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Williamson TR, Kay RS, Robinson PG, Murray AD, Clement ND. Epidemiology of musculoskeletal injury in professional and amateur golfers: a systematic review and meta-analysis. Br J Sports Med 2024:bjsports-2023-107324. [PMID: 38508702 DOI: 10.1136/bjsports-2023-107324] [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] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/12/2024] [Indexed: 03/22/2024]
Abstract
OBJECTIVE To determine the prevalence and incidence of musculoskeletal injury in amateur and professional golfers, and to identify common injury sites and factors associated with increased injury frequency. DESIGN Systematic epidemiological review and meta-analysis. DATA SOURCES PubMed (Medline), Embase, the Cochrane Library and SPORTDiscus were searched in September 2023. ELIGIBILITY CRITERIA Studies published in the English language reporting the incidence or prevalence of musculoskeletal injuries in golfers at all anatomical sites. RESULTS 20 studies (9221 golfers, 71.9% male, 28.1% female) were included, with mean age 46.8 years. Lifetime injury prevalence was significantly greater in professional golfers (73.5% (95% CI: 47.3% to 93.0%)) than amateur golfers (56.6% (95% CI: 47.4% to 65.5%); relative risk (RR)=1.50, p<0.001). Professional golfers had a significantly greater lifetime prevalence of hand and wrist (RR=3.33, p<0.001) and lower back injury (RR=3.05, p<0.001). Soft tissue injuries were most common, and diagnoses were typically non-specific. Injury frequency was not associated with age or sex. Two studies reported a greater injury risk in amateur golfers playing more than three and four rounds per week. CONCLUSION Over half of golfers are at risk of sustaining a musculoskeletal injury during their lifetime. Risks and patterns of injury differ between professional and amateur golfers, with professionals significantly more likely to develop lower back, and hand and wrist injuries. A recent international consensus statement on the reporting of injury and illness in golf should aid consistency in future research assessing the epidemiology of specific diagnoses, informing golf injury prevention and management strategies. PROSPERO REGISTRATION NUMBER CRD42023408738.
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Affiliation(s)
| | - Robert S Kay
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- PGA European Tour Performance Institute, Virginia Water, UK
- Edinburgh Sports Medicine Research Network & UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), IOC Research Centre, University of Edinburgh, Edinburgh, UK
| | - Andrew D Murray
- PGA European Tour Performance Institute, Virginia Water, UK
- Edinburgh Sports Medicine Research Network & UK Collaborating Centre on Injury and Illness Prevention in Sport (UKCCIIS), IOC Research Centre, University of Edinburgh, Edinburgh, UK
- Medical and Scientific Department, The R&A, St Andrews, UK
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2
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Broomhead T, Gibson BJ, Parkinson C, Robinson PG, Vettore MV, Baker SR. Development and psychometric validation of the gum health experience questionnaire. J Clin Periodontol 2024; 51:33-42. [PMID: 37735867 DOI: 10.1111/jcpe.13878] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2023] [Revised: 07/10/2023] [Accepted: 08/31/2023] [Indexed: 09/23/2023]
Abstract
AIM To develop and validate a new health-related quality of life measure to capture a wide range of gum-related impacts. MATERIALS AND METHODS The measure was developed using a multi-stage approach and a theoretical model. Development involved semi-structured interviews, pilot testing, cross-sectional analysis among a general population (n = 152) to assess psychometric properties and test-retest reliability among a subsample (n = 27). RESULTS Psychometric analysis supports the validity and reliability of the measure's impact scale. The measure has excellent internal reliability (nearly all item-total correlations above .4; Cronbach's alpha between .84 and .91 for subscales), with test-retest reliability also performing well (Intra-class correlation coefficient [ICC] of .91-.97 for subscales). Good content validity (indicated by large standard deviations for item and total scores) and construct validity (correlations of .54-.73 with global gum health rating for subscales, all p < .05) were also observed. Qualitative and quantitative data indicate that people with gum health-related symptoms experience different degrees of discomfort and impacts caused by their condition. CONCLUSIONS The gum health experience questionnaire holds substantial promise as a measure of gum-related quality of life in people across the gum health-disease continuum. Further face validity, refining and reducing the number of items and longitudinal studies to test evaluative properties are required before the measure can be used with confidence.
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Affiliation(s)
- T Broomhead
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - B J Gibson
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | | | - P G Robinson
- Bristol Dental School, University of Bristol, Bristol, UK
| | - M V Vettore
- Department of Health and Nursing Sciences, Universitet i Agder, Kristiansand, Norway
| | - S R Baker
- Unit of Oral Health, Dentistry and Society, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
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3
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Robinson PG, Carson HJ, Richards J, Murray A, Duckworth AD, Campbell D. What differences exist between the lead and trail wrist in extensor carpi ulnaris activity and golf swing