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Schmidt GJ, Dmochowski JM, Gudeman AS, Cage ES, Greenberg JA, Hoyer RW. Primary Repair of Chronic Distal Biceps Tendon Tears. Hand (N Y) 2024; 19:38-43. [PMID: 35815641 PMCID: PMC10786113 DOI: 10.1177/15589447221107691] [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] [Indexed: 02/10/2023]
Abstract
BACKGROUND This study reports the clinical results following primary repair of distal biceps tendon ruptures more 6 weeks after injury. METHODS A retrospective review of distal biceps tendon repairs performed by 8 different hand surgeons from January 1, 2015 to October 15, 2020 was performed. Patients with complete tears surgically treated ≥6 weeks after injury without tendon graft were included. Thirty patients qualified and underwent chart review for complication and range of motion (ROM) data. They were contacted for final patient-reported outcome measures (PROMs) using Quick Disabilities of the Arm, Shoulder, and Hand (QuickDASH) and Patient Reported Elbow Evaluation (PREE) scores. Final PROMs were obtained from 21 patients with an average follow-up of 31.3 months (range: 4-71 months). RESULTS Average time from injury to repair was 71 days (range: 42-204). The average QuickDASH score was 6.6 (±6.2) and PREE score was 7.8 (±8.0). The amount of elbow flexion necessary to complete the repair was documented in 21 patients and averaged 64º (±10º). Postoperatively, patients achieved an average extension/flexion of 1º (±1º) to 138º (±2º) and pronation/supination of 76º (±4º) to 77º (±3º). Complications were reported in 14 patients (47%) and included 2 re-ruptures, 1 adhesive scar formation, 1 superficial infection, 1 intraoperative lateral antebrachial cutaneous nerve laceration, 12 neuropraxias, and 1 case of heterotopic ossification (HO). CONCLUSIONS Primary repair of chronic distal biceps tendon tears greater than 6 weeks from injury demonstrated excellent PROMs and elbow ROM. However, the complication rate may be higher than early repair.
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Bhosale P, Kolke(PT) S. Effectiveness of instrument assisted soft tissue mobilization (IASTM) and muscle energy technique (MET) on post-operative elbow stiffness: a randomized clinical trial. J Man Manip Ther 2023; 31:340-348. [PMID: 36171728 PMCID: PMC10566405 DOI: 10.1080/10669817.2022.2122372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/14/2022] Open
Abstract
BACKGROUND Stiffness is a common complication following trauma and surgeries around the elbow, which can result in upper limb functional disabilities. Soft tissue mobilization techniques such as Instrument-assisted Soft Tissue Mobilization (IASTM) and Muscle Energy Technique (MET) have limited evidence in elbow rehabilitation. This study aimed to compare their effects on postoperative elbow stiffness. METHODOLOGY 26 subjects were recruited (13 each group) with postoperative elbow stiffness (minimum 6 weeks post surgery) and randomly allocated in two groups: IASTM and MET. Pain [Numeric Pain Rating Scale NPRS)], ROM (Goniometer), and Function [Disability of Arm, Shoulder and Hand (DASH) and Patient-Specific Functional Scale (PSFS)] were assessed at baseline and post-intervention. RESULTS The data of 26 subjects were analyzed and both groups significantly improved in outcome scores post-intervention. The improvements in ROM and function between groups were comparable, but NPRS and PSFS showed greater improvement in the IASTM group (p < 0.05). CONCLUSION IASTM and MET were both effective in improving outcomes in postoperative elbow stiffness. IASTM was more effective in improving pain and patient-specific function.
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Affiliation(s)
- Prajakta Bhosale
- Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, India
| | - Sona Kolke(PT)
- Department of Musculoskeletal Physiotherapy, Sancheti Institute College of Physiotherapy, Pune, India
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Wang Y, Jiang M, Dai X, Zhang Q. Determinants of Complex Regional Pain Syndrome Type I among Radial Head Fracture Patients with Unilateral Arthroplasty. Orthop Surg 2022; 14:1395-1403. [PMID: 35673902 PMCID: PMC9251304 DOI: 10.1111/os.13320] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Revised: 05/07/2022] [Accepted: 05/11/2022] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE This study aims to assess the proportions of complex regional pain syndrome type I (CRPS I) in radial head fracture patients undergoing unilateral arthroplasty and to explore associated factors. METHODS This is a prospective observational study. From March 2016 to May 2019, a total of 221 adult patients with radial head fracture patients were included in consecutive studies and completed the 1-year follow-up. All patients were treated by unilateral arthroplasty. At each follow-up visit, the visual analogue scale was used to measure patients' pain level. Occurrence of CRPS I, which was diagnosed by Budapest criteria, was the main outcome collected at baseline and the 1-, 3-, 6-, and 9-month follow-ups. The baseline data were collected before surgery and included demographic and clinical data. Independent t-tests and χ2 tests were used as univariate analyses to compare the baseline data of patients with and without CRPS I. Multivariate analysis (Backword-Wald) was used to identify factors independently associated with CRPS I. RESULTS The proportion of CRPS I cases among radial head fracture patients undergoing unilateral arthroplasty was 11% (n = 24). A total of 19 (79%) patients were diagnosed with CRPS I within 1 month after surgery. Multivariable logistic regression analysis revealed that female gender (odds ratios [OR]: 1.537; 95% confidence interval [CI]: 1.138-2.072), age younger than 60 years (OR: 1.682; 95% CI: 1.246-2.267), moderate and severe Mayo Elbow Performance Score (MEPS) pain (OR: 3.229; 95% CI: 2.392-4.351) and anxiety (OR: 83.346; 95% CI: 61.752-112.320) were independently associated with CRPS I. CONCLUSIONS This exploratory study reported that the incidence of CRPS I developing after radial head arthroplasty was 11%. Female sex, younger age, moderate and severe MEPS pain and anxiety patients seems more likely to develop CRPS I.
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Affiliation(s)
- Ye Wang
- Department of Anesthesiology, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Menglu Jiang
- Department of Anesthesiology, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, China.,Soochow University, Soochow, China
| | - Xu Dai
- Department of Anesthesiology, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, China
| | - Qin Zhang
- Department of Anesthesiology, Wuxi No. 9 People's Hospital Affiliated to Soochow University, Wuxi, China
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Goyal T, Choudhury AK, Paul S, Sethy SS, Singh V, Yadav RK. Outcomes of Continued Intensive Conservative Treatment Versus Arthroscopic Extensor Carpi Radialis Brevis Release for Recalcitrant Lateral Epicondylitis: A Non-randomized Controlled Trial. Indian J Orthop 2022; 56:1578-1586. [PMID: 36052381 PMCID: PMC9385926 DOI: 10.1007/s43465-022-00649-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2021] [Accepted: 04/19/2022] [Indexed: 02/04/2023]
Abstract
INTRODUCTION There is no consensus on treatment of recalcitrant lateral epicondylitis (RLE). This is a prospective, non-randomized, interventional study comparing pain scores and functional outcomes between arthroscopic extensor carpi radialis brevis release and continued intensive conservative treatment. MATERIALS AND METHODS The study compared two groups: Group 1, consisting of 25 patients undergoing continued conservative treatment for 24 months, and Group 2, consisting of 25 patients undergoing arthroscopic extensor carpi radialis brevis release with decortication (ARD). VAS (Visual Analogue Scale) score for lateral elbow pain at rest and after routine daily activities were compared at 6 weeks, 24 weeks, 12 months and 24 months. Functional outcomes were compared with grip strength, and patients reported functional outcome scores, pre-intervention and 24 months post-intervention. RESULTS There was a significant improvement in VAS scores for pain, functional outcome scores, and grip strength in both the groups post-intervention (P < 0.05). VAS scores for pain at rest in both the groups were significantly better after the interventions, at all follow-up durations (P < 0.001). VAS scores for pain after routine daily activities were significantly better in group 2 at 24 weeks (P = 0.002) and afterward (P < 0.001). Group 2 had significantly better functional outcome scores at 24 months (P < 0.001) though the difference in grip strength was not statistically significant (P = 0.121). CONCLUSION The present study shows favourable functional outcomes and pain scores of ARD compared to continued intensive conservative treatment for RLE. LEVEL OF STUDY II, Non-randomized comparative study. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-022-00649-w.
