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Héroux J, Bessette PO, Bédard S, Lamarche D, Gagnon A, Échavé P, Loignon MJ, Patenaude N, Baillargeon JP, D'Aragon F. Functional recovery of wrist surgery with regional versus general anesthesia: a prospective observational study. Can J Anaesth 2024; 71:761-772. [PMID: 37932649 DOI: 10.1007/s12630-023-02615-y] [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: 12/20/2022] [Revised: 05/17/2023] [Accepted: 05/21/2023] [Indexed: 11/08/2023] Open
Abstract
PURPOSE Regional anesthesia may favour postoperative rehabilitation by inhibiting peripheral sensitization and secondary hyperalgesia. The literature on this subject is limited. In the present FUNCTION study, we sought to compare the functional recovery post orthopedic wrist surgery with regional versus general anesthesia. METHODS We conducted a single-centre prospective observational cohort study in adult patients with a distal radial fracture. Functional recovery was assessed with validated psychometrics questionnaires (Quick Disabilities of Arm, Shoulder and Hand [QuickDASH] and Patient-Rated Wrist Evaluation [PRWE]), range of motion, and grip strength. We used a linear mixed regression model to assess the impact of the anesthesia technique on functional recovery. Postoperative pain and patient satisfaction were evaluated using a visual analog scale. RESULTS We recruited 76 patients. At 12 weeks post surgery, there was no difference between the type of anesthesia and functional recovery with the QuickDASH (higher scores worse; regional anesthesia [RA], 22.7 vs general anesthesia [GA], 19.3; adjusted mean difference [aMD], -0.3; 95% confidence interval [CI], -9.6 to 9.0; P = 0.9) and PRWE (higher scores worse; RA group, 21.0 vs GA group, 20.5; aMD, -3.3; 95% CI, -12.1 to 5.6; P = 0.93) questionnaires. Range of motion, satisfaction, and postoperative pain were similar between groups. Right-hand grip strength was higher in the GA group. CONCLUSION Regional anesthesia was not associated with improved functional recovery compared with general anesthesia. The dominance of the operated limb was a confusion factor in all evaluation modalities. Further research taking into account the dominance of the hand is necessary to establish the effects of regional anesthesia on functional recovery. STUDY REGISTRATION ClinicalTrials.gov (NCT04541745); registered 9 September 2020.
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Affiliation(s)
- Jennifer Héroux
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
- Department of Anesthesiology, Faculté de Médecine et des Sciences de la Santé, Université de Sherbrooke, 3001 12e Avenue Nord, Sherbrooke, QC, J1H 5H3, Canada.
| | | | - Sonia Bédard
- Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Daphnée Lamarche
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Anthony Gagnon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pablo Échavé
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Josée Loignon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Patenaude
- Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Patrice Baillargeon
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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Franssen M, Achten J, Appelbe D, Costa ML, Dutton S, Mason J, Gould J, Gray A, Rangan A, Sheehan W, Singh H, Gwilym SE. A protocol for the conduct of a multicentre, prospective, randomized superiority trial of surgical versus non-surgical interventions for humeral shaft fractures. Bone Jt Open 2024; 5:343-349. [PMID: 38643977 PMCID: PMC11033090 DOI: 10.1302/2633-1462.54.bjo-2023-0151.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 04/23/2024] Open
Abstract
Aims Fractures of the humeral shaft represent 3% to 5% of all fractures. The most common treatment for isolated humeral diaphysis fractures in the UK is non-operative using functional bracing, which carries a low risk of complications, but is associated with a longer healing time and a greater risk of nonunion than surgery. There is an increasing trend to surgical treatment, which may lead to quicker functional recovery and lower rates of fracture nonunion than functional bracing. However, surgery carries inherent risk, including infection, bleeding, and nerve damage. The aim of this trial is to evaluate the clinical and cost-effectiveness of functional bracing compared to surgical fixation for the treatment of humeral shaft fractures. Methods The HUmeral SHaft (HUSH) fracture study is a multicentre, prospective randomized superiority trial of surgical versus non-surgical interventions for humeral shaft fractures in adult patients. Participants will be randomized to receive either functional bracing or surgery. With 334 participants, the trial will have 90% power to detect a clinically important difference for the Disabilities of the Arm, Shoulder and Hand questionnaire score, assuming 20% loss to follow-up. Secondary outcomes will include function, pain, quality of life, complications, cost-effectiveness, time off work, and ability to drive. Discussion The results of this trial will provide evidence regarding clinical and cost-effectiveness between surgical and non-surgical treatment of humeral shaft fractures. Ethical approval has been obtained from East of England - Cambridge Central Research Ethics Committee. Publication is anticipated to occur in 2024.
