lateral Approach for Total Hip Replacement in Patients with Parkinson's Disease. Med Sci Monit 2023; 29:e939682. [PMID: 37050859 PMCID: PMC10112043 DOI: 10.12659/msm.939682] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2023] [Accepted: 03/06/2023] [Indexed: 03/30/2023] Open
Abstract
BACKGROUND The present study was performed to evaluate the efficacy of direct anterior approach (DAA) versus posterolateral approach (PLA) for total hip arthroplasty (THA) in patients with Parkinson's disease (PD). The aim of the study was to compare the speed of recovery of hip function and postoperative complications between the 2 approaches. MATERIAL AND METHODS The study included 285 Parkinson's patients who underwent THA; 209 eligible patients were recruited for analysis as per the inclusion criteria and assigned into DAA group (n=90) and PLA group (n=119) according to the surgical approach. Postoperative Harris Hip Score (HHS), Western Ontario and McMaster University Osteoarthritis Index (WOMAC), and Forgotten joint score (FJS) were collected to assess hip function. RESULTS The DAA had a statistically lower incidence of postoperative complications than the PLA, particularly the rate of postoperative dislocation. Perioperative outcomes showed a longer operative time in the DAA than in the PLA group and more intraoperative blood loss in the DAA than in the PLA group. At 3 months postoperatively, the HHS and WOMAC scores in the DAA group showed significantly higher scores compared to the PLA group versus the DAA group. However, these differences disappeared at 6 months postoperatively and the FJS in the DAA group had a statistically higher score compared to the PLA group. CONCLUSIONS In patients with Parkinson's disease complicated with hip disease, the DAA approach exhibited a lower rate of dislocation than the PLA approach and had faster recovery of hip function.
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Affiliation(s)
- Meng Yang
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Mengxuan Yao
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Kun Chu
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Congcong Wei
- Department of Orthopedics, The Second 15 Hospital of Shaanxi Nuclear Industry, Xianyang, Shaanxi, PR China
| | - Zihang Li
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Jia Huo
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Sikai Liu
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
| | - Huijie Li
- The Third Hospital of Hebei Medical University, Shijiazhuang, Hebei, PR China
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Brown-Taylor L, Harris-Hayes M, Foraker R, Vasileff WK, Glaws K, Di Stasi S. Treatment decisions after interdisciplinary evaluation for nonarthritic hip pain: A randomized controlled trial. PM R 2022; 14:297-308. [PMID: 34181823 PMCID: PMC8712617 DOI: 10.1002/pmrj.12661] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 04/14/2021] [Accepted: 04/27/2021] [Indexed: 11/11/2022]
Abstract
BACKGROUND Physical therapy and hip arthroscopy are two viable treatment options for patients with nonarthritic hip pain (NAHP); however, patients may experience considerable decisional conflict when making a treatment decision. Interdisciplinary evaluation with a physical therapist and surgeon may better inform the decision-making process and reduce decisional conflict. OBJECTIVE To identify the extent to which an interdisciplinary evaluation between a surgeon, physical therapist, and patient influences treatment plans and decisional conflict of persons with NAHP. DESIGN Randomized controlled trial. SETTING Hip preservation clinic. PARTICIPANTS Adults with primary NAHP. INTERVENTIONS Participants were randomized to receive a standard (surgeon) or interdisciplinary (surgeon+physical therapist) evaluation. Surgeon evaluations included patient interview, strength and range-of-motion examination, palpation, gross motor observation, and special testing. Interdisciplinary evaluations started with the surgeon evaluation, then a physical therapist evaluated movement impairments during sitting, sit-to-stand, standing, single-leg stance, single-leg squat, and walking. All evaluations concluded with treatment planning with the respective provider(s). OUTCOME MEASURES Treatment plan and decisional conflict were collected pre- and postevaluation. Inclusion of physical therapy in participants' postevaluation treatment plans and postevaluation decisional conflict were compared between groups using chi-square tests and Mann-Whitney U tests, respectively. RESULTS Seventy-eight participants (39 in each group) met all eligibility criteria and were included in all analyses. Sixty-six percent of participants who received an interdisciplinary evaluation included physical therapy in their postevaluation treatment plan, compared to 48% of participants who received a standard evaluation (p = .10). Participants who received an interdisciplinary evaluation reported 6.3 points lower decisional conflict regarding their postevaluation plan (100-point scale; p = .04). The interdisciplinary and standard groups reduced decisional conflict on average 24.8 ± 18.9 and 23.6 ± 14.6 points, respectively. CONCLUSIONS Adding a physical therapist to a surgical clinic increased interest in physical therapy treatment, but this increase was not statistically significant. The interdisciplinary group displayed lower postevaluation decisional conflict; however, both groups displayed similar reductions in decisional conflict from pre- to postevaluation. This study also demonstrated the feasibility of an interdisciplinary evaluation in a hip preservation clinic.