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Affiliation(s)
- Tarun Goyal
- Department of Orthopaedics, All India Institute of Medical Sciences, Bathinda, Punjab 151001 India
| | | | - Souvik Paul
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Siddharth S. Sethy
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Vivek Singh
- Department of Orthopaedics, All India Institute of Medical Sciences, Rishikesh, India
| | - Raj Kumar Yadav
- Department of Physical Medicine and Rehabilitation, All India Institute of Medical Sciences, Rishikesh, India
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Athanaselis ED, Komnos G, Deligeorgis D, Hantes M, Karachalios T, Malizos KN, Varitimidis S. Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome. Strategies Trauma Limb Reconstr 2022; 17:7-13. [PMID: 35734034 PMCID: PMC9166263 DOI: 10.5005/jp-journals-10080-1546] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Purpose This is a retrospective cohort study of type C distal humeral fractures (AO classification system) aimed at evaluating the effectiveness of current operative treatment options. Materials and methods Thirty-seven patients with type C distal humeral fractures, treated operatively from January 2002 to September 2016, were retrospectively studied. Thirty-two were eligible for inclusion. Patients were treated by open reduction using the posterior approach, olecranon osteotomy and parallel-plate two-column internal fixation. Patients were evaluated for fracture healing, functional outcomes and complications (infection, ulnar neuropathy, heterotopic ossification and need for implant removal). Restoration of the normal anatomy was defined by measuring carrying angle, posterior angulation and intercondylar distance of distal humerus. Results The mean follow-up time was 8.7 years [range 2–15.5 years, standard deviation (SD) = 3.96]. Mean time to fracture union was 8 weeks for 29 patients (90.6%) (range, 6–10 weeks). In nine cases, there was malunion of varied importance (28.1%). There was one case with postoperative ulnar neuropathy and one case with deep infection. The mean Disabilities of the Arm, Shoulder and Hand (DASH) score and mean Mayo Elbow Performance Score (MEPS) were 20 (range 0–49) and 83.3 (range 25–100), respectively. Conclusion In complex distal humerus fractures, the posterior approach with olecranon osteotomy and parallel plating of two columns, after anatomic reconstruction of the articular segment, is a prerequisite for successful elbow function. How to cite this article Athanaselis ED, Komnos G, Deligeorgis D, et al. Double Plating in Type C Distal Humerus Fractures: Current Treatment Options and Factors that Affect the Outcome. Strategies Trauma Limb Reconstr 2022;17(1):7–13.
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Affiliation(s)
- Efstratios D Athanaselis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Georgios Komnos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Dimitrios Deligeorgis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Michael Hantes
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Theofilos Karachalios
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Konstantinos N Malizos
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
| | - Sokratis Varitimidis
- Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece
- Sokratis Varitimidis, Department of Orthopaedic Surgery and Musculoskeletal Trauma, University Hospital of Larissa, Larissa, Greece, e-mail:
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David SL, Farnsworth JL, Theige M. Content Validity of the Disability of the Arm, Shoulder, and Hand Questionnaire in a College-Age Patient Population. JSES Int 2022; 6:512-517. [PMID: 35572428 PMCID: PMC9091923 DOI: 10.1016/j.jseint.2022.01.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Objective The Disability of the Arm, Shoulder, and Hand questionnaire (DASH) is a region-specific Patient Reported Outcome Measure and has been found to be valid and reliable. However, it has not been evaluated in a young patient population. Our objective was to understand how often the uninjured ‘collegiate’ population completes the specific tasks on the DASH. Design A questionnaire-based survey. Methods A total of 256 participants (age: 19.44 ± 1.83) completed the study. Participants were asked to track how often they completed 21 tasks taken from the DASH over a 14-day period. Data were analyzed using descriptive statistics and A Rasch partial-credit model. Results The 3 most commonly completed tasks are Recreational Activities in which you take some force or impact through your arm, shoulder, or hand (e.g., golf, hammering, tennis, etc.), Wash or blow-dry your hair, and Put on a pullover sweater while the least most commonly completed tasks were garden or do yard work, change a light bulb overhead, and sexual activities. Infit statistics ranged from .94 to 1.12, and Outfit ranged from .27 to 1.33. Person and item separation indices were 0.40 and 5.24, respectively. Person and item reliability indices were 0.14 and 0.96, respectively. Conclusions Findings from this study suggest that clinicians should be cautious when using the DASH with the ‘college aged’ patient population.
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Vincent JI, MacDermid JC, King GJW, Grewal R. The Patient-Rated Elbow Evaluation and the American Shoulder and Elbow Surgeons-Elbow form capture aspects of functioning that are important to patients with elbow injuries. J Hand Ther 2021; 34:415-422. [PMID: 32327289 DOI: 10.1016/j.jht.2020.02.001] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/08/2019] [Revised: 01/20/2020] [Accepted: 02/04/2020] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a cross-sectional study. INTRODUCTION The Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder Elbow Surgeons-elbow form (pASES-e) are two important elbow-specific self-report measures used in routine clinical practice. PURPOSE OF THE STUDY To use the International Classification of Functioning Disability and Health (ICF) to link aspects of functioning that are reported using the Patient-Specific Functional Scale by a cohort of patients with elbow disorders and compare it to the content of the PREE and the pASES-e. METHODS One hundred patients with a variety of elbow disorders (mean age and SD 53.88 (14.51); M: F 48: 52) were recruited from the Roth-McFarlane Hand and Upper Limb Centre. They self-reported important aspects of functioning using the Patient-Specific Functional Scale. These concerns were linked to the ICF using formal linking procedures. These ICF categories were compared to the categories related to the PREE and the pASES-e. Linking was carried out by two independent raters, and agreement was calculated using percentage agreement. RESULTS A total of 423 self-reported functional activities were linked to 25 second-level ICF categories from the activity and participation domain. Commonly reported activities were D640 doing housework (52%); D540 dressing (47%); and D475 driving (35%). PREE had better coverage of the patient concerns (71%) than pASES-e (50%). D475-driving (35%) and D440-fine hand use (24%) were the 2 major categories that were not captured by the questionnaires. Agreement between the raters was 90.5%. DISCUSSION This study established that the PREE and the pASES-e were able to capture aspects of functioning important to patients and that align with the ICF, with this happening to a greater extent on the PREE than the pASES-e. Because all patients reported concerns from the activity and participation section ('d' categories) of the ICF, this validated that these PROMs measure this conceptual domain. CONCLUSION The PREE provided more comprehensive coverage of patients' functional concerns than the pASES-e.
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Affiliation(s)
- Joshua I Vincent
- School of Physical Therapy, Western University, London, ON, Canada; Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada.
| | - Joy C MacDermid
- School of Physical Therapy, Western University, London, ON, Canada; Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, University of Western Ontario, London, ON, Canada
| | - Graham J W King
- Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada
| | - Ruby Grewal
- Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, ON, Canada; Department of Surgery, Western University, London, ON, Canada
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Patel MS, Kirsch JM, Gutman MJ, McEntee RM, Alberta F, Ramsey ML, Abboud JA, Namdari S. Single Assessment Numeric Evaluation Correlates with American Shoulder and Elbow Surgeons Score for Common Elbow Pathology: A Retrospective Cohort Study. Am J Sports Med 2021; 49:2771-2777. [PMID: 34170754 DOI: 10.1177/03635465211024253] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND There are currently a variety of patient-reported outcomes (PROs) for elbow pathology, without any established gold standard. The Single Assessment Numeric Evaluation (SANE) is a single question assessment of the patient's perceived overall function compared with normal. The SANE score has been correlated with PROs from the shoulder and knee literature. PURPOSE To correlate the SANE score for a variety of elbow pathologies with a traditionally reported elbow outcome measure, the American Shoulder and Elbow Surgeons-Elbow score (ASES-E). STUDY DESIGN Cohort study (diagnosis); Level of evidence, 3. METHODS A retrospective review was performed of all patients identified at a single center between April 2016 and January 2019 who presented as a new patient with elbow pathology. All patients prospectively completed the ASES-E along with the SANE score for elbow (SANE-E) at the time of initial consultation. Spearman correlations (r) were performed to evaluate the correlation between the ASES-E and the SANE-E score for specific elbow pathology, along with descriptive data such as age, sex, and chronicity of the problem. RESULTS A total of 555 patients (166 women, 29.9%) with a mean ± SD age of 51.0 ± 11.7 years with the diagnoses of medial epicondylitis (n = 72; 13.0%), lateral epicondylitis (n = 224; 40.4%), biceps tendon rupture (n = 139; 25.0%), triceps tendon rupture (n = 21; 3.8%), and elbow arthritis (n = 99; 17.8%) were included in this analysis. There was moderate correlation between the SANE-E and the ASES-E (r = 0.623; P < .001), with strongest correlation with the visual analog scale (VAS) (r = -0.518; P < .001) compared with any individual question and moderate to strong correlations based on specific diagnoses. SANE-E and ASES-E scores for the entire cohort were 42.9 ± 26.7 and 56.9 ± 21.4, respectively (P < .001). Age (r = 0.027; P = .526), sex (r = 0.026; P = .555), VAS (r = -0.106; P = .013), and chronicity of the problem (r = -0.037; P = .384) were not found to be correlated with differences in ASES-E and SANE-E. CONCLUSION The SANE-E score is a simple way to assess patient-perceived function relative to normal. The findings of this study demonstrated moderate to strong correlation between the ASES-E and the SANE-E score for a variety of commonly encountered elbow conditions.
