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Bruhn SM, Skou ST, Harris LK, Bandholm T, Møller A, Schrøder HM, Troelsen A, Ingelsrud LH. Usage of guideline-adherent core treatments for knee osteoarthritis before and after consulting an orthopaedic surgeon: A prospective cohort study. Osteoarthr Cartil Open 2023; 5:100411. [PMID: 37818279 PMCID: PMC10560838 DOI: 10.1016/j.ocarto.2023.100411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Accepted: 09/20/2023] [Indexed: 10/12/2023] Open
Abstract
Objective To describe 1) the proportion of patients with knee osteoarthritis (OA) undergoing guideline-adherent core treatments until six months after primary referral to an orthopaedic surgeon, 2) which specific treatment pathways these patients undertake and 3) the characteristics of patients choosing different treatment pathways. Design This prospective cohort study consecutively invited patients referred to an orthopaedic surgeon due to knee OA at two Danish hospitals from October 2018 to December 2020. Before and six months after consulting the surgeon, patients answered a questionnaire reporting which treatments they had received for knee OA. The proportion receiving the combination of guideline-adherent treatments (i.e., exercise, education, and dietary weight management if needed) was determined. We evaluated the specific treatment usage before and until six months after the consultation and investigated characteristics of patients undertaking different pathways. Results Out of 5251 eligible patients, 2574 (49%) had complete data and were included in analyses. 23% received guideline-adherent treatments, 10% had no treatment. Patients underwent 1143 unique treatment pathways, 62% including treatments not recommended/recommended against. Those who underwent guideline-adherent pathways had similar characteristics to those who did not but tended to be females, retired, had longer-lasting knee problems, have comorbidities, and higher education levels. Conclusions Only one in four patients with knee OA received treatment adhering to clinical guidelines before and six months after consulting the surgeon. Patients used many different treatment pathways. There is a need for a structured effort to increase the use of guideline-adherent core treatments. Trial Identifiers Registration: NCT03746184, Protocol: PMID: 34233992.
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Affiliation(s)
- Simon Majormoen Bruhn
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital—Hvidovre, Denmark
| | - Søren T. Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Lasse Kindler Harris
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital—Hvidovre, Denmark
| | - Thomas Bandholm
- Department of Orthopaedic Surgery, Copenhagen University Hospital—Hvidovre, Denmark
- Physical Medicine & Rehabilitation Research Copenhagen (PMR-C), Department of Physical and Occupational Therapy, Copenhagen University Hospital—Hvidovre, Denmark
- Department of Clinical Research, Copenhagen University Hospital—Hvidovre, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Center for Research and Education in General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Henrik M. Schrøder
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
- Department of Orthopaedic Surgery, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Anders Troelsen
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital—Hvidovre, Denmark
| | - Lina Holm Ingelsrud
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital—Hvidovre, Denmark
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Ingelsrud LH, Terluin B, Thorlund JB, Pedersen JR, Roos EM. Knee Injury and Osteoarthritis Outcome Score Interpretation Thresholds at 3 and 12 Months After Arthroscopic Meniscal Surgery. What Changes, and What Stays the Same? J Orthop Sports Phys Ther 2023; 53:685-702. [PMID: 37787579 DOI: 10.2519/jospt.2023.11993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/04/2023]
Abstract
OBJECTIVE: To evaluate the change in minimal important change (MIC), patient acceptable symptom state (PASS), and treatment failure (TF) thresholds for the Knee injury and Osteoarthritis Outcome Score (KOOS) from 3 to 12 months following arthroscopic meniscus surgery. DESIGN: Retrospective cohort study. METHODS: We included patients from the Knee Arthroscopy Cohort Southern Denmark who had meniscus surgery between 2013 and 2015. We calculated the interpretation threshold values for MIC, PASS, and TF using an anchor-based adjusted predictive modeling method. Thresholds at 3 and 12 months postoperatively were compared to evaluate changes over time. RESULTS: The proportions of people who reported a clinically relevant improvement, or their symptoms being acceptable, increased by 10% to 15% points from 3 to 12 months after surgery. MIC thresholds for the 5 KOOS subscales remained stable from 3 to 12 months with statistically nonsignificant differences (95% confidence intervals) ranging from -0.3 (-3.0, 2.6) to -2.4 (-6.1, 1.3). All PASS thresholds except for quality of life (QOL) decreased by -6.5 (-11.8, -1.5) to -3.7 (-7.1, -0.4) points, indicating that higher symptom levels were accepted at 12 months. In contrast, the proportion reporting their treatment to have failed remained stable over time (19% and 17%). For QOL, a 7.4 (2.0, 13.2) higher TF threshold at 12 months suggested that improved QOL was required to not consider that the treatment had failed. CONCLUSION: More patients reported being improved at 1 year compared to at 3 months following meniscus surgery. The KOOS MIC thresholds were stable over time, whereas time-specific PASS values should be applied after meniscus surgery. J Orthop Sports Phys Ther 2023;53(11):685-702. Epub 3 October 2023. doi:10.2519/jospt.2023.11993.