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Affiliation(s)
- Lindsey Brown-Taylor
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH,Health and Rehabilitation Sciences Doctoral Program, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
| | - Marcie Harris-Hayes
- Program in Physical Therapy and Department of Orthopaedic Surgery, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - Randi Foraker
- Institute for Informatics, Washington University in St. Louis School of Medicine, St. Louis, MO
| | - W Kelton Vasileff
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Department of Orthopaedics, The Ohio State University, Columbus, OH
| | - Kathryn Glaws
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH
| | - Stephanie Di Stasi
- Sports Medicine Research Institute, The Ohio State University Wexner Medical Center, Columbus, OH,Division of Physical Therapy, School of Health and Rehabilitation Sciences, The Ohio State University, Columbus, OH
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Myburgh C, Larsen TB, Kjaer P. 'When the picture does not really tell the story'- A qualitative exploration of the MRI report of findings as a means for generating shared diagnostic meaning during the management of patients suffering from persistent spinal pain. PATIENT EDUCATION AND COUNSELING 2022; 105:221-227. [PMID: 34001396 DOI: 10.1016/j.pec.2021.04.031] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Revised: 04/27/2021] [Accepted: 04/27/2021] [Indexed: 06/12/2023]
Abstract
OBJECTIVES To explore the magnetic resonance imaging (MRI) feedback report as a health care encounter for generating shared diagnostic meaning. METHODS An exploratory, qualitative case study was conducted using video observation of the MRI report of findings, individual face-to-face and telephonic interviews. RESULTS From fourteen distinct encounters, three key themes emerged, these being: 'a powerful shared experience, 'a legacy of biomedical thinking' and 'clinical practice quandaries'. Generally speaking, the MRI encounter was observed to be both an effective and satisfying method for developing shared diagnostic meaning. However, in instances where a structure-based diagnosis could not be reasonably established, clinicians experienced doubts in what to present in a 'soft report'. A feature of these was the communication of speculative causal feedback, based on non-visualised structures and/or incidental findings observed. CONCLUSION Shared diagnostic meaning can result from a 'soft' MRI report of findings. However, the emergence of diagnostic closure is not guaranteed. Further exploration of this phenomenon in the context of shared decision making and the therapeutic alliance is warranted. PRACTICE IMPLICATIONS Pre-feedback peer conferences might be considered in order to standardise the information communicated to patients. Clinicians might also consider limiting the MRI scan as a visual aid in 'soft' reports.
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Affiliation(s)
- Corrie Myburgh
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK 5230 Odense M, Denmark.