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Affiliation(s)
| | - Jacob M Kirsch
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | | | | | - Frank Alberta
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | | | - Joseph A Abboud
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
| | - Surena Namdari
- Rothman Orthopaedic Institute, Philadelphia, Pennsylvania, USA
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Gouveia K, Zhang K, Kay J, Memon M, Simunovic N, Garrigues GE, Pollock JW, Ayeni OR. The Use of Elbow Arthroscopy for Management of the Pediatric Elbow: A Systematic Review of Indications and Outcomes. Arthroscopy 2021; 37:1958-1970.e1. [PMID: 33539972 DOI: 10.1016/j.arthro.2021.01.047] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2020] [Revised: 01/08/2021] [Accepted: 01/12/2021] [Indexed: 02/08/2023]
Abstract
PURPOSE The purpose of this review was to systematically examine the literature surrounding elbow arthroscopy for pediatric patients and to assess indications, functional outcomes, and complication rates. METHODS This systematic review was carried out in accordance with PRISMA guidelines. EMBASE, PubMed, and MEDLINE were searched for relevant literature from inception until December 2019, and studies were screened by 2 reviewers independently and in duplicate for those investigating elbow arthroscopy in a pediatric population (<18 years). Editorials, review articles, and case reports were excluded. Demographic data and data on surgical indications, treatment outcomes, and complications were recorded. A methodological quality assessment was performed for all included studies using the Methodological Index for Non-Randomized Studies. RESULTS Overall, 19 studies, all of level IV evidence, were identified with a total of 492 patients (513 elbows). The patient population was 22.3% female with a mean age of 14.0 years (range, 4.0-15.7) and a mean follow-up time of 33.0 months (range, 7.4-96 months). Twelve studies (263 patients) exclusively recruited patients with osteochondritis dissecans (OCD), although other indications for elbow arthroscopy included arthrofibrosis (50 patients), elbow fracture (37 patients), medial ulnar collateral ligament injury (31 patients), and posterior impingement (17 patients). All 13 reporting studies showed a significant improvement in the elbow flexion-extension arc, and 4 of 5 that reported a functional outcome score before and after surgery demonstrating a significant improvement. Last, the overall complication rates ranged from 0% to 23.8%, with a total of 8 instances of neurological injury (5 ulnar, 2 radial, 1 unspecified), all being transient and resolving within 3 to 6 months. CONCLUSION Although elbow arthroscopy is primarily being performed for OCD in children and adolescents, there is evidence surrounding several other potential indications. Case series published to date have demonstrated significant improvements in functional outcomes and low rates of major complications. LEVEL OF EVIDENCE Level IV, systematic review of level IV studies.
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Affiliation(s)
- Kyle Gouveia
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Kailai Zhang
- Department of Physical Medicine and Rehabilitation, McMaster University, Hamilton, Ontario, Canada
| | - Jeffrey Kay
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Muzammil Memon
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Nicole Simunovic
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada
| | - Grant E Garrigues
- Midwest Orthopaedics at Rush, Rush University Medical Center, Chicago, Illinois, U.S.A
| | - J W Pollock
- Division of Orthopaedic Surgery, Department of Surgery, University of Ottawa, Ottawa, Ontario, Canada
| | - Olufemi R Ayeni
- Division of Orthopaedic Surgery, Department of Surgery, McMaster University, Hamilton, Ontario, Canada.
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Kröger I, Nerz C, Schwickert L, Schölch S, Müßig JA, Studier-Fischer S, Nolte PC, Becker C, Augat P. Robot-assisted training after proximal humeral fracture: A randomised controlled multicentre intervention trial. Clin Rehabil 2020; 35:242-252. [PMID: 33016132 DOI: 10.1177/0269215520961654] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To examine whether robotic-assisted training as a supplement to usual therapy is safe, acceptable and improves function and patient reported outcome after proximal humeral fractures (PHF). DESIGN Multicentre, assessor-blinded, randomised controlled prospective trial. SETTING Three different rehabilitation hospitals in Germany. SUBJECTS In total 928 PHF patients between 35 and 70 years were screened. Forty-eight participants were included in the study (intervention group n = 23; control group n = 25). INTERVENTION The control group received usual occupational and physiotherapy over three weeks, and the intervention group received additional 12 robot-assisted training sessions at the ARMEO®-Spring. MAIN MEASURES Disabilities of the Arm, Shoulder and Hand Questionnaire (DASH), the Wolf Motor Function Test-Orthopaedic, active range of motion and grip strength were determined before and after intervention period. The DASH was additionally obtained postal 6 and 13 months following surgery. RESULTS The mean age of participants was 55 ± 10 years and was similar in both groups (p > 0.05). The change in DASH as the primary endpoint in the intervention group after intervention was -15 (CI = 8-22), at follow-up six month -7 (CI = -2 to 16) at follow up 13 month -9 (CI = 1-16); in control group -14 (CI = 11-18), at follow-up six month -13 (CI = 7-19) at follow up 13 month -6 (CI = -3 to 14). No difference in the change was found between groups (p > 0.05). None of the follow-up time points demonstrated an additional benefit of the robotic therapy. CONCLUSION The additional robot-assisted therapy was safe, acceptable but showed no improvement in functional shoulder outcome compared to usual therapy only.
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Affiliation(s)
- Inga Kröger
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Corinna Nerz
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Lars Schwickert
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Sabine Schölch
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Janina Anna Müßig
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Stefan Studier-Fischer
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Philip-Christian Nolte
- Department of Trauma and Orthopaedic Surgery, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Germany
| | - Clemens Becker
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Stuttgart, Germany
| | - Peter Augat
- Institute for Biomechanics, Berufsgenossenschaftliche Unfallklinik Murnau, Murnau, Germany.,Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
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11
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The Association Between Conditioned Pain Modulation and Manipulation-induced Analgesia in People With Lateral Epicondylalgia. Clin J Pain 2020; 35:435-442. [PMID: 30801339 PMCID: PMC6467555 DOI: 10.1097/ajp.0000000000000696] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Conditioned pain modulation (CPM) and manipulation-induced analgesia (MIA) may activate similar neurophysiological mechanisms to mediate their analgesic effects. This study assessed the association between CPM and MIA responses in people with lateral epicondylalgia. MATERIALS AND METHODS Seventy participants with lateral epicondylalgia were assessed for CPM followed by MIA. A single assessor measured pressure pain thresholds (PPT) before, during, and after cold water immersion (10°C) of the asymptomatic hand and contralateral lateral glide (CLG) mobilization of the neck. For analyses, linear mixed models evaluated differences in CPM and MIA responses. Pearson partial correlations and regression analyses evaluated the association between CPM and MIA PPT. RESULTS There was a significant increase (CPM and MIA, P<0.001) in PPT from baseline during the interventions (CPM mean: 195.84 kPa for elbow and 201.87 kPa for wrist, MIA mean: 123.01 kPa for elbow and 126.06 kPa for wrist) and after the interventions (CPM mean: 126.06 kPa for elbow, 114.24 kPa for wrist, MIA mean: 123.50 kPa for elbow and 122.16 kPa for wrist). There were also significant moderate and positive partial linear correlations (r: 0.40 to 0.54, P<0.001) between CPM and MIA measures, controlling for baseline measures. Regression analyses showed that CPM PPT was a significant predictor of MIA PPT (P<0.001) and the models explained between 73% and 85% of the variance in MIA PPT. DISCUSSION This study showed that CPM and MIA responses were significantly correlated and that the CPM response was a significant predictor of MIA response.