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Affiliation(s)
- Marloes Franssen
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - Juul Achten
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - Duncan Appelbe
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - Matthew L. Costa
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - Susan Dutton
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - James Mason
- Warwick Clinical Trials Unit, Warwick Medical School, University of Warwick, Coventry, UK
| | - Jenny Gould
- Patient and Public Representative, Abingdon, UK
| | - Andrew Gray
- James Cook University Hospital, Middlesbrough, UK
| | - Amar Rangan
- James Cook University Hospital, Middlesbrough, UK
| | - Warren Sheehan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
| | - Harvinder Singh
- University Hospital of Leicester, NHS Foundation Trust, Leicester, UK
| | - Stephen E. Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, UK
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Albahrani YA, Alshami AM. Construct validity, test-retest reliability, and responsiveness of the Arabic version of the upper limb functional index. BMC Musculoskelet Disord 2023; 24:855. [PMID: 37907914 PMCID: PMC10617054 DOI: 10.1186/s12891-023-06969-8] [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: 06/27/2023] [Accepted: 10/15/2023] [Indexed: 11/02/2023] Open
Abstract
BACKGROUND The upper limb functional index (ULFI) is a widely used self-report outcome measure questionnaire with robust psychometric properties to assess the upper limb musculoskeletal disorders (UL-MSDs). This study aimed to investigate the psychometric properties of the Arabic version of ULFI (ULFI-Ar). METHODS In this observational study, 139 patients (87 male, 52 females with mean age of 38.67 ± 13.04 year) with various UL-MSD's, completed the ULFI-Ar, Disability of Arm, Shoulder, and Hand questionnaire (DASH-Arabic), and numeric pain rating scale (NPRS-Arabic). All participants determined the factor structure, and the construct validity. A subgroup of the participants determined test-retest reliability (n = 46) and responsiveness (n = 27). RESULTS The ULFI-Ar construct validity obtained by the expletory factor analysis as one-factor structure, demonstrated an excellent test-retest reliability [intraclass correlation coefficient (ICC2:1) = 0.95], measurement error [standard error of measurement (SEM) = 4.43%; minimal detectable change at 90% confidence interval (MDC90) = 10.34%], medium internal responsiveness [Cohen's d = 0.62 and standard response of mean (SRM) = 0.67], strong external responsiveness DASH-Arabic (r =-0.90; p < 0.001), and negative strong correlation with NPRS-Arabic (r =-0.75, p < 0.001). CONCLUSIONS The ULFI-Ar is a valid, reliable, and responsive self-report questionnaire to assess UL-MSDs in Arabic speaking patients.
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Affiliation(s)
- Yousef A Albahrani
- Department of Rehabilitation, Prince Mohammed Bin Abdulaziz Hospital, Riyadh, Saudi Arabia.