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Whittaker JL, Culvenor AG, Juhl CB, Berg B, Bricca A, Filbay SR, Holm P, Macri E, Urhausen AP, Ardern CL, Bruder AM, Bullock GS, Ezzat AM, Girdwood M, Haberfield M, Hughes M, Ingelsrud LH, Khan KM, Le CY, Losciale JM, Lundberg M, Miciak M, Øiestad BE, Patterson B, Räisänen AM, Skou ST, Thorlund JB, Toomey C, Truong LK, Meer BLV, West TJ, Young JJ, Lohmander LS, Emery C, Risberg MA, van Middelkoop M, Roos EM, Crossley KM. OPTIKNEE 2022: consensus recommendations to optimise knee health after traumatic knee injury to prevent osteoarthritis. Br J Sports Med 2022; 56:1393-1405. [DOI: 10.1136/bjsports-2022-106299] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/29/2022] [Indexed: 11/16/2022]
Abstract
The goal of the OPTIKNEE consensus is to improve knee and overall health, to prevent osteoarthritis (OA) after a traumatic knee injury. The consensus followed a seven-step hybrid process. Expert groups conducted 7 systematic reviews to synthesise the current evidence and inform recommendations on the burden of knee injuries; risk factors for post-traumatic knee OA; rehabilitation to prevent post-traumatic knee OA; and patient-reported outcomes, muscle function and functional performance tests to monitor people at risk of post-traumatic knee OA. Draft consensus definitions, and clinical and research recommendations were generated, iteratively refined, and discussed at 6, tri-weekly, 2-hour videoconferencing meetings. After each meeting, items were finalised before the expert group (n=36) rated the level of appropriateness for each using a 9-point Likert scale, and recorded dissenting viewpoints through an anonymous online survey. Seven definitions, and 8 clinical recommendations (who to target, what to target and when, rehabilitation approach and interventions, what outcomes to monitor and how) and 6 research recommendations (research priorities, study design considerations, what outcomes to monitor and how) were voted on. All definitions and recommendations were rated appropriate (median appropriateness scores of 7–9) except for two subcomponents of one clinical recommendation, which were rated uncertain (median appropriateness score of 4.5–5.5). Varying levels of evidence supported each recommendation. Clinicians, patients, researchers and other stakeholders may use the definitions and recommendations to advocate for, guide, develop, test and implement person-centred evidence-based rehabilitation programmes following traumatic knee injury, and facilitate data synthesis to reduce the burden of knee post-traumatic knee OA.
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Macri EM, Young JJ, Ingelsrud LH, Khan KM, Terluin B, Juhl CB, Whittaker JL, Culvenor AG, Crossley KM, Roos EM. Meaningful thresholds for patient-reported outcomes following interventions for anterior cruciate ligament tear or traumatic meniscus injury: a systematic review for the OPTIKNEE consensus. Br J Sports Med 2022; 56:1432-1444. [PMID: 35973755 DOI: 10.1136/bjsports-2022-105497] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/07/2022] [Indexed: 11/04/2022]
Abstract
OBJECTIVE We synthesised and assessed credibility (ie, trustworthiness) of thresholds that define meaningful scores for patient-reported outcome measures (PROMs) following interventions for anterior cruciate ligament (ACL) tear or traumatic meniscus injury. DESIGN Systematic review, narrative synthesis. DATA SOURCES We searched five databases, handsearched references of included studies and tracked citations. ELIGIBILITY Included studies investigated: individuals with ACL tear or meniscus injury; mean age <35 years; and PROM thresholds calculated using any method to define a minimal important change (MIC) or a meaningful post-treatment score (Patient Acceptable Symptom State (PASS) or Treatment Failure). RESULTS We included 18 studies (15 ACL, 3 meniscus). Three different methods were used to calculate anchor-based MICs across 9 PROMs, PASS thresholds across 4 PROMs and treatment failure for 1 PROM. Credibility was rated 'high' for only one study-an MIC of 18 for the Knee injury and Osteoarthritis Outcome Score Quality-of-life (KOOS-QOL) subscale (using the MID Credibility Assessment Tool). Where multiple thresholds were calculated among 'low' credibility thresholds in ACL studies, MICs converged to within a 10-point range for KOOS-Symptoms (-1.2 to 5.4) and function in daily living (activities of daily living, ADL 0.5-8.1) subscales, and the International Knee Documentation Committee Subjective Knee Form (7.1-16.2). Other PROM thresholds differed up to 30 points. PASS thresholds converged to within a 10-point range in KOOS-ADL for ACL tears (92.3-100), and KOOS-Symptoms (73-78) and KOOS-QOL (53-57) in meniscus injuries. CONCLUSION Meaningful PROM thresholds were highly susceptible to study heterogeneity. While PROM thresholds can aid interpretability in research and clinical practice, they should be cautiously interpreted.
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Affiliation(s)
- Erin M Macri
- Department of Orthopaedics and Sports Medicine, Erasmus University Medical Center, Rotterdam, The Netherlands.,Dept General Practice, Erasmus University Medical Center, Rotterdam, The Netherlands.,Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada
| | - James J Young
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.,Research Division, Canadian Memorial Chiropractic College, Toronto, Ontario, Canada
| | | | - Karim M Khan
- Department of Family Practice, University of British Columbia, Vancouver, British Columbia, Canada.,School of Kinesiology, University of British Columbia, Vancouver, British Columbia, Canada
| | - Berend Terluin
- Department of General Practice, Amsterdam UMC, VU University, Amsterdam, The Netherlands
| | - Carsten Bogh Juhl
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Herlev-Gentofte, Copenhagen, Denmark
| | - Jackie L Whittaker
- Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, British Columbia, Canada.,Arthritis Research Canada, Richmond, British Columbia, Canada
| | - Adam G Culvenor
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Kay M Crossley
- La Trobe Sport and Exercise Medicine Research Centre, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Victoria, Australia
| | - Ewa M Roos
- Center for Muscle and Joint Health, University of Southern Denmark, Odense, Denmark
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Cramer A, Ingelsrud LH, Hansen MS, Hölmich P, Barfod KW. Estimation of Patient Acceptable Symptom State (PASS) and Treatment Failure (TF) Threshold Values for the Achilles Tendon Total Rupture Score (ATRS) at 6 Months, 1 Year, and 2 Years After Acute Achilles Tendon Rupture. J Foot Ankle Surg 2022; 61:503-507. [PMID: 34776330 DOI: 10.1053/j.jfas.2021.09.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/16/2021] [Revised: 09/18/2021] [Accepted: 09/21/2021] [Indexed: 02/03/2023]
Abstract
Interpretation of the Achilles tendon Total Rupture Score (ATRS) is challenging because limited knowledge exists about at which score the patients consider the outcome of treatment as satisfactory. The aims of the study were (1) to describe the proportion of patients who find their symptom levels to be satisfactory, to reflect treatment failure or neither after acute Achilles tendon rupture (ATR), and (2) to estimate the Patient Acceptable Symptom State (PASS) and the Treatment Failure (TF) threshold values for the ATRS at 6 months, 1 year, and 2 years after ATR. The study was based on data extracted from the nationwide Danish Achilles tendon Database which includes patients treated operatively or nonoperatively after ATR. The PASS and TF threshold values for ATRS were estimated using the adjusted predictive modeling method. One hundred and sixty-six patients were included at 6 months, 248 patients at 1 year, and 287 patients at 2 years after ATR. The proportion of patients who considered their symptom level to be satisfactory was 61% at 6 months, 50% at 1 year, and 66% at 2 years, while 5% at 6 months, 11% at 1 year, and 10% at 2 years considered their symptom level to reflect treatment failure. The PASS threshold value for ATRS (95% confidence interval) was 49 (46-52) at 6 months, 57 (54-60) at 1 year, and 52 (49-55) at 2 years. The TF threshold value for ATRS was 30 (23-36) at 6 months, 33 (26-40) at 1 year, and 35 (29-39) at 2 years. The calculated PASS and TF threshold values can help interpret the outcome of ATR when measured with the ATRS. About 50% to 66% of the patients had a satisfactory symptom level after ATR.