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The Influence of a Positive Empathetic Interaction on Conditioned Pain Modulation and Manipulation-induced Analgesia in People With Lateral Epicondylalgia. Clin J Pain 2020; 36:411-419. [PMID: 32079999 DOI: 10.1097/ajp.0000000000000822] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Conditioned pain modulation (CPM) and manipulation-induced analgesia (MIA) are 2 forms of endogenous analgesia. Many forms of analgesia can be influenced by the nature of the patient-clinician interaction. The aim of this study was to evaluate the influence of an empathetic and supportive interaction on CPM and MIA in people with lateral epicondylalgia (LE). MATERIAL AND METHODS In a double-blind, randomized, controlled trial, 68 participants with LE were assigned to 2 groups: the empathetic and neutral interaction groups. The interactions were carried out by a trained, professional role-play actor, playing the part of a research assistant. The research assistant actor spent 15 minutes before CPM and MIA assessment interacting with the participants in an empathetic or neutral manner. Immediately after the interaction, a blinded assessor measured pressure pain threshold at the symptomatic elbow and ipsilateral wrist during CPM and MIA testing. Linear mixed models were used to evaluate differences in CPM and MIA responses between the interaction groups. RESULTS There was a significant difference in Consultation and Relational Empathy scores between the groups (P<0.001), indicating that the intervention group experienced a more empathic interaction. Both groups showed a significant increase in pressure pain threshold measures, indicative of a CPM and MIA analgesic response (P<0.001), however, the analgesic responses were greater in the group that had experienced a supportive, empathetic interaction (post CPM, wrist: P<0.001; elbow: P=0.001) (post MIA wrist: P<0.001; elbow: P=0.001). DISCUSSION A single session of empathetic interaction positively influenced both CPM and MIA responses in people with LE.
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Vincent JI, MacDermid JC, King GJW, Grewal R, Lalone E. Establishing the psychometric properties of 2 self-reported outcome measures of elbow pain and function: A systematic review. J Hand Ther 2020; 32:222-232. [PMID: 30587433 DOI: 10.1016/j.jht.2018.07.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 07/15/2018] [Accepted: 07/20/2018] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Systematic review. INTRODUCTION The Patient-Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder and Elbow Surgeons-elbow form (pASES-e) are 2 patient-reported outcome measures (PROMs) commonly used to assess pain and disability arising from elbow disorders. PURPOSE OF THE STUDY To systematically review and summarize the quality and content of the evidence that is available on the psychometric properties of the PREE and pASES-e. METHODS We systematically searched the online databases PubMed, EMBASE, ProQuest, Scopus, Cumulative Index to Nursing and Allied Health Literature, UptoDate, ProQuest Dissertations & Theses, and Google Scholar. Ninety-one articles were retrieved, and after screening, 9 were included in the final analysis. Data extraction and quality appraisal was performed by 2 independent raters. Descriptive synthesis of the reviewed studies was completed. RESULTS Seven of the 9 studies had a quality score of 75% or higher. Agreement between the raters was good (kappa, 0.81). Both the PROMs did not demonstrate any floor and ceiling effects except for the satisfaction subscale of the pASES-e. Factor analysis revealed multidimensionality in the function subscale for both the PROMs. Construct validity was good with correlations above 0.70. Both were highly reliable with interclass correlation coefficient of >0.90. They were also highly responsive with an effect size and standardized response mean above 1. The minimal clinical important difference was not estimated for either measures. DISCUSSION This study concluded that strong clinical measurement properties exist for both the PREE and the pASES-e. We identified gaps in the current evidence for both the ASES-e and the PREE. Future studies need to calculate clinically important estimates like MCID, SEM, and others; and provide clear and specific conclusions. CONCLUSION The PREE and pASES-e have been established to be valid, reliable, and sensitive to change in both clinical and research settings based on high-quality evidence.
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Affiliation(s)
- Joshua I Vincent
- School of Rehabilitation Sciences, McMaster University, Hamilton, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada; Lifemark Health Corp., Toronto, Ontario, Canada.
| | - Joy C MacDermid
- University of Western Ontario, School of Physical Therapy, London, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Centre, St. Joseph's Hospital, London, Ontario, Canada
| | - Graham J W King
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada
| | - Ruby Grewal
- Department of Surgery, University of Western Ontario, London, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada
| | - Emily Lalone
- Faculty of Engineering, University of Western Ontario, London, Ontario, Canada
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Hazar Kanik Z, Pala OO, Karabicak GO, Citaker S. Cross-cultural adaptation, validity, and reliability of the Turkish version of the Patient-Rated Elbow Evaluation. Clin Rheumatol 2019; 38:3289-3295. [PMID: 31280380 DOI: 10.1007/s10067-019-04665-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 06/21/2019] [Accepted: 06/25/2019] [Indexed: 11/27/2022]
Abstract
INTRODUCTION The Patient-Rated Elbow Evaluation (PREE) is a joint-specific, self-administered outcome measure used to determine the level of pain and disability in patients with various elbow pathologies. The aim of this study was to cross-culturally adapt the PREE into Turkish (PREE-T) and to test its reliability and validity. METHODS Fifty-nine patients with elbow disorders were included in the present study. The original version of the PREE was translated and culturally adapted into Turkish by following standard procedure. Test-retest reliability and internal consistency were determined using intraclass correlation coefficient and Cronbach's alpha, respectively. Construct validity of PREE-T was determined with Disabilities of the Arm, Shoulder, and Hand (DASH) and Short Form-36 (SF-36) questionnaires by using Pearson's correlation coefficient analysis. Floor and ceiling effects were also analyzed. RESULTS A high internal consistency (Cronbach's alpha of 0.959) and an excellent test-retest reliability (the intraclass correlation coefficient of 0.970) indicated that the PREE-T was reliable. Neither floor nor ceiling effects were observed in sub-parameters (0-1.7%) and the total score (0%) of PREE-T. Correlation coefficients between the PREE-T total score and DASH disability/symptom and work sub-parameters were 0.636 and 0.461, respectively. PREE-T pain and function sub-parameters correlated with related sub-parameters of the SF-36 bodily pain (r = - 0.721) and physical functioning (r = - 0.263). CONCLUSION The Turkish version of the PREE is a valid and reliable outcome measure for assessing patients with elbow disorders. It is recommended to be used in research and clinical settings. Key Points • The Turkish version of the Patient-Rated Elbow Evaluation was successfully translated into Turkish and validated in a population with various elbow pathologies according to established guidelines • The Turkish version of the Patient-Rated Elbow Evaluation has high internal consistency and test-retest values • The Turkish version of the Patient-Rated Elbow Evaluation is valid and reliable.