- Department of Physical Therapy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia.
| | - Ali M Alshami
- Department of Physical Therapy, Imam Abdulrahman Bin Faisal University, Dammam, Saudi Arabia
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Narulla R, Song M, Karunaratne S, Smithers C, Petchell J. Trends in shoulder surgery patient-reported outcome measures. JSES Int 2023; 7:653-661. [PMID: 37426935 PMCID: PMC10328759 DOI: 10.1016/j.jseint.2023.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/11/2023] Open
Abstract
Patient-reported outcome measures (PROMs) are a vital part of the toolkit for the current practice of orthopedic surgery. We are witnessing the expansion of the use of PROMs in clinical practice and in research; the ultimate direction of this expansion is unclear. The purpose of this systematic review was to identify the trends in the use of PROMs in major upper limb publications over a 7-year period. We retrospectively reviewed all articles published in 6 of the most influential upper limb orthopedic journals based on impact factor from January 2013 to January 2020. PubMed, Medline, and Embase were used to access the abstracts for all articles published for this period. We included all articles related to shoulder arthroplasty, shoulder instability, rotator cuff surgery, and involving the use of PROMs. There were 4175 articles identified from the selected journals over the chosen time period, of which 607 were eligible for inclusion in the study. The number of articles reporting PROMs increased from 57 in 2013 to 115 in 2019, which was a 102% increase. The total number of PROM usages recorded was 1593 which was comprised of 63 different scoring systems, with each article using a median of 3 different PROMs. The most commonly used score in articles originating from North America was the American Shoulder and Elbow Surgeons score (216 uses in 273 articles; 78.1%), from Europe it was the Constant-Murley Score (129 uses in 183 articles; 70.4%), and from Asia it was the American Shoulder and Elbow Surgeons score (80 uses in 126 articles; 63.4%). The use of PROMs is evolving with an increasing prevalence of and diversity of PROMs being used in upper limb surgery. There is geographical variation in the use of PROMs, and a variety of systems used, with only 3 of the top 10 most used PROMs reporting on patient satisfaction or wellbeing. Given that a diverse range of PROMs study a diverse range of conditions and procedures, there may not be a need for a consensus on the best overall use of PROMs, but there may be ideal PROMs suited to answer specific questions.
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Affiliation(s)
- Rajpal Narulla
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
- University of New South Wales, Sydney, NSW, Australia
| | - Mark Song
- University of New South Wales, Sydney, NSW, Australia
| | - Sascha Karunaratne
- Surgical Outcomes Research Centre (SOuRCe), Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Christopher Smithers
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
| | - Jeffrey Petchell
- Department of Orthopaedic Surgery, Royal Prince Alfred Hospital, Camperdown, NSW, Australia
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5
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Héroux J, Bessette PO, Belley-Côté E, Lamarche D, Échavé P, Loignon MJ, Patenaude N, Baillargeon JP, D'Aragon F. Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review. BMC Anesthesiol 2023; 23:91. [PMID: 36964490 PMCID: PMC10037794 DOI: 10.1186/s12871-023-02038-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 03/08/2023] [Indexed: 03/26/2023] Open
Abstract
BACKGROUND Peripheral nerve block is a common anesthetic technique used during orthopedic upper limb surgery. Injection of local anesthetics around the target nerve inhibits the action of voltage-dependent sodium channels, inhibiting neurotransmission of pain impulses and providing motor immobility. Compared to general anesthesia, it could improve functional recovery by inhibiting nociceptive impulses and inflammation, thus reducing postoperative pain and immobilization and improving postoperative rehabilitation. This systematic review evaluates the impact of peripheral nerve block versus general anesthesia on postoperative functional recovery following orthopedic upper limb surgery. METHODS We searched CENTRAL, MEDLINE, CINHAL, EMBASE, and Scopus trial databases from inception until September 2021 for studies comparing peripheral nerve block to general anesthesia. We collected data on functional recovery, range of motion, patient satisfaction, quality of life, and return to work. We pooled studies using a random-effects model and summarized the quality of evidence with the GRADE approach. RESULTS We assessed 373 citations and 19 full-text articles for eligibility, and included six studies. Six studies reported on functional recovery, but failed to detect a significant superiority of peripheral nerve block over general anesthesia (3 RCT studies, N = 160; SMD -0.15; CI at 95% -0.60-0.3; I2 = 45%; p = 0.07; low quality of evidence and 3 observational studies, N = 377; SMD -0.35; CI at 95% -0.71-0.01; I2 = 64%; p = 0.06; very low quality of evidence). CONCLUSIONS Current literature is limited and fails to identify the benefit of peripheral nerve block on functional recovery. More studies are needed to assess the impact on long-term recovery. Considering the potential impact on clinical practice and training, a prospective study on functional recovery is ongoing (NCT04541745). TRIAL REGISTRATION PROSPERO ID CRD42018116298. Registered on December 4, 2018.