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Affiliation(s)
- Allan Cramer
- Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Hvidovre, Denmark.
| | - Lina Holm Ingelsrud
- Department of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Denmark
| | - Maria Swennergren Hansen
- Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Hvidovre, Denmark; Department of Physical and Occupational Therapy, and Clinical Research Centre, Physical Medicine & Rehabilitation Research-Copenhagen (PMR-C), Copenhagen University Hospital Amager-Hvidovre, Hvidovre, Denmark
| | - Per Hölmich
- Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Hvidovre, Denmark
| | - Kristoffer Weisskirchner Barfod
- Department of Orthopedic Surgery, Sports Orthopedic Research Center - Copenhagen (SORC-C), Copenhagen University Hospital, Hvidovre, Denmark
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Bohm ER, Kirby S, Trepman E, Hallstrom BR, Rolfson O, Wilkinson JM, Sayers A, Overgaard S, Lyman S, Franklin PD, Dunn J, Denissen G, W-Dahl A, Ingelsrud LH, Navarro RA. Collection and Reporting of Patient-reported Outcome Measures in Arthroplasty Registries: Multinational Survey and Recommendations. Clin Orthop Relat Res 2021; 479:2151-2166. [PMID: 34288899 PMCID: PMC8445553 DOI: 10.1097/corr.0000000000001852] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/28/2021] [Accepted: 05/12/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Patient-reported outcome measures (PROMs) are validated questionnaires that are completed by patients. Arthroplasty registries vary in PROM collection and use. Current information about registry collection and use of PROMs is important to help improve methods of PROM data analysis, reporting, comparison, and use toward improving clinical practice. QUESTIONS/PURPOSES To characterize PROM collection and use by registries, we asked: (1) What is the current practice of PROM collection by arthroplasty registries that are current or former members of the International Society of Arthroplasty Registries, and are there sufficient similarities in PROM collection between registries to enable useful international comparisons that could inform the improvement of arthroplasty care? (2) How do registries differ in PROM administration and demographic, clinical, and comorbidity index variables collected for case-mix adjustment in data analysis and reporting? (3) What quality assurance methods are used for PROMs, and how are PROM results reported and used by registries? (4) What recommendations to arthroplasty registries may improve PROM reporting and facilitate international comparisons? METHODS An electronic survey was developed with questions about registry structure and collection, analysis, reporting, and use of PROM data and distributed to directors or senior administrators of 39 arthroplasty registries that were current or former members of the International Society of Arthroplasty Registries. In all, 64% (25 of 39) of registries responded and completed the survey. Missing responses from incomplete surveys were captured by contacting the registries, and up to three reminder emails were sent to nonresponding registries. Recommendations about PROM collection were drafted, revised, and approved by the International Society of Arthroplasty Registries PROMs Working Group members. RESULTS Of the 25 registries that completed the survey, 15 collected generic PROMs, most frequently the EuroQol-5 Dimension survey; 16 collected joint-specific PROMs, most frequently the Knee Injury and Osteoarthritis Outcome Score and Hip Disability and Osteoarthritis Outcome Score; and 11 registries collected a satisfaction item. Most registries administered PROM questionnaires within 3 months before and 1 year after surgery. All 16 registries that collected PROM data collected patient age, sex or gender, BMI, indication for the primary arthroplasty, reason for revision arthroplasty, and a comorbidity index, most often the American Society of Anesthesiologists classification. All 16 registries performed regular auditing and reporting of data quality, and most registries reported PROM results to hospitals and linked PROM data to other data sets such as hospital, medication, billing, and emergency care databases. Recommendations for transparent reporting of PROMs were grouped into four categories: demographic and clinical, survey administration, data analysis, and results. CONCLUSION Although registries differed in PROM collection and use, there were sufficient similarities that may enable useful data comparisons. The International Society of Arthroplasty Registries PROMs Working Group recommendations identify issues that may be important to most registries such as the need to make decisions about survey times and collection methods, as well as how to select generic and joint-specific surveys, handle missing data and attrition, report data, and ensure representativeness of the sample. CLINICAL RELEVANCE By collecting PROMs, registries can provide patient-centered data to surgeons, hospitals, and national entities to improve arthroplasty care.