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Affiliation(s)
- Zeynep Hazar Kanik
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Emniyet Mahallesi, Muammer Yasar Bostanci Cad. No:16 Besevler, 06500, Ankara, Turkey. .,Department of Neurobiology, Harvard Medical School, Boston, MA, USA.
| | - Omer Osman Pala
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Sivas Cumhuriyet University, Sivas, Turkey
| | - Gul Oznur Karabicak
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Adnan Menderes University, Aydin, Turkey
| | - Seyit Citaker
- Department of Physiotherapy and Rehabilitation, Faculty of Health Sciences, Gazi University, Ankara, Turkey
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Nerz C, Schwickert L, Schölch S, Gordt K, Nolte PC, Kröger I, Augat P, Becker C. Inter-rater reliability, sensitivity to change and responsiveness of the orthopaedic Wolf-Motor-Function-Test as functional capacity measure before and after rehabilitation in patients with proximal humeral fractures. BMC Musculoskelet Disord 2019; 20:315. [PMID: 31279331 PMCID: PMC6612085 DOI: 10.1186/s12891-019-2691-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 06/25/2019] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND The incidence of proximal humeral fractures (PHF) increased by more than 30% over the last decade, which is accompanied by an increased number of operations. However, the evidence on operative vs. non-operative treatment and post-operative treatments is limited and mostly based on expert opinion. It is mandatory to objectively assess functional capacity to compare different treatments. Clinical tools should be valid, reliable and sensitive to change assessing functional capacity after PHFs. This study aimed to analyse inter-rater reliability of the videotaped Wolf-Motor-Function-Test-Orthopaedic (WMFT-O) and the association between the clinical WMFT-O and the Disability of the Arm, Shoulder and Hand (DASH) and to determine the sensitivity to change of the WMFT-O and the DASH to measure functional capacity before and after rehabilitation in PHF patients. METHODS Fifty-six patients (61.7 ± 14.7 years) after surgical treatment of PHF were assessed using the WMFT-O at two different time points. To determine inter-rater reliability, the videotaped WMFT-O was evaluated through three blinded raters. Inter-rater agreement was determined by Fleiss' Kappa statistics. Pearson correlation coefficients were calculated to assess the association between the clinical WMFT-O and the video rating as well as the DASH. Sensitivity to change and responsiveness were analysed for the WMFT-O and the DASH in a subsample of forty patients (53.8 ± 1.4 years) who were assessed before and after a three week robotic-assisted training intervention. RESULTS Inter-rater agreement was indicated by Fleiss' Kappa values ranging from 0.33-0.66 for functional capacity and from 0.27-0.54 for quality of movement. The correlation between the clinical WMFT-O and the video rating was higher than 0.77. The correlation between the clinical WMFT-O and the DASH was weak. Sensitivity to change was high for the WMFT-O and the DASH and responsiveness was given. In comparison to the DASH, the sensitivity to change of the WMFT-O was higher. CONCLUSION The overall results indicate that the WMFT-O is a reliable, sensitive and responsive instrument to measure more objectively functional change over time in rehabilitation after PHF. Furthermore, it has been shown that video assessment is eligible for studies to ensure a full blinding of raters. TRIAL REGISTRATION Clinicaltrials.gov, NCT03100201 . Registered on 28 March 2017. The trial was retrospectively registered.
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Affiliation(s)
- Corinna Nerz
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany.
| | - Lars Schwickert
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Sabine Schölch
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
| | - Katharina Gordt
- Network Aging Research (NAR), Heidelberg University, Heidelberg, Germany
| | - Philip-Christian Nolte
- Department of Trauma and Orthopaedic Surgery, BG Trauma Centre Ludwigshafen, Ludwigshafen, Germany
| | - Inga Kröger
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
| | - Peter Augat
- Institute for Biomechanics, BG Unfallklinik Murnau, Murnau, Germany
- Institute for Biomechanics, Paracelsus Medical University, Salzburg, Austria
| | - Clemens Becker
- Department for Clinical Gerontology, Robert-Bosch-Hospital, Auerbachstr. 110, 70376, Stuttgart, Germany
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Psychometric Properties of the Dance Functional Outcome Survey (DFOS): Reliability, Validity, and Responsiveness. J Orthop Sports Phys Ther 2019; 49:64-79. [PMID: 30053790 DOI: 10.2519/jospt.2019.8247] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
BACKGROUND There are no outcomes measures that focus on the unique functional requirements of dancers. OBJECTIVES To evaluate test-retest reliability, internal consistency, construct validity, sensitivity, and responsiveness of the Dance Functional Outcome Survey (DFOS) in professional and preprofessional adult dancers. METHODS This prospective cohort study examined test-retest reliability of the DFOS in 198 healthy and injured dancers over 2 weeks, using intraclass correlation coefficients (ICC2,1). In a sample of 725 healthy and injured dancers, the following were examined: (1) construct validity, by comparing the DFOS to the Medical Outcomes Study 36-Item Short-Form Health Survey (SF-36) using Pearson correlations; (2) exploratory factor analysis and internal consistency; and (3) sensitivity, by generating receiver operating characteristic curves and determining area under the curve (AUC). In a subgroup of 47 injured dancers, we determined internal responsiveness across 4 time points using repeated-measures analysis of variance (P<.05). Injured dancers' scores were analyzed for floor and ceiling effects. RESULTS The DFOS demonstrated high test-retest reliability (ICC≥0.93). Single-factor loading in exploratory factor analysis supported unidimensionality of the scale, with high internal consistency (α = .96). The DFOS total score and activities-of-daily-living (ADL) and dance technique subscores had strong construct validity compared with scores on the SF-36 physical component summary (r≥0.77). This study found excellent sensitivity, with high AUC values (AUC≥0.91). There were significant differences across time for DFOS scores (P<.001), demonstrating responsiveness to change. There were no floor or ceiling effects. CONCLUSION The DFOS demonstrates acceptable psychometric performance as an outcome and screening measure for dancers. The DFOS is a useful tool to monitor both healthy state and functional limitation following lower extremity or low back injury in adult ballet and modern dancers. J Orthop Sports Phys Ther 2019;49(2):64-79. Epub 27 Jul 2018. doi: 10.2519/jospt.2019.8247.
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Faqih AI, Bedekar N, Shyam A, Sancheti P. Effects of muscle energy technique on pain, range of motion and function in patients with post-surgical elbow stiffness: A randomized controlled trial. Hong Kong Physiother J 2018; 39:25-33. [PMID: 31156315 PMCID: PMC6467834 DOI: 10.1142/s1013702519500033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Accepted: 11/13/2017] [Indexed: 11/21/2022] Open
Abstract
Background: Elbow is a very functional joint. Elbow stiffness is a significant cause of disability hampering the function of the upper extremity as a whole. Muscle Energy Techniques (METs) are relatively pain-free techniques used in clinical practice for restricted range of motion (ROM). Objective: To study the effects of MET on pain, ROM and function given early in the rehabilitation in post-surgical elbow stiffness. Methods: An RCT was conducted on 30 patients post elbow fracture fixation. Group 1 was given MET immediately post removal of immobilization while Group 2 received MET 1 week later along with the rehabilitation protocol. Pain (Visual Analogue Scale), ROM (goniometry) and function (Disability of Arm, Shoulder and Hand questionnaire) were assessed pre and post 3 weeks. Results: Group 1 showed greater improvement than Group 2, mean flexion and extension change between groups being 11.7±2.8, 95%CI(5.9,17.4) and 8.5±2.0, 95%CI(4.4,12.7), respectively. VAS and DASH scores improved better in Group 1, mean change being 1.2±0.2, 95%CI(0.6,1.8) and 18.2±2.2, 95%CI(13.5,22.8) for VAS and DASH scores, respectively. Conclusion: MET can be used as an adjunct to the rehabilitation protocol to treat elbow stiffness and can be given safely in the early stages of post elbow fracture rehabilitation managed surgically with open reduction and rigid internal fixation.
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Affiliation(s)
- Anood I Faqih
- Sancheti Institute College of Physiotherapy Shivajinagar, Pune, India
| | - Nilima Bedekar
- Department of Musculoskeletal Physiotherapy Sancheti Institute College of Physiotherapy Shivajinagar, Pune, India
| | - Ashok Shyam
- Department of Academic Research Sancheti Institute for Orthopaedics and Rehabilitation Pune, India
| | - Parag Sancheti
- Sancheti Institute for Orthopaedics and Rehabilitation Pune, India
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Abstract
Patient-reported outcome measures (PROMs) are objective metrics critical to evaluating outcomes throughout orthopedic surgery. New instruments continue to emerge, increasing the breadth of information required for those intending to use these measures for research or clinical care. Although earlier metrics were developed using the principles of classic test theory, newer instruments constructed using item response theory are amenable to computer-adaptive testing and may change the way these instruments are administered. This article aims to define the psychometric properties that are important to understand when using all PROMs and to review the most widely used instruments in sports medicine.