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Affiliation(s)
- Jennifer Héroux
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada.
| | | | - Emilie Belley-Côté
- Divisions of Cardiology and Critical Care, Department of Medicine, McMaster University, Hamilton, ON, Canada
- Population Health Research Institute, Hamilton, ON, Canada
| | - Daphnée Lamarche
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Pablo Échavé
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Marie-Josée Loignon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Nicolas Patenaude
- Department of Orthopedic Surgery, Université de Sherbrooke, Sherbrooke, QC, Canada
| | - Jean-Patrice Baillargeon
- Division of Endocrinology, Department of Medicine, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
| | - Frédérick D'Aragon
- Department of Anesthesiology, Université de Sherbrooke, Sherbrooke, QC, Canada
- Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, QC, Canada
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Albahrani YA, Alshami AM. Cross-cultural adaptation of the upper limb functional index in Arabic. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022307. [PMID: 36300220 PMCID: PMC9686146 DOI: 10.23750/abm.v93i5.13417] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Accepted: 10/07/2022] [Indexed: 01/25/2023]
Abstract
BACKGROUND AND AIM The upper limb functional index (ULFI) is a widely used self-reported outcome measure questionnaire with robust psychometric properties to assess the upper limb musculoskeletal disorders (UL-MSDs). This study aimed to adapt the ULFI cross-culturally in Arabic (ULFI-Ar) and to examine its face validity, content validity, internal consistency, criterion validity, and interpretability. METHODS In this observational cross-sectional study, the English version of ULFI was cross-culturally adapted to the Arabic language through double forward and backward translations, following the recommended guidelines. Interviews with participants and reviews by experts were used to assess the face and content validity of the prefinal version of ULFI-Ar. Internal consistency was determined by Cronbach's alpha coefficient (a). Criterion validity was analyzed by correlating the ULFI-Ar with the Arabic version of the Disabilities of the Arm, Shoulder, and Hand (DASH-Arabic) using Pearson's correlation coefficients. RESULTS A total of 54 participants reported no major language barriers or difficulties in completing the ULFI-Ar. The participants' interview demonstrated adequate face validity. The review by experts showed that the content validity was excellent (content validity index = 0.81 - 1.00 for each item and 0.96 for the scale). The ULFI-Ar showed high internal consistency (a = 0.88). For criterion validity, there was strong correlation with the DASH-Arabic (r = -0.802, p < 0.0001) and moderate correlation with NPRS-Arabic (r = -0.502, p < 0.0001). CONCLUSIONS The ULFI-Ar was easy to complete with no linguistic difficulties. The results demonstrate the suitability of using the ULFI-AR for Arabic-speaking patients with UL-MSD.