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Affiliation(s)
- Eric R. Bohm
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
| | - Sarah Kirby
- George and Fay Yee Centre for Healthcare Innovation, Winnipeg, Manitoba, Canada
| | - Elly Trepman
- Department of Surgery, University of Manitoba, Winnipeg, Manitoba, Canada
- Department of Medical Microbiology and Infectious Diseases, University of Manitoba, Winnipeg, Manitoba, Canada
- University of South Alabama College of Medicine, Mobile, AL, USA
| | - Brian R. Hallstrom
- Department of Orthopaedic Surgery, University of Michigan, Ann Arbor, MI, USA
| | - Ola Rolfson
- Department of Orthopaedics at Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - J. Mark Wilkinson
- Department of Oncology and Metabolism, University of Sheffield, The Medical School, Sheffield, UK
| | - Adrian Sayers
- Musculoskeletal Research Unit, Learning and Research, University of Bristol, Southmead Hospital, Bristol, UK
| | - Søren Overgaard
- Department of Orthopaedic Surgery and Traumatology, Odense University Hospital, Odense, Denmark
- Department of Clinical Research, University of South Denmark, Odense, Denmark
- Department of Orthopaedic Surgery and Traumatology, Copenhagen University Hospital, Bispebjerg, Denmark
- Department of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark
| | - Stephen Lyman
- Hospital for Special Surgery, New York, NY, USA
- Kyushu University School of Medicine, Fukuoka, Japan
| | - Patricia D. Franklin
- Department of Medical Social Sciences, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Jennifer Dunn
- Department of Orthopaedic Surgery and Musculoskeletal Medicine, University of Otago, Christchurch, New Zealand
| | - Geke Denissen
- Dutch Arthroplasty Register (Landelijke Registratie Orthopedische Implantaten), 's-Hertogenbosch, the Netherlands
| | - Annette W-Dahl
- Department of Orthopedics, Clinical Sciences Lund, Lund University, Lund, Sweden
| | - Lina Holm Ingelsrud
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
| | - Ronald A. Navarro
- Department of Orthopaedic Surgery, Kaiser Permanente South Bay Medical Center, Harbor City, CA, USA
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Bruhn SM, Ingelsrud LH, Bandholm T, Skou ST, Schroder HM, Reventlow S, Møller A, Kjellberg J, Kallemose T, Troelsen A. Disentangling treatment pathways for knee osteoarthritis: a study protocol for the TREATright study including a prospective cohort study, a qualitative study and a cost-effectiveness study. BMJ Open 2021; 11:e048411. [PMID: 34233992 PMCID: PMC8264876 DOI: 10.1136/bmjopen-2020-048411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Accepted: 06/27/2021] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION Knee osteoarthritis (OA) is associated with chronic knee pain and functional disability that negatively affect the ability to carry out normal daily activities. Patients are offered a large variety of non-surgical treatments, often not in accordance with clinical guidelines. This observational study will provide a comprehensive overview of treatment pathways for knee OA during the first 2 years after consulting an orthopaedic surgeon, including timing and order of treatment modalities, predictors of treatment outcomes, cost-effectiveness of treatment pathways and patients' views on different treatment pathways. METHODS AND ANALYSIS Patients with primary referrals to an orthopaedic surgeon due to knee OA are consecutively invited to participate and fill out a questionnaire prior to their consultation with an orthopaedic surgeon. Follow-up questionnaires will be obtained at 6 and 24 months after inclusion. Based on a prospective cohort study design, including questionnaires and register data, we will (1) describe treatment pathways for knee OA during the first 2 years after consulting an orthopaedic surgeon; (2) describe the characteristics of patients choosing different treatment pathways; (3) develop predictive models for patient-self-determined classifications of good and poor treatment outcomes; (4) evaluate the cost-effectiveness of treatment pathways that live up to clinical guidelines versus pathways that do not; based on a qualitative study design using semistructured individual interviews, we will (5) describe the patients' perspectives on treatment pathways for knee OA. ETHICS AND DISSEMINATION The study is approved by the Danish regional ethical committee (journal number H-17017295) and the Danish Data Protection Agency (journal number AHH-2017-072). Data will be anonymised and handled in line with the General Data Protection Regulation and the Danish Data Protection Act. The study results will be submitted to international open-access peer-reviewed journals and disseminated at conferences. TRIAL REGISTRATION NUMBER NCT03746184, pre-results.
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Affiliation(s)
- Simon Majormoen Bruhn
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lina Holm Ingelsrud
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Thomas Bandholm
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
- Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
- Physical Medicine and Rehabilitation Research Copenhagen (PMR-C), Department Physical and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark
| | - Søren Thorgaard Skou
- Research Unit for Musculoskeletal Function and Physiotherapy, Institute of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
- The Research Unit PROgrez, Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
| | - Henrik M Schroder
- Department of Orthopaedic Surgery, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
- Department of Regional Health Research, University of Southern Denmark, Odense, Denmark
| | - Susanne Reventlow
- Center for Research and Education in General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Anne Møller
- Center for Research and Education in General Practice, Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Jakob Kjellberg
- VIVE - The Danish Center for Social Science Research, Copenhagen, Denmark
| | - Thomas Kallemose
- Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark
| | - Anders Troelsen
- Clinical Orthopaedic Research Hvidovre (CORH), Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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Omari A, Ingelsrud LH, Bandholm TQ, Lentz SI, Troelsen A, Gromov K. What is the effect of supervised rehabilitation regime vs. self-management instruction following unicompartmental knee arthroplasty? - a pilot study in two cohorts. J Exp Orthop 2021; 8:38. [PMID: 34106345 PMCID: PMC8190216 DOI: 10.1186/s40634-021-00354-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/17/2021] [Accepted: 04/21/2021] [Indexed: 02/07/2023] Open
Abstract
PURPOSE The optimal rehabilitation strategy after a unicompartmental knee arthroplasty (UKA) is unclear. This study aims to compare the effect of transitioning from a supervised to a self-management rehabilitation regime by pilot study of patient outcomes subsequent to UKA surgery. METHODS Fifty consecutive patients scheduled to undergo unilateral UKA surgery at our institution between 22nd February 2016 and 18thof January 2017 were prospectively identified via local medical database and included. Performed UKAs were grouped into two cohorts, Supervised Cohort and Self-management Cohort, temporally separated by introduction of new rehabilitation. Self-management Cohort(n = 25) received an extensive inpatient rehabilitation regime along with outpatient referral to rehabilitation center. The Self-management Cohort(n = 25) were only instructed in use of crutches and free ambulation at own accord. Follow-up (F/U) was 1 year from receiving UKA. A range of outcomes were recorded, and between-cohort differences compared: knee joint range of motion, pain and functional limitations, length of stay (LOS), readmission rate, pain during activity and rest, and knee circumference. RESULTS Complete data was obtained for n = 45 patients. The mean between-cohort difference in ROM (range of motion) from preoperatively to discharge was 15.4 degrees (CI:5.2,25.8, p = 0.004), favoring the supervised regime, with no difference detected in any outcome at 3- or 12 months F/U. Median LOS was 1 day in both cohorts. CONCLUSION Transition to a simple rehabilitation regime following UKA surgery was associated with decreased ROM at discharge, which was not present at 3-month F/U. We found no other between-cohort differences for any other outcomes at 3- and 12-month F/U including functional limitations, although the study was likely underpowered for these outcomes. We encourage large-scale replication of these findings using randomized designs. LEVEL OF EVIDENCE Therapeutic level II.