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Affiliation(s)
- Joseph J Ruzbarsky
- Department of Sports Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Niv Marom
- Department of Sports Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA
| | - Robert G Marx
- Department of Sports Medicine, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA.
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Evans JP, Smith CD, Fine NF, Porter I, Gangannagaripalli J, Goodwin VA, Valderas JM. Clinical rating systems in elbow research-a systematic review exploring trends and distributions of use. J Shoulder Elbow Surg 2018; 27:e98-e106. [PMID: 29444754 DOI: 10.1016/j.jse.2017.12.027] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2017] [Revised: 12/21/2017] [Accepted: 12/26/2017] [Indexed: 02/01/2023]
Abstract
BACKGROUND Clinical rating systems are used as outcome measures in clinical trials and attempt to gauge the patient's view of his or her own health. The choice of clinical rating system should be supported by its performance against established quality standards. METHODS A search strategy was developed to identify all studies that reported the use of clinical rating systems in the elbow literature. The strategy was run from inception in Medline Embase and CINHAL. Data extraction identified the date of publication, country of data collection, pathology assessed, and the outcome measure used. RESULTS We identified 980 studies that reported clinical rating system use. Seventy-two separate rating systems were identified. Forty-one percent of studies used ≥2 separate measures. Overall, 54% of studies used the Mayo Elbow Performance Score (MEPS). For arthroplasty, 82% used MEPS, 17% used Disabilities of Arm, Shoulder and Hand (DASH), and 7% used QuickDASH. For trauma, 66.7% used MEPS, 32% used DASH, and 23% used the Morrey Score. For tendinopathy, 31% used DASH, 23% used Patient-Rated Tennis Elbow Evaluation (PRTEE), and 13% used MEPS. Over time, there was an increased proportional use of the MEPS, DASH, QuickDASH, PRTEE, and the Oxford Elbow Score. CONCLUSIONS This study identified a wide choice and usage of clinical rating systems in the elbow literature. Numerous studies reported measures without a history of either a specific pathology or cross-cultural validation. Interpretability and comparison of outcomes is dependent on the unification of outcome measure choice. This was not demonstrated currently.
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Affiliation(s)
- Jonathan P Evans
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK; Health Services and Policy Research Group, University of Exeter, Exeter, UK; National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK.
| | - Chris D Smith
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Nicola F Fine
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Ian Porter
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
| | | | - Victoria A Goodwin
- National Institute for Health Research (NIHR) Collaboration for Leadership in Applied Health Research and Care (CLAHRC) South West Peninsula, University of Exeter Medical School, Exeter, UK
| | - Jose M Valderas
- Health Services and Policy Research Group, University of Exeter, Exeter, UK
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Effect of Concomitant Elbow Injuries on the Outcomes of Radial Head Arthroplasty: A Cohort Comparison. J Orthop Trauma 2017; 31:e327-e333. [PMID: 28614146 DOI: 10.1097/bot.0000000000000921] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
OBJECTIVES To compare physical impairments and patient-reported outcomes in patients after simple and complex elbow injuries who were treated with radial head arthroplasty. DESIGN Prospective. SETTING Quaternary upper extremity referral hospital. PATIENTS/PARTICIPANTS 148 patients with isolated elbow trauma and no previous injury to the elbow were prospectively enrolled after radial head arthroplasty for an acute unreconstructable fracture. Injury patterns were classified as simple or complex based on the presence or absence of associated elbow fractures and/or dislocation. INTERVENTION Radial head arthroplasty. MAIN OUTCOME MEASUREMENTS Patient-Rated Elbow Evaluation (PREE), Disability of the Arm, Shoulder, and Hand, range of motion (ROM), and Biodex measurements. RESULTS At a minimum 1-year follow-up PREE and Disability of the Arm, Shoulder, and Hand, and ROM and strength values were similar. Forty-four patients evaluated at a mean of 7 years demonstrated no effect of injury pattern on clinical outcomes at any time point. Continued statistical improvements in PREE, supination ROM, and flexion ROM at medium term compared with earlier follow-up were observed. Eight patients required secondary surgery, 2 in the simple injury group and 6 complex injury patients. CONCLUSIONS Concomitant elbow injuries do not affect the longer term outcomes of patients with unreconstructable radial head fractures requiring radial head arthroplasty. Patient outcomes continued to improve beyond 2 years of follow-up. LEVEL OF EVIDENCE Therapeutic Level II. See Instructions for Authors for a complete description of levels of evidence.
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Rasch Model Analysis Gives New Insights Into the Structural Validity of the QuickDASH in Patients With Musculoskeletal Shoulder Pain. J Orthop Sports Phys Ther 2017; 47:664-672. [PMID: 28704620 DOI: 10.2519/jospt.2017.7288] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Study Design Cross-sectional secondary analysis of a prospective cohort study. Background The shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH) is a widely used outcome measure that has been extensively evaluated using classical test theory. Rasch model analysis can identify strengths and weaknesses of rating scales and goes beyond classical test theory approaches. It uses a mathematical model to test the fit between the observed data and expected responses and converts ordinal-level scores into interval-level measurement. Objective To test the structural validity of the QuickDASH using Rasch analysis. Methods A prospective cohort study of 1030 patients with shoulder pain provided baseline data. Rasch analysis was conducted to (1) assess how the QuickDASH fits the Rasch model, (2) identify sources of misfit, and (3) explore potential solutions to these. Results There was evidence of multidimensionality and significant misfit to the Rasch model (χ2 = 331.09, P<.001). Two items had disordered threshold responses with strong floor effects. Response bias was detected in most items for age and sex. Rescoring resulted in ordered thresholds; however, the 11-item scale still did not meet the expectations of the Rasch model. Conclusion Rasch model analysis on the QuickDASH has identified a number of problems that cannot be easily detected using traditional analyses. While revisions to the QuickDASH resulted in better fit, a "shoulder-specific" version is not advocated at present. Caution needs to be exercised when interpreting results of the QuickDASH outcome measure, as it does not meet the criteria for interval-level measurement and shows significant response bias by age and sex. J Orthop Sports Phys Ther 2017;47(9):664-672. Epub 13 Jul 2017. doi:10.2519/jospt.2017.7288.
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Evaluation of the reliability and validity of the Persian version of Patient-Rated Elbow Evaluation questionnaire. Rheumatol Int 2016; 37:743-750. [PMID: 27904948 DOI: 10.1007/s00296-016-3605-1] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2016] [Accepted: 11/08/2016] [Indexed: 10/20/2022]
Abstract
Elbow joint pathologies are highly prevalent in Persian-speaking countries. A reliable low-cost method like an appropriate questionnaire is mandatory for the early diagnosis of elbow joint disorders. Among designed questionnaires, Patient-Rated Elbow Evaluation (PREE) is an accepted commonly used scale evaluating pain and dysfunction of the patients. The aims of the study were to cross-culturally adapt and also to identify the psychometric properties of the Persian PREE. The original version of the PREE was translated and cross-culturally adapted to Persian according to the guidelines by Beaton et al. Seventy-three patients and thirty-nine healthy people were enrolled in the study. Test-retest reliability and internal consistency were evaluated using ICC, Cronbach's alpha, and item-total correlation, respectively. Construct validity was investigated using Disability of Arm, Shoulder, and Hand (DASH) questionnaire and physical component scale of SF-36 (PCS). To determine a cutoff point for discriminating patients from non-patients, receiver operating characteristic curve was plotted. The Persian PREE displayed high internal consistency (Cronbach's alpha = 0.91) and had acceptable ICC values in the subscales and total score (ICC > 0.90). A positive moderate correlation with DASH (r = 0.66, P < 0.001) and a negative moderate correlation with PCS of SF-36 (r = -0.44, P < 0.001) were observed. The cutoff point equal to 13.16 was determined for Persian PREE. The Persian PREE exhibited promising validity and reliability. The findings supported its applicability in clinical situations that were consistent with the original version.