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Shafiee E, MacDermid JC, Walton D, Vincent JI, Grewal R. Psychometric properties and cross-cultural adaptation of the Patient-Rated Tennis Elbow Evaluation (PRTEE); a systematic review and meta-analysis. Disabil Rehabil 2021; 44:5402-5417. [PMID: 34196231 DOI: 10.1080/09638288.2021.1938248] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
PURPOSE To synthesize and appraise the evidence on the translation, cross-cultural adaptation, and psychometric properties of the Patient-Rated Tennis Elbow Evaluation (PRTEE). METHOD Five electronic databases were searched from 1999 to 2021. Two independent reviewers assessed the risk of bias and quality of the included studies using the COSMIN recommended guidelines. The overall quality of the evidence on each psychometric property was provided using the GRADE approach. RESULTS Twenty-one studies met the criteria for inclusion in this review. The PRTEE was translated and cross-culturally adapted to 13 languages and cultures. High quality of evidence supports sufficient pooled results for test-retest reliability (0.96(CI: 0.94-0.97)), construct validity (against Disabilities of the Arm, Shoulder, and Hand (DASH): 0.81(CI: 0.76-0.85), against Visual Analogue Scale (VAS): 0.70 (0.62-0.74)), and responsiveness of the PRTEE. The overall rating of the structural validity and internal consistency (0.96(CI: 0.94-0.97)) was indeterminate, and the quality of evidence was low and moderate, respectively. Regarding measurement error, the overall rating of the summarized results (Standard error of measurement (SEM): 3.1 (1.8 to 4.4) and Minimal Detectable Change (MDC95): 8.9 (5.3-12.5)) was sufficient, and the quality of evidence was moderate. CONCLUSION Moderate to high quality evidence supports adequate psychometric properties of the PRTEE in terms of internal consistency, test-retest reliability, measurement error, hypothesis testing for construct validity, and responsiveness.Implications for RehabilitationThe PRTEE can measure the construct of pain and disability at a single time-point and detect changes over time precisely.The PRTEE can be used in clinical setting for patients with acute, subacute, and chronic Lateral Elbow Tendinopathy (LET), athletes who suffer from elbow pain and tennis players.
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Affiliation(s)
- Erfan Shafiee
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Canada.,Department of Occupational Therapy, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Joy C MacDermid
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Canada.,Co-director Clinical Research Lab, Hand and Upper Limb Centre, St. Joseph's Health Centre, London, Canada.,School of Rehabilitation Science, McMaster University, Hamilton, Canada
| | - David Walton
- School of Physical Therapy, Department of Health and Rehabilitation Sciences, University of Western Ontario, London, Canada
| | - Joshua I Vincent
- School of Rehabilitation Science, McMaster University, Hamilton, Canada.,Department of Clinical Expert, Workers Safety Insurance Board, Toronto, Canada.,Roth-MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Canada
| | - Ruby Grewal
- Roth-MacFarlane Hand and Upper Limb Centre, University of Western Ontario, London, Canada
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Barger J, Zhang D, Stenquist DS, Ostergaard P, Hall M, Dyer GSM, Earp BE, von Keudell A. Correlation and responsiveness of global health, upper extremity-specific, and shoulder-specific functional outcome measures following reverse total shoulder arthroplasty for proximal humerus fracture. BMC Musculoskelet Disord 2021; 22:574. [PMID: 34162369 PMCID: PMC8223380 DOI: 10.1186/s12891-021-04450-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/01/2021] [Indexed: 11/10/2022] Open
Abstract
PURPOSE Reverse total shoulder arthroplasty (rTSA) is effective and increasingly utilized for the management of proximal humerus fracture (PHF). However, the optimal patient-reported outcome metrics (PROMs) for the evaluation of patient outcomes after this surgery are unclear. We investigated the correlation among global, upper extremity-specific, and shoulder-specific PROMs in patients undergoing rTSA for PHF as well as the responsiveness of these PROMs as assessed by floor and ceiling effects. We hypothesized that patients' post-operative outcome would be best reflected by a combination of these metrics. METHODS Thirty patients with a history of rTSA for ipsilateral PHF filled out the following outcomes questionnaires at a minimum of 3 years post-op: EQ-5D, EQ-5D VAS, PROMIS physical function, DASH, SSV, SPADI, and ASES. Correlation between metrics was assessed using the Spearman correlation coefficient. Responsiveness was assessed by comparing the proportion of patients reaching floor or ceiling values using McNemar's test. RESULTS Global health metrics (EQ-5D and PROMIS physical function) were strongly correlated with the upper extremity-specific metric (DASH). Shoulder-specific outcomes (SPADI, ASES, and ASES) were moderately correlated with both the global metrics and DASH. There was no significant difference between PROMs with regards to floor and ceiling effects. CONCLUSIONS The DASH score has been shown to be valid and responsive for shoulder interventions, and our data demonstrate that it correlates strongly with overall quality of life. Shoulder-specific metrics are valid and responsive for shoulder interventions but correlate less with global quality of life. An optimal PROM strategy in rTSA for PHF might involve both DASH and a shoulder-specific score. Based on our assessment of floor and ceiling effects, none of these metrics should be excluded for poor responsiveness.