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Affiliation(s)
- Adam Omari
- University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200, Copenhagen N, Denmark.
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark.
| | - Lina Holm Ingelsrud
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
| | - Thomas Quaade Bandholm
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
- Department of Clinical Research, Copenhagen University Hospital, Amager and Hvidovre, Kettegaard Alle 30, 2650, Hvidovre, Copenhagen, Denmark
- Department of Physical - and Occupational Therapy, Copenhagen University Hospital, Amager and Hvidovre, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
| | - Susanne Irene Lentz
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
| | - Kirill Gromov
- University of Copenhagen, Faculty of Health and Medical Sciences, Blegdamsvej 3B, 2200, Copenhagen N, Denmark
- Department of Orthopedic Surgery, Copenhagen University Hvidovre Hospital, Kettegård Alle 30, 2650, Hvidovre, Copenhagen, Denmark
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Husted CE, Husted H, Ingelsrud LH, Nielsen CS, Troelsen A, Gromov K. Are functional outcomes and early pain affected by discharge on the day of surgery following total hip and knee arthroplasty? Acta Orthop 2021; 92:62-66. [PMID: 33103526 PMCID: PMC7919888 DOI: 10.1080/17453674.2020.1836322] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Outpatient total knee and total hip arthroplasty (TKA and THA) has been shown to be feasible and safe in selected patients. However, little data is available on functional outcome and early pain in patients discharged on the day of surgery (DOS). We investigated patient-reported outcomes at 1 year and early pain in outpatient TKA and THA patients discharged on the day of surgery (DOS) (DDOS) compared with patients scheduled for outpatient surgery but not discharged on the DOS (nDDOS).Patients and methods - Prospective data on 261 consecutive patients scheduled for outpatient TKA (n = 126) and THA (n = 135) were collected. 37% of TKA patients and 33% of THA patients were discharged on the DOS. Pain scores at rest and activity and use of morphine were registered on postoperative days 1-7. Oxford Knee Score (OKS) and Oxford Hip Score (OHS) were collected preoperatively and at 3 and 12 months' follow-up.Results - DDOS and nDDOS patients were similar in respect to age, sex, procedure type (TKA vs. THA), or preoperative OKS or OHS. Neither OKS nor OHS differed between groups at 3 and 12 months' follow-up. Pain at rest and activity and use of morphine did not differ between the 2 groups on days 1-7.Interpretation - In patients scheduled for outpatient TKA and THA, we found similar patient-reported outcomes both early and at 1 year in those discharged on the DOS and those who had at least 1 overnight stay.
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Affiliation(s)
- Christian E Husted
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark,Correspondence:
| | - Henrik Husted
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Lina Holm Ingelsrud
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | | | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
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10
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Puggaard RS, Ingelsrud LH, Jacobsen S, Kjellberg J, Bandholm T, Hölmich P, Boesen M, Bliddal H, Skou ST, Schrøder HM, Larsen SW, Møller A, Ziegler C, Troelsen A. Establishing research priorities related to osteoarthritis care via stakeholder input from patients. Dan Med J 2021; 68:A09200683. [PMID: 33543702] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
INTRODUCTION Stakeholder involvement in research is emphasised to improve relevance. We aimed to identify, define and prioritise important research topics seen from the point of view of people with osteoarthritis (OA). METHODS We invited 1,315 members of the user panel of the Danish Rheumatism Association to answer an electronic survey that included; 1) an open-ended question about important research topics (free-text response option), 2) 15 predefined research topics to be rated for importance and 3) predefined topics grouped into four categories in which the most important was prioritised. Free-text responses were analysed using content analysis. RESULTS Out of 850 (65%) respondents, 483 had OA (mean ± standard deviation age 60.3 ± 10.2 years, 91% female). From the free-text responses, we identified seven research topics; 1) diagnostics, 2) prevention, 3) side effects, 4) treatment, 5) aetiology, 6) being young with OA and 7) quality of life. For "treatment", we identified seven subtopics. Out of all topics and subtopics, "pain management" was the most frequently highlighted. All predefined topics were rated as "very important" or "somewhat important" by more than 75% of the respondents. The top prioritised topics within each category were 1) improving the diagnosis, 2) individualised treatment, 3) shared decision-making and 4) cross-sector collaboration and collaboration between professionals. CONCLUSIONS We identified research topics that were important in the eyes of people with OA and found that "pain management" was particularly emphasised. FUNDING none. TRIAL REGISTRATION not relevant.
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11
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Mikkelsen M, Gao A, Ingelsrud LH, Beard D, Troelsen A, Price A. Categorization of changes in the Oxford Knee Score after total knee replacement: an interpretive tool developed from a data set of 46,094 replacements. J Clin Epidemiol 2020; 132:18-25. [PMID: 33301905 DOI: 10.1016/j.jclinepi.2020.12.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2020] [Revised: 11/25/2020] [Accepted: 12/03/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVES The objective of the study was to create an interpretive categorical classification for the transition in the Oxford Knee Score (OKS) change score (ΔOKS) using the anchor-based method. STUDY DESIGN AND SETTING Registry data from 46,094 total knee replacements from the year 2014/15, were accessed via the Health and Social Care Information Center official website. Data included preoperative and 6-month follow-up OKS and response to the transition anchor question. Categories were determined using Gaussian approximation probability and k-fold cross-validation. RESULTS Four categories were identified with the corresponding ΔOKS intervals: "1. much better" (≥16), "2. a little better" (7-15), "3. about the same" (1-6), and "4. much worse" (≤0) based on the anchor questions' original five categories. The mean 10-fold cross-validation error was 0.35 OKS points (95% confidence interval 0.12 to 0.63). Sensitivity ranged from 0.34 to 0.68; specificity ranged from 0.74 to 0.95. CONCLUSION We have categorized the change score into a clinically meaningful classification. We argue it should be an addition to the continuous OKS outcome to contextualize the results in a way more applicable to the shared decision-making process and for interpreting research results.