| | - Trine Boye Larsen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK 5230 Odense M, Denmark
| | - Per Kjaer
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Campusvej 55, DK 5230 Odense M, Denmark; Health Sciences Research Centre, UCL University College, Niels Bohrs Alle 1, DK 5230 Odense M, Denmark
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Wang Z, Bao HW, Hou JZ. Direct anterior versus lateral approaches for clinical outcomes after total hip arthroplasty: a meta-analysis. J Orthop Surg Res 2019; 14:63. [PMID: 30808382 PMCID: PMC6390312 DOI: 10.1186/s13018-019-1095-z] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2018] [Accepted: 02/05/2019] [Indexed: 12/14/2022] Open
Abstract
Objective To compare the outcomes of the direct anterior approach (DAA) with the lateral approach (LA) for total hip arthroplasty (THA) patients. Methods Three English databases, PubMed, Embase, and the Cochrane Library, were searched for randomized controlled trials (RCTs) comparing the DAA with LA for THA. Information on the country, sample size, intervention, outcomes, and follow-up were extracted. Meta-analysis was performed using Stata 12.0. Results Five RCTs totaling 475 patients (DAA = 236, LA = 239) were included in this meta-analysis. Compared with the LA, the DAA was associated with a reduction in the VAS at 6 weeks (weighted mean difference (WMD) = − 0.41, 95% confidence interval (CI) − 0.63 to − 0.19, P = 0.000) and total blood loss for THA patients (WMD = − 45.73, 95% CI − 84.72 to − 6.02, P = 0.024). Moreover, the DAA was associated with an increase in walking velocity (WMD = 5.01, 95% CI 2.32 to 7.70, P = 0.000), stride length (WMD = 3.12, 95% CI 2.42 to 3.82, P = 0.000), and step length (WMD = 4.09, 95% CI 1.03 to 7.14, P = 0.009) compared with the LA group. There was no significant difference between groups in the Harris hip score, operation time, transfusion rate, length of hospital stay, and the occurrence of complications. Conclusion Current evidence demonstrated a trend showing that the DAA had a better effect on pain relief and blood-saving effects for THA patients. However, considering the number and sample size of the included trials, more large-scale RCTs with high quality are needed to confirm our conclusion.
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Affiliation(s)
- Zhao Wang
- Department of Orthopaedics, Jingjiang People's Hospital, 28 No, Zhongzhou Road, Jingjiang, Taizhou City, 214500, Jiangsu Province, China
| | - Hong-Wei Bao
- Department of Orthopaedics, Jingjiang People's Hospital, 28 No, Zhongzhou Road, Jingjiang, Taizhou City, 214500, Jiangsu Province, China
| | - Jing-Zhao Hou
- Department of Orthopaedics, Jingjiang People's Hospital, 28 No, Zhongzhou Road, Jingjiang, Taizhou City, 214500, Jiangsu Province, China.
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Thaler M, Lechner R, Putzer D, Mayr E, Huber DC, Liebensteiner MC, Nogler M. Two-year gait analysis controls of the minimally invasive total hip arthroplasty by the direct anterior approach. Clin Biomech (Bristol, Avon) 2018; 58:34-38. [PMID: 30015203 DOI: 10.1016/j.clinbiomech.2018.06.018] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2017] [Revised: 04/30/2018] [Accepted: 06/25/2018] [Indexed: 02/07/2023]
Abstract
BACKGROUND The purpose of the study was to determine the long-term functional outcome of two hip approaches by gait analysis. Patients were selected by prospective randomization, and operated on either by the anterolateral approach or by a minimally invasive direct anterior approach. METHODS 33 patients (17 anterolateral approach; 16 direct anterior approach) were analyzed using a Vicon 870 system. Gait analysis was performed two years after total hip arthroplasty. Temporo-spatial and kinematic variables were obtained. FINDINGS On chest and pelvic kinematics, no patient group demonstrated significant differences. The time-distance parameters showed significant differences with the anterior approach in cadence and stride time. INTERPRETATION The study indicates that the direct anterior approach exerts positive effects compared with the anterolateral approach two years after surgery. The muscle-sparing concept of direct anterior approach results in significant differences in gait compared to the anterolateral approach 2 years after surgery.
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Affiliation(s)
- Martin Thaler
- Medical University Innsbruck, Department of Orthopedic Surgery, Austria.
| | - Ricarda Lechner
- Medical University Innsbruck, Department of Orthopedic Surgery, Austria
| | - David Putzer
- Medical University Innsbruck, Department of Orthopedic Surgery, Experimental Orthopedics, Austria
| | - Eckart Mayr
- Allgemeines Krankenhaus Celle, Department of Orthopedic Surgery, Germany
| | - Dèbora Coraça Huber
- Medical University Innsbruck, Department of Orthopedic Surgery, Experimental Orthopedics, Austria
| | | | - Michael Nogler
- Medical University Innsbruck, Department of Orthopedic Surgery, Experimental Orthopedics, Austria
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