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Affiliation(s)
- James Barger
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA. .,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA.
| | - Dafang Zhang
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Derek S Stenquist
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Peter Ostergaard
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Matthew Hall
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - George S M Dyer
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Brandon E Earp
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
| | - Arvind von Keudell
- Department of Orthopaedic Surgery, Brigham and Women's Hospital, 55 Fruit Street, MA, 02115, Boston, USA.,Harvard Medical School, 25 Shattuck St, 02115, Boston, MA, USA
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Cheema AS, O’Brien PJ, Broekhuyse HM, Lefaivre KA. Measuring Outcomes Over Time in Distal Radius Fractures: A Comparison of Generic, Upper Extremity-Specific and Wrist-Specific Outcome Measures. JOURNAL OF HAND SURGERY GLOBAL ONLINE 2020; 2:272-276. [PMID: 35415515 PMCID: PMC8991422 DOI: 10.1016/j.jhsg.2020.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2020] [Accepted: 06/25/2020] [Indexed: 12/26/2022] Open
Abstract
Purpose This study compared the responsiveness of a generic (Short Form-36 [SF-36]), an upper extremity-specific (Disabilities of the Arm, Shoulder, and Hand [DASH]) and a wrist-specific (Patient-Rated Wrist Evaluation [PRWE]) outcome score when evaluating distal radius fractures over time. Methods We observed 235 patients who met the inclusion criteria of an isolated distal radius fracture treated surgically or nonsurgically and greater than age 50 years for 12 months in this prospective study. Standardized assessments were performed at baseline and at 6 and 12 months. Exclusion criteria included subjects with concomitant injuries in the ipsilateral limb and follow-up of less than 1 year. Responsiveness was evaluated through the standardized response mean and the proportion who met a minimal clinically important difference. Floor and ceiling effects were also calculated. Results The standardized response mean was significantly greatest for the DASH between baseline and 6 months (P < .001), and the PRWE between both baseline and 6 months (P < .01) and 6 and 12 months (P < .01) compared with the SF-36. The proportion of patients who met a minimal clinically important difference between baseline and 6 months was greater in the PRWE, but it did not meet statistical significance (P = .12). The PRWE demonstrated a high ceiling effect at baseline (76.6%) but less so at 12 months (16.9%). The DASH demonstrated similar ceiling effects at baseline (62.9%) and 12 months (18.6%). The SF-36 had no ceiling effect. Conclusions In the first 6 months, both the DASH and PRWE have greater responsiveness in assessing change over the SF-36 in distal radius fractures. From 6 to 12 months, the wrist-specific PRWE has greater responsiveness over both the DASH and SF-36. This supports the use of the anatomy- and injury-specific outcome measures over the generic outcome measure in detecting change over a patient's early recovery. However, as the time from injury increases, the absence of a ceiling effect from the generic outcome measure may become more useful. Clinical relevance This study demonstrates the responsiveness of the DASH, PRWE, and SF36 in assessing distal radius fractures treated in patients greater than age 50 in the first year. In establishing the most responsive measure, respondent burden can be decreased in future research.
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Affiliation(s)
- Amarpal S. Cheema
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Peter J. O’Brien
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Henry M. Broekhuyse
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
| | - Kelly A. Lefaivre
- Department of Orthopaedic Surgery, Division of Orthopaedic Trauma, University of British Columbia, Vancouver, British Columbia, Canada
- Corresponding author: Kelly A. Lefaivre, MD, MSc, FRCSC, Department of Orthopaedics, Division of Orthopaedic Trauma, University of British Columbia, VGH Research Pavilion, 110-828 West 10th Avenue, Vancouver, BC, Canada V5Z 1M9.