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Affiliation(s)
- Mette Mikkelsen
- Dept. of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark.
| | - Anqi Gao
- Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - Lina Holm Ingelsrud
- Dept. of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - David Beard
- Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
| | - Anders Troelsen
- Dept. of Orthopaedic Surgery, Clinical Orthopaedic Research Hvidovre (CORH), Copenhagen University Hospital Hvidovre, Kettegård Alle 30, 2650 Hvidovre, Copenhagen, Denmark
| | - Andrew Price
- Nuffield Dept. of Orthopaedics, Rheumatology and Musculoskeletal Science, University of Oxford, Windmill Road, Headington, Oxford, OX3 7LD, UK
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12
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Galea VP, Ingelsrud LH, Florissi I, Shin D, Bragdon CR, Malchau H, Gromov K, Troelsen A. Patient-acceptable symptom state for the Oxford Hip Score and Forgotten Joint Score at 3 months, 1 year, and 2 years following total hip arthroplasty: a registry-based study of 597 cases. Acta Orthop 2020; 91:372-377. [PMID: 32316804 PMCID: PMC8023959 DOI: 10.1080/17453674.2020.1750877] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Background and purpose - Patient-acceptable symptom states (PASS) represent the level on a patient-reported outcome measure (PROM) at which patients are satisfied with postoperative outcomes. We defined the PASS for the Oxford Hip Score (OHS) and Forgotten Joint Score (FJS-12) at 3-month, 1-year, and 2-year intervals after primary total hip arthroplasty (THA).Patients and methods - Between July 2018 and April 2019, primary THA patients in an academic medical center's registry completed the OHS, FJS-12, and a satisfaction anchor question at 3-month (n = 230), 1-year (n = 180), or 2-year (n = 187) postoperative intervals. PASS thresholds were derived with receiver operating characteristic analysis using the 80% specificity method. 95% confidence intervals (CI) were calculated using 1,000 non-parametric bootstrap replications.Results - 74%, 85%, and 86% of patients reported having a satisfactory symptom state at 3 months, 1, and 2 years after surgery, respectively. At 3-month, 1-year, and 2-year intervals, PASS thresholds were 34 (CI 31-36), 40 (CI 36-44), and 39 (CI 35-42) points for the OHS and 59 (CI 54-64), 68 (CI 61-75), and 69 (CI 62-75) points for the FJS-12.Interpretation - PASS thresholds varied with time for both the OHS and the FJS-12, with lower 3-month compared with 1-year and 2-year thresholds. These PASS thresholds represent OHS and FJS-12 levels at which the average patient is satisfied with THA outcomes, helping to interpret PROMs and serving as clinically significant benchmarks and patient-centered outcomes for research.
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Affiliation(s)
- Vincent P Galea
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA;
| | - Lina Holm Ingelsrud
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark;
| | - Isabella Florissi
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA;
| | - David Shin
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA; ,Correspondence:
| | - Charles R Bragdon
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA; ,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Henrik Malchau
- Harris Orthopaedic Laboratory, Massachusetts General Hospital, Boston, MA, USA; ,Department of Orthopaedic Surgery, Harvard Medical School, Boston, MA, USA
| | - Kirill Gromov
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark;
| | - Anders Troelsen
- Department of Orthopedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark;
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13
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Terluin B, Griffiths P, van der Wouden JC, Ingelsrud LH, Terwee CB. Unlike ROC analysis, a new IRT method identified clinical thresholds unbiased by disease prevalence. J Clin Epidemiol 2020; 124:118-125. [PMID: 32438022 DOI: 10.1016/j.jclinepi.2020.05.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Revised: 03/30/2020] [Accepted: 05/06/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE This study introduces a new method to establish clinical thresholds for multi-item tests, based on item response theory (IRT), as an alternative to receiver operating characteristic (ROC) analysis. The performance of IRT method was examined and compared with the ROC method across multiple simulated data sets and in a real data set. STUDY DESIGN AND SETTING Simulated data sets (sample size: 1,000) varied in means and variability of the test scores and the prevalence of disease. The true clinical threshold was defined as a predetermined location on the latent trait underlying the questionnaire, with its corresponding expected test score. The real data set (sample size: 295) comprised Hospital Anxiety Depression Scale (HADS) depression scores and Diagnostic and Statistical Manual of Mental Disorders-Fourth Edition major depressive disorder (MDD) diagnoses. RESULTS The IRT method recovered the clinical thresholds without bias, whereas the ROC method identified thresholds that were biased by the prevalence of disease. Mild MDD was clinically diagnosed in 23%, moderate MDD in 12%, and severe MDD in 14% of the participants. The IRT method identified the following HADS depression score thresholds for mild, moderate, and severe MDD: 10.7, 13.2, and 15.1, respectively. CONCLUSION The new IRT method identifies clinical thresholds that are unbiased by disease prevalence.