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Szekeres M, MacDermid JC, King GJW, Grewal R. The relationship between the Patient-rated Ulnar Nerve Evaluation and the common impairment measures of grip strength, pinch strength, and sensation. J Hand Ther 2016; 28:39-44; quiz 45. [PMID: 25727009 DOI: 10.1016/j.jht.2014.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Accepted: 10/09/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Prospective cohort study. INTRODUCTION Grip strength, pinch strength, and sensory threshold are common evaluations used on a daily basis. Identifying how these variables relate to function for patients allows these assessments to be used for screening to identify who may benefit from surgical intervention, and provides valuable information about what impairments patients think are important with respect to functional use of their upper extremity. Therapists can use this information to focus rehabilitation programs on the most important impairments. PURPOSE To evaluate the relationship between the Patient-rated Ulnar Nerve Evaluation (PRUNE) and impairment measures of grip strength, pinch strength, and one-point sensory threshold. METHODS Data was prospectively collected from 77 patients before surgery and during regular time points for 2 years following surgery. Patients completed the PRUNE, grip and pinch strength measures, and a one-point sensory threshold evaluation. Correlations between these variables were calculated at baseline, 2 years after surgery, and for change scores during the 2-year follow up. A multiple regression analysis was used to determine the contribution of the impairment variables for determining functional change. RESULTS Grip strength showed moderate, statistically significant correlation with PRUNE scores at both baseline (r = -0.38) and at two years (r = -0.29). There was also a statistically significant correlation between one point sensory threshold for the small finger at two years (r = 0.36), but not at baseline. Change in grip strength (r = -0.28) and pinch strength (r = -0.30) both demonstrated significant correlations with PRUNE change scores. Overall, changes in grip strength, pinch strength, and sensation accounted for 20% of the variance in PRUNE changes. CONCLUSION Since grip strength was most highly correlated with PRUNE scores at baseline and at two years, rehabilitation programs that target grip strengthening is supported. While neither grip nor pinch strength were significant contributors to the regression when used together, each showed significant contributions to PRUNE variability when used in the model independently. Therefore, a combination of grip and pinch strengthening may be important during rehabilitation for improving functional results in patients that undergo surgical intervention for cubital tunnel syndrome. LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Mike Szekeres
- Health and Rehabilitation Sciences, Western University, London, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; The Roth McFarlane Hand and Upper Limb Centre, London, Ontario, Canada
| | - Graham J W King
- The Roth McFarlane Hand and Upper Limb Centre, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
| | - Ruby Grewal
- The Roth McFarlane Hand and Upper Limb Centre, London, Ontario, Canada; Department of Surgery, Western University, London, Ontario, Canada
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Linking of the Patient Rated Elbow Evaluation (PREE) and the American Shoulder and Elbow Surgeons - Elbow questionnaire (pASES-e) to the International Classification of Functioning Disability and Health (ICF) and Hand Core Sets. J Hand Ther 2016; 28:61-7; quiz 68. [PMID: 25727010 DOI: 10.1016/j.jht.2014.10.002] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/09/2014] [Revised: 10/01/2014] [Accepted: 10/02/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Content analysis-ICF linking. INTRODUCTION The Patient Rated Elbow Evaluation (PREE) and the self-report section of the American Shoulder and Elbow Surgeons society - Elbow form (ASES-e) are the two commonly used elbow pain and disability self-report measures (PROs). The content of these questions have never been analyzed in light of the International Classification of Functioning Disability and Health (ICF) which is the current standard to describe health and health-related states. PURPOSE The purposes of this study were to analyze the conceptual basis of the PREE and the ASES-e by linking the meaningful concepts in these PROs to the ICF using standardized linking rules and to determine the extent to which the ICF core set for hand conditions cover the content of elbow questionnaires using summary ICF linkage indicators. METHODS Two raters linked the two PROs to the ICF using the linking rules proposed by Cieza and colleagues. Percentage agreement was calculated between the raters. Summary linkage indicators proposed by MacDermid were used to estimate the extent to which the ICF core set for hand conditions cover the content of the elbow questionnaires. RESULTS All the items of the PREE (Measure to ICF linkage - 100%) and all but one item of the pASES-e (Measure to ICF linkage - 95%) were linked to the ICF. The satisfaction item on the ASES-e was not-covered by the ICF. Percentage agreement on linking between the raters was 96% and 95% for the PREE and the pASES-e respectively. The unique linkage of the PREE and the pASES-e to the unique codes on the brief and comprehensive core set were lower than absolute linkage to the core set for hand conditions. The PROs represented less than 20% of the comprehensive core set and more than 70% of the brief core set. While for the unique core set disability representation the 2 PROMs represented 100% brief core set unique disability codes and less than 35% of the comprehensive core set unique disability codes. CONCLUSION The PREE and the ASES-e are aligned with the ICF framework and the core sets for hand conditions. The ICF Core Set devised for hand conditions may also be useful for elbow conditions. LEVEL OF EVIDENCE 1b.
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Rasch analysis of the Patient Rated Elbow Evaluation questionnaire. Health Qual Life Outcomes 2015; 13:84. [PMID: 26092294 PMCID: PMC4482053 DOI: 10.1186/s12955-015-0275-8] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2014] [Accepted: 05/26/2015] [Indexed: 01/22/2023] Open
Abstract
Background The Patient Rated Elbow Evaluation (PREE) was developed as an elbow joint specific measure of pain and disability and validated with classical psychometric methods. More recently, Rasch analysis has contributed new methods for analyzing the clinical measurement properties of self-report outcome measures. The objective of the study was to determine aspects of validity of the PREE using the Rasch model to assess the overall fit of the PREE data, the response scaling, individual item fit, differential item functioning (DIF), local dependency, unidimensionality and person separation index (PSI). Methods A convenience sample of 236 patients (Age range 21–79 years; M: F- 97:139) with elbow disorders were recruited from the Roth│McFarlane Hand and Upper Limb Centre, London, Ontario, Canada. The baseline scores of the PREE were used. Rasch analysis was conducted using RUMM 2030 software on the 3 sub scales of the PREE separately. Results The 3 sub scales showed misfit initially with disordered thresholds on17 out of 20 items), uniform DIF was observed for two items (“Carrying a 10lbs object” from specific activities subscale for age group; and “household work” from the usual activities subscale for gender); multidimensionality and local dependency. The Pain subscale satisfied Rasch expectations when item 2 “Pain – At rest” was split for age group, while the usual activities subscale readily stood up to Rasch requirements when the item 2 “household work” was split for gender. The specific activities subscale demonstrated fit to the Rasch model when sub test analysis accounted for local dependency. All three subscales of the PREE were well targeted and had high reliability (PSI >0.80). Conclusion The three subscales of the PREE appear to be robust when tested against the Rasch model when subject to a few alterations. The value of changing the 0–10 format is questionable given its widespread use; further Rasch-based analysis of whether these findings are stable in other samples is warranted.
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Translation and validation of the PREE (Patient Rated Elbow Evaluation) to a French version. Orthop Traumatol Surg Res 2015; 101:405-9. [PMID: 25936242 DOI: 10.1016/j.otsr.2015.03.012] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2013] [Revised: 03/19/2014] [Accepted: 03/12/2015] [Indexed: 02/02/2023]
Abstract
BACKGROUND Only a few outcome measures specific to elbow pathology and the assessment of their impacts on function are valid and reliable when used in French speaking populations. The English version of the Patient Rated Elbow Evaluation (PREE) was determined to be an optimal candidate for translation. HYPOTHESIS A French version of the PREE (PREE-Fr) will be generated and compared to its original version in terms of reliability and responsiveness. MATERIALS AND METHODS The PREE was translated following the guidelines of the American Academy of Orthopedic Surgeons. Patients with a variety of elbow pathologies completed the French version of the PREE (PREE-Fr), the Quick Disabilities of the Arm, Shoulder and Hand (QuickDASH) and the Mayo Elbow Performance Score (MEPS) on three different occasions. The test-retest reliability of the PREE-Fr was calculated using questionnaires that were filled out with a one-week interval between them. The responsiveness was assessed using questionnaires filled out six months after treatment. RESULTS A French version of the PREE was generated. Data gathered from 54 patients yielded an intra-class correlation coefficient for reliability of 0.89 (CI95%: 0.79-0.94) for the PREE-Fr. For construct validity, using the Pearson correlation coefficient, we obtained excellent correlation between the PREE-Fr and QuickDASH at day one, one week and six months (0.89-0.96) while that between the PREE and MEPS was good to excellent (0.70-0.95). Responsiveness of the PREE-Fr was assessed and yielded a standardized response mean of 1.03, meaning that a large change was recorded between day one and six months. DISCUSSION The PREE-Fr should be considered in French speaking populations for patients with elbow pathology, whether it is for research or evaluation purposes as it is valid, reliable and responsive to change.