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Héroux J, Belley-Côté E, Echavé P, Loignon MJ, Bessette PO, Patenaude N, Baillargeon JP, D’Aragon F. Functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery: a systematic review protocol. Syst Rev 2019; 8:273. [PMID: 31711533 PMCID: PMC6844046 DOI: 10.1186/s13643-019-1204-4] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Accepted: 10/16/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND Peripheral nerve block is a single injection that inhibits the transmission of peripheral nerve impulses to the central nervous system. The inhibition of the nociceptive impulse may decrease the occurrence of muscle spasm following mobilization postoperatively. This mechanism may contribute to a better functional recovery following upper limb surgery. This systematic review will investigate the impact of peripheral nerve block on functional recovery after an upper limb surgery. METHODS We will search studies comparing peripheral nerve block to general anesthesia for upper limb surgery in the following databases: CENTRAL, MEDLINE (Ovid), CINAHL, EMBASE, and Scopus. In duplicate, independent reviewers will assess eligibility, evaluate risk of bias, and abstract data on type of peripheral nerve block and functional outcome. Where possible, we will pool results using a random effects model. For each outcome, we will assess the quality of evidence using GRADE methodology. DISCUSSION We aim to summarize the available evidence comparing functional recovery with peripheral nerve block versus general anesthesia for upper limb surgery. These data will inform the design of a trial on the topic. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42018116298.
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Affiliation(s)
| | | | - Pablo Echavé
- Université de Sherbrooke, Sherbrooke, Québec Canada
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Construct Validity and Precision of Different Patient-reported Outcome Measures During Recovery After Upper Extremity Fractures. Clin Orthop Relat Res 2019; 477:2521-2530. [PMID: 31490347 PMCID: PMC6903842 DOI: 10.1097/corr.0000000000000928] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient perceptions of their limitations after illness and injury can be quantified using patient-reported outcome measures (PROMs). Few studies have assessed construct validity (using correlations and factor analysis) and precision (floor and ceiling effects) of a range of frequently used PROMs longitudinally in a population of patients recovering from common upper extremity fractures according to area (general health, region-specific, or joint-specific measures) and mode of administration (fixed-scale or computer adaptive test). QUESTIONS/PURPOSES (1) What is the strength of the correlation between different PROMs within 1 week, 2 to 4 weeks and 6 to 9 months after shoulder, elbow, and wrist fractures? (2) Using a factor analysis, what underlying constructs are being measured by these PROMs? (3) Are there strong floor and ceiling effects with these instruments? METHODS Between January 2016 and August 2016, 734 patients recovering from an isolated shoulder, elbow, or wrist fracture completed physical-limitation PROMs at baseline (the initial office visit after diagnosis in the emergency department), 2 to 4 weeks after injury, and at the final assessment 6 to 9 months after injury. In all, 775 patients were originally approached; 31 patients (4%) declined to participate due to time constraints, four patients died of unrelated illness, and six patients were lost to follow-up. The PROMs included the PROMIS Physical Function (PF, a computer adaptive, general measure of physical function), the PROMIS Upper Extremity (UE, a computer adaptive measure of upper extremity physical function), the QuickDASH (a fixed-scale, region-specific measure), the Oxford Shoulder Score (OSS), the Oxford Elbow Score (OES) and the Patient-rated Wrist Evaluation (PRWE) (a fixed-scale, joint-specific measure), and the EQ-5D-3L (a fixed-scale measure of general health). PROMs were evaluated during recovery for construct validity (using correlations and factor analysis) and precision (using floor and ceiling effects). RESULTS Physical-limitation PROMs were intercorrelated at all time points, and the correlation strengthened over time (for example, PROMIS UE and QuickDASH at 1 week, r = -0.4665; at 2 to 4 weeks, r = -0.7763; at 6 to 9 months, r = -0.8326; p < 0.001). Factor analysis generated two factors or groupings of PROMs that could be described as capability (perceived ability to perform or engage in activities), and quality of life (an overall sense of health and wellbeing) that varied by time point and fracture type, Joint-specific and general-health PROMs demonstrated high ceiling effects 6 to 9 months after injury and PROMIS PF, PROMIS UE and QuickDASH had no floor or ceiling effects at any time points. CONCLUSIONS There is a substantial correlation between PROMs that assess physical limitations (based on anatomic region) and general health after upper extremity fractures, and these relationships strengthen during recovery. Regardless of the delivery mode or area of focus, PROMs largely appear to represent two underlying constructs: capability and quality of life. Computer adaptive tests may be favored over fixed-scale measures for their efficiency and limited censoring. LEVEL OF EVIDENCE Level II, therapeutic study.