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Affiliation(s)
- Berend Terluin
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
| | - Philip Griffiths
- Adelphi Values, Adelphi Mill, Bollington, Cheshire, SK10 5JB, UK
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
| | - Lina Holm Ingelsrud
- Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, Amsterdam Public Health research institute, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands
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14
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Roos EM, Boyle E, Frobell RB, Lohmander LS, Ingelsrud LH. It is good to feel better, but better to feel good: whether a patient finds treatment 'successful' or not depends on the questions researchers ask. Br J Sports Med 2019; 53:1474-1478. [PMID: 31072841 DOI: 10.1136/bjsports-2018-100260] [Citation(s) in RCA: 35] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Revised: 02/08/2019] [Accepted: 04/09/2019] [Indexed: 11/03/2022]
Abstract
INTRODUCTION In sports physiotherapy, medicine and orthopaedic randomised controlled trials (RCT), the investigators (and readers) focus on the difference between groups in change scores from baseline to follow-up. Mean score changes are difficult to interpret ('is an improvement of 20 units good?'), and follow-up scores may be more meaningful. We investigated how applying three different responder criteria to change and follow-up scores would affect the 'outcome' of RCTs. Responder criteria refers to participants' perceptions of how the intervention affected them. METHODS We applied three different criteria-minimal important change (MIC), patient acceptable symptom state (PASS) and treatment failure (TF)-to the aggregate Knee injury and Osteoarthritis Outcome Score (KOOS4) and the five KOOS subscales, the primary and secondary outcomes of the KANON trial (ISRCTN84752559). This trial included young active adults with an acute ACL injury and compared two treatment strategies: exercise therapy plus early reconstructive surgery, and exercise therapy plus delayed reconstructive surgery, if needed. RESULTS MIC: At 2 years, more than 90% in the two treatment arms reported themselves to be minimally but importantly improved for the primary outcome KOOS4. PASS: About 50% of participants in both treatment arms reported their KOOS4 follow-up scores to be satisfactory. TF: Almost 10% of participants in both treatment arms found their outcomes so unsatisfactory that they thought their treatment had failed. There were no statistically significant or meaningful differences between treatment arms using these criteria. CONCLUSION We applied change criteria as well as cross-sectional follow-up criteria to interpret trial outcomes with more clinical focus. We suggest researchers apply MIC, PASS and TF thresholds to enhance interpretation of KOOS and other patient-reported scores. The findings from this study can improve shared decision-making processes for people with an acute ACL injury.
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Affiliation(s)
- Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Richard B Frobell
- Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lunds Universitet, Lund, Sweden
| | - L Stefan Lohmander
- Orthopaedics, Department of Clinical Sciences Lund, Faculty of Medicine, Lunds Universitet, Lund, Sweden
| | - Lina Holm Ingelsrud
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Hvidovre, Denmark
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15
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Thorlund JB, Rodriguez Palomino J, Juhl CB, Ingelsrud LH, Skou ST. Infographic. Exercise therapy for meniscal tears: evidence and recommendations. Br J Sports Med 2018; 53:315-316. [PMID: 29936433 DOI: 10.1136/bjsports-2018-099492] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/08/2018] [Indexed: 11/04/2022]
Affiliation(s)
- Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Jorge Rodriguez Palomino
- La Trobe Sports and Exercise Medicine Research Centre, School of Allied Health, La Trobe University, Bundoora, Victoria, Australia
| | - Carsten B Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Occupational and Physical Therapy, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Lina Holm Ingelsrud
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Orthopedics, Copenhagen University Hospital, Hvidovre, Denmark
| | - Søren Thorgaard Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
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16
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Ingelsrud LH, Terwee CB, Terluin B, Granan LP, Engebretsen L, Mills KAG, Roos EM. Meaningful Change Scores in the Knee Injury and Osteoarthritis Outcome Score in Patients Undergoing Anterior Cruciate Ligament Reconstruction. Am J Sports Med 2018. [PMID: 29517924 DOI: 10.1177/0363546518759543] [Citation(s) in RCA: 66] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND Meaningful change scores in the Knee injury and Osteoarthritis Outcome Score (KOOS) in patients undergoing anterior cruciate ligament (ACL) reconstruction have not yet been established. PURPOSE To define the minimal important change (MIC) for the KOOS after ACL reconstruction. STUDY DESIGN Cohort study (diagnosis); Level of evidence, 2. METHODS KOOS and anchor questions with 7-point scales ranging from "better, an important improvement" to "worse, an important worsening" were completed postoperatively by randomly chosen participants from the Norwegian Knee Ligament Registry. Presurgery KOOS scores were retrieved from the registry. The MIC for improvement was calculated with anchor-based approaches using the predictive modeling method adjusted for the proportion of improved patients, the mean change method, and the receiver operating characteristic (ROC) method. RESULTS Complete data for at least one of the KOOS subscales were obtained from 542 (45.3%) participants. Predictive modeling MIC values were 12.1 for the KOOS subscales of Sport and Recreational Function and 18.3 for Knee-Related Quality of Life. These values aid in interpreting within-group improvement over time and can be used as responder criteria when comparing groups. The corresponding and much lower values for the subscales of Pain (2.5), Symptoms (-1.2), and Activities of Daily Living (2.4) are the results from patients reporting, on average, only mild problems with these domains preoperatively. Although 4% to 10% of patients reported subscale-specific worsening, MIC deterioration calculations were not possible. The ROC MIC values were associated with high degrees of misclassification. Values obtained by the mean change method were considered less reliable because these estimates are derived from subgroups of patients. Average KOOS change scores were approximately similar for patients reporting acceptable symptoms postoperatively and patients reporting important improvements on the anchor items after surgery. CONCLUSION KOOS users should apply subscale-specific cutoffs for meaningful improvement. Our results confirm using the subscales of Sport and Recreational Function and Knee-Related Quality of Life as primary patient-reported outcomes after ACL reconstruction. The predictive modeling approach gave the most robust estimates of MIC values. Our data suggest that reporting acceptable symptoms postoperatively corresponds to reporting an important improvement after ACL reconstruction.