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Vincent JI, MacDermid JC, Michlovitz SL, Rafuse R, Wells-Rowsell C, Wong O, Bisbee L. The push-off test: development of a simple, reliable test of upper extremity weight-bearing capability. J Hand Ther 2015; 27:185-90; quiz 191. [PMID: 24794466 DOI: 10.1016/j.jht.2014.03.002] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2013] [Revised: 02/18/2014] [Accepted: 03/01/2014] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Longitudinal clinical measurement study. INTRODUCTION The push-off test (POT) is a novel and simple measure of upper extremity weight-bearing that can be measured with a grip dynamometer. There are no published studies on the validity and reliability of the POT. The relationship between upper extremity self-report activity/participation and impairment measures remain an unexplored realm. PURPOSE The primary purpose of this study is to estimate the intra and inter-rater reliability and construct validity of the POT. The secondary purpose is to estimate the relationship between upper extremity self-report activity/participation questionnaires and impairment measures. METHODS A convenience sample of 22 patients with wrist or elbow injuries were tested for POT, wrist/elbow range of motion (ROM), isometric wrist extension strength (WES) and grip strength; and completed two self-report activity/participation questionnaires: Disability of the Arm, Shoulder and the Hand (DASH) and Work Limitations Questionnaire (WLQ-26). POT's inter and intra-rater reliability and construct validity was tested. Pearson's correlations were run between the impairment measures and self-report questionnaires to look into the relationship amongst them. RESULTS The POT demonstrated high inter-rater reliability (ICC affected = 0.97; 95% C.I. 0.93-0.99; ICC unaffected = 0.85; 95% C.I. 0.68-0.94) and intra-rater reliability (ICC affected = 0.96; 95% C.I. 0.92-0.97; ICC unaffected = 0.92; 95% C.I. 0.85-0.97). The POT was correlated moderately with the DASH (r = -0.47; p = 0.03). While examining the relationship between upper extremity self-reported activity/participation questionnaires and impairment measures the strongest correlation was between the DASH and the POT (r = -0.47; p = 0.03) and none of the correlations with the other physical impairment measures reached significance. At-work disability demonstrated insignificant correlations with physical impairments. CONCLUSION The POT test provides a reliable and easily administered quantitative measure of ability to bear the load through an injured arm. Preliminary evidence supports a moderate relationship between loading bearing measured by the POT and upper extremity function measured by the DASH. LEVEL OF EVIDENCE 1b.
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Affiliation(s)
- Joshua I Vincent
- University of Western Ontario, Health and Rehabilitation Sciences, London, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada.
| | - Joy C MacDermid
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Roth-McFarlane Hand and Upper Limb Center, St. Joseph's Hospital, London, Ontario, Canada
| | - Susan L Michlovitz
- School of Rehabilitation Science, McMaster University, Hamilton, Ontario, Canada; Cayuga Hand Therapy PT, Ithaca, NY, USA
| | - Richard Rafuse
- School of Physiotherapy, University of Western Ontario, London, Ontario, Canada
| | | | - Owen Wong
- School of Physiotherapy, University of Western Ontario, London, Ontario, Canada
| | - Leslie Bisbee
- School of Physiotherapy, University of Western Ontario, London, Ontario, Canada
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Yoon A, King GJW, Grewal R. Is ORIF superior to nonoperative treatment in isolated displaced partial articular fractures of the radial head? Clin Orthop Relat Res 2014; 472:2105-12. [PMID: 24577616 PMCID: PMC4048435 DOI: 10.1007/s11999-014-3541-x] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND While good results have been reported with both nonoperative and operative treatment of isolated displaced partial radial head fractures, there remains considerable disagreement about the role of surgery in the management of these injuries. QUESTIONS/PURPOSES We (1) compared isolated displaced partial articular radial head fractures treated nonoperatively with open reduction internal fixation (ORIF) in terms of validated outcomes scores, ROM, and strength; (2) assessed whether there were any predictor variables for outcomes; and (3) compared complications between groups. METHODS We retrospectively compared patients with isolated partial articular radial head fractures displaced greater than 2 mm but less than 5 mm who received either nonoperative treatment (30 patients) or ORIF (30 patients). We reviewed the nonoperative and ORIF groups at a mean of 3 and 4.5 years, respectively. The nonoperative and ORIF groups were similar except for age (51 ± 17 years versus 39 ± 10 years, respectively) and fracture displacement (2.3 ± 0.3 mm versus 2.8 ± 0.6 mm, respectively). As there were no definitive guidelines on which treatment represented best management, treatment type was decided by the attending surgeon in conjunction with the patient on a case-by-case basis. Patients were evaluated using the Patient-rated Elbow Evaluation (PREE) (primary outcome measure), Mayo Elbow Performance Score (MEPS), QuickDASH, SF-12, clinical examination, and radiographic evaluation (14 and 28 in the nonoperative and ORIF groups, respectively). Elbow ROM was assessed with a goniometer and hand grip strength with calibrated strength testing. We assessed possible predictive variables (age, displacement, energy of injury) for clinical outcome scores and recorded complications. RESULTS PREE scores were not different between groups, but the MEPS favored the nonoperative group (93 versus 86; p = 0.012). ROM and grip strength were similar between groups. Younger age was associated with worse outcome, but displacement and energy were not. More complications occurred in the ORIF group (eight cases of mild heterotopic ossification, two cases of hardware failure) than in the nonoperative group (one case of mild heterotopic ossification, one case of complex regional pain syndrome). CONCLUSIONS No clinical benefit with ORIF could be found compared to nonoperative management of isolated partial articular radial head fractures with displacement of greater than 2 mm but less than 5 mm at short-term followup. A well-designed randomized trial and followup at longer term are required to provide better information about how to treat these common fractures. LEVEL OF EVIDENCE Level III, therapeutic study. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Albert Yoon
- />Department of Orthopaedics, North Shore Hospital, Auckland, New Zealand
| | - Graham J. W. King
- />Roth/McFarlane Hand and Upper Limb Centre, St Joseph’s Health Care London, 268 Grosvenor Street, London, ON N6A4L6 Canada
| | - Ruby Grewal
- />Roth/McFarlane Hand and Upper Limb Centre, St Joseph’s Health Care London, 268 Grosvenor Street, London, ON N6A4L6 Canada
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A literature synthesis indicates very low quality, but consistent evidence of improvements in function after surgical interventions for primary osteoarthritis of the elbow. ARTHRITIS 2013; 2013:487615. [PMID: 23424682 PMCID: PMC3572647 DOI: 10.1155/2013/487615] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 11/29/2012] [Indexed: 11/23/2022]
Abstract
Background. Primary osteoarthritis of the elbow is a debilitating disease with an overall incidence of about 2%. Pain and reduced motion (ROM) lead to disability and loss of functional independence. Purpose. To critically review the literature on patient-related important functional outcomes (pain, ROMs and functional recovery) after surgery for primary OA of the elbow, utilizing the 2011 OCEBM levels of evidence. Design. A literature synthesis. Results. Twenty-six articles satisfied the inclusion and exclusion criteria; 25 of the studies were at level IV evidence, and 1 at level III. All three surgical techniques led to improvement in pain, ROM, and functional recovery in the short- and medium-term follow-up. Long-term follow-up results, available only for open joint debridement, showed recurrence of osteoarthritic signs on X-ray with minimal loss of motion. Recently, there seems to be an increased focus on arthroscopic debridement. Conclusion. The quality of research addressing surgical interventions is very low, including total elbow arthroplasty (TEA). However, the evidence concurs that open and arthroscopic joint debridement can improve function in patients with moderate-to-severe OA of the elbow. TEA is reserved for treating severe joint destruction, mostly for elderly individuals with low physical demands when other intervention options have failed.
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