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Jayakumar P, Teunis T, Vranceanu AM, Lamb S, Ring D, Gwilym S. Relationship Between Magnitude of Limitations and Patient Experience During Recovery from Upper-Extremity Fracture. JB JS Open Access 2019; 4:e0002.1-7. [PMID: 31592059 PMCID: PMC6766382 DOI: 10.2106/jbjs.oa.19.00002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/05/2022] Open
Abstract
The relationship between the magnitude of limitations (measured by patient-reported outcome measures, or PROMs) and satisfaction with care providers and hospital services (measured by patient-reported experience measures, or PREMs) over the course of recovery after injury is unclear. The purpose of this study was to assess the relationship between a range of PROMs and 2 PREMs at 3 time points (initial office visit within a week, 2 to 4 weeks, and 6 to 9 months) after shoulder, elbow, and wrist fractures. METHODS We enrolled 744 adult patients with an isolated shoulder, elbow, or wrist fracture and invited them to complete PROMs (the Patient-Reported Outcomes Measurement Information System Upper Extremity Physical Function computer adaptive test [PROMIS UE], PROMIS Physical Function (PROMIS PF) scale, Quick Disabilities of the Arm, Shoulder and Hand [QuickDASH] questionnaire, EuroQol 5-Dimensions 3-Level Index [EQ-5D-3L], and Oxford Shoulder Score [OSS], Oxford Elbow Score [OES], or Patient-Rated Wrist Evaluation [PRWE]) and PREMs (Numerical Rating Scale [NRS] for satisfaction with care providers [NRS-C] and for satisfaction with hospital services [NRS-S]) at their initial visit at the outpatient surgical practice (maximum, 1 week after the fracture), between 2 and 4 weeks after the injury, and between 6 and 9 months after the injury. Correlational analysis was performed at each time point. RESULTS There was moderate correlation between the PROMIS UE and the NRS-C (r = 0.56) and NRS-S (r = 0.59) at 6 to 9 months after injury, which was stronger than the correlation at the 2 to 4-week mark (NRS-C, r = 0.34; NRS-S, r = 0.36) and at the evaluation that took place within a week after the injury (NRS-C, r = 0.18; NRS-S, r = 0.16). These correlational trends were observed with all forms of PROMs. Patients reporting greater limitations after injury were also less satisfied with their care and services. CONCLUSIONS The increasing alignment of PROMs and PREMs over the course of recovery after an upper-extremity fracture suggests that restored physical function may improve perceptions of satisfaction with care providers and hospital services over time. Future studies should assess factors that could be addressed to improve patient satisfaction and their limitations during recovery after fracture in order to maximize patient outcomes. LEVEL OF EVIDENCE Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Prakash Jayakumar
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, United Kingdom
- Department of Surgery and Perioperative Care (P.J. and D.R.) and Value Institute for Health & Care (P.J.), Dell Medical School, The University of Texas at Austin, Austin, Texas
- The Commonwealth Fund, New York, NY
| | - Teun Teunis
- University Medical Center, Utrecht, the Netherlands
| | - Ana-Maria Vranceanu
- Department of Psychiatry, Massachusetts General Hospital and Harvard Medical School, Boston, Massachusetts
| | - Sarah Lamb
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, United Kingdom
| | - David Ring
- Department of Surgery and Perioperative Care (P.J. and D.R.) and Value Institute for Health & Care (P.J.), Dell Medical School, The University of Texas at Austin, Austin, Texas
| | - Stephen Gwilym
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, Oxford University Hospitals, Oxford, United Kingdom
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