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Affiliation(s)
- Lina Holm Ingelsrud
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital Hvidovre, Copenhagen, Denmark
| | - Caroline B Terwee
- Department of Epidemiology and Biostatistics, VU University Medical Center, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
| | - Berend Terluin
- Department of General Practice and Elderly Care Medicine, VU University Medical Center, Amsterdam, the Netherlands
| | - Lars-Petter Granan
- Department of Pain Management and Research, Division of Emergencies and Critical Care, Oslo University Hospital, Oslo, Norway
| | - Lars Engebretsen
- Oslo Sports Trauma Research Center, Norwegian School of Sport Sciences, Oslo, Norway.,Department of Orthopaedic Surgery, Oslo University Hospital and Faculty of Medicine, University of Oslo, Norway
| | - Kathryn A G Mills
- Department of Health Professions, Macquarie University, Sydney, Australia
| | - Ewa M Roos
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
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17
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Thorlund JB, Juhl CB, Ingelsrud LH, Skou ST. Risk factors, diagnosis and non-surgical treatment for meniscal tears: evidence and recommendations: a statement paper commissioned by the Danish Society of Sports Physical Therapy (DSSF). Br J Sports Med 2018; 52:557-565. [PMID: 29420236 DOI: 10.1136/bjsports-2017-098429] [Citation(s) in RCA: 20] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/09/2018] [Indexed: 01/08/2023]
Abstract
This statement aimed at summarising and appraising the available evidence for risk factors, diagnostic tools and non-surgical treatments for patients with meniscal tears. We systematically searched electronic databases using a pragmatic search strategy approach. Included studies were synthesised quantitatively or qualitatively, as appropriate. Strength of evidence was determined according to the Grading of Recommendations Assessment Development and Evaluation framework. Low-quality evidence suggested that overweight (degenerative tears, k=3), male sex (k=4), contact and pivoting sports (k=2), and frequent occupational kneeling/squatting (k=3) were risk factors for meniscal tears. There was low to moderate quality evidence for low to high positive and negative predictive values, depending on the underlying prevalence of meniscal tears for four common diagnostic tests (k=15, n=2474). Seven trials investigated exercise versus surgery (k=2) or the effect of surgery in addition to exercise (k=5) for degenerative meniscal tears. There was moderate level of evidence for exercise improving self-reported pain (Effect Size (ES)-0.51, 95% CI -1.16 to 0.13) and function (ES -0.06, 95% CI -0.23 to 0.11) to the same extent as surgery, and improving muscle strength to a greater extent than surgery (ES -0.45, 95% CI -0.62 to -0.29). High-quality evidence showed no clinically relevant effect of surgery in addition to exercise on pain (ES 0.18, 95% 0.05 to 0.32) and function (ES, 0.13 95% CI -0.03 to 0.28) for patients with degenerative meniscal tears. No randomised trials comparing non-surgical treatments with surgery in patients younger than 40 years of age or patients with traumatic meniscal tears were identified. Diagnosis of meniscal tears is challenging as all clinical diagnostic tests have high risk of misclassification. Exercise therapy should be recommended as the treatment of choice for middle-aged and older patients with degenerative meniscal lesions. Evidence on the best treatment for young patients and patients with traumatic meniscal tears is lacking.
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Affiliation(s)
- Jonas Bloch Thorlund
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Carsten Bogh Juhl
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Rehabilitation, Copenhagen University Hospital, Herlev and Gentofte, Denmark
| | - Lina Holm Ingelsrud
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Orthopaedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark
| | - Søren Thorgaard Skou
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.,Department of Physiotherapy and Occupational Therapy, Næstved-Slagelse-Ringsted Hospitals, Region Zealand, Denmark
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18
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Jønsson LR, Ingelsrud LH, Tengberg LT, Bandholm T, Foss NB, Kristensen MT. Physical performance following acute high-risk abdominal surgery: a prospective cohort study. Can J Surg 2018; 61:42-49. [PMID: 29368676 PMCID: PMC5785288] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/08/2017] [Indexed: 11/13/2023] Open
Abstract
BACKGROUND Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). METHODS Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization. RESULTS Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. CONCLUSION Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.
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Affiliation(s)
- Line Rokkedal Jønsson
- From the Physical Medicine & Rehabilitation Research — Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Lina Holm Ingelsrud
- From the Physical Medicine & Rehabilitation Research — Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Line Toft Tengberg
- From the Physical Medicine & Rehabilitation Research — Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Thomas Bandholm
- From the Physical Medicine & Rehabilitation Research — Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Nicolai Bang Foss
- From the Physical Medicine & Rehabilitation Research — Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Morten Tange Kristensen
- From the Physical Medicine & Rehabilitation Research — Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
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Jønsson LR, Ingelsrud LH, Tengberg LT, Bandholm T, Foss NB, Kristensen MT. Physical performance following acute high-risk abdominal surgery: a prospective cohort study. Can J Surg 2017. [PMID: 29368676 DOI: 10.1503/cjs.012616] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND Acute high-risk abdominal (AHA) surgery is associated with high mortality, multiple postoperative complications and prolonged hospital stay. Further development of strategies for enhanced recovery programs following AHA surgery is needed. The aim of this study was to describe physical performance and barriers to independent mobilization among patients who received AHA surgery (postoperative days [POD] 1-7). METHODS Patients undergoing AHA surgery were consecutively enrolled from a university hospital in Denmark. In the first postoperative week, all patients were evaluated daily with regards to physical performance, using the Cumulated Ambulation Score (CAS; 0-6 points) to assess basic mobility and the activPAL monitor to assess the 24-hour physical activity level. We recorded barriers to independent mobilization. RESULTS Fifty patients undergoing AHA surgery (mean age 61.4 ± 17.2 years) were included. Seven patients died within the first postoperative week, and 15 of 43 (35%) patients were still not independently mobilized (CAS < 6) on POD-7, which was associated with pulmonary complications developing (53% v. 14% in those with CAS = 6, p = 0.012). The patients lay or sat for a median of 23.4 hours daily during the first week after AHA surgery, and the main barriers to independent mobilization were fatigue and abdominal pain. CONCLUSION Patients who receive AHA surgery have very limited physical performance in the first postoperative week. Barriers to independent mobilization are primarily fatigue and abdominal pain. Further studies investigating strategies for early mobilization and barriers to mobilization in the immediate postoperative period after AHA surgery are needed.
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Affiliation(s)
- Line Rokkedal Jønsson
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Lina Holm Ingelsrud
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Line Toft Tengberg
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Thomas Bandholm
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Nicolai Bang Foss
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
| | - Morten Tange Kristensen
- From the Physical Medicine & Rehabilitation Research -Copenhagen (PMR-C), Department of Physiotherapy and Occupational Therapy, Copenhagen University Hospital, Hvidovre, Denmark (Jønsson, Bandholm, Kristensen); the Department of Orthopedic Surgery, Copenhagen University Hospital, Hvidovre, Denmark (Ingelsrud, Tange Kristensen); the Gastro Unit Surgical Division, Copenhagen University Hospital, Hvidovre, Denmark, and the Department of Surgery, Zealand University Hospital, Køge, Denmark (Tengberg); the Clinical Research Centre, Copenhagen University Hospital, Hvidovre, Denmark (Bandholm); and the Department of Anesthesiology and Intensive Care Medicine, Copenhagen University Hospital, Hvidovre, Denmark (Foss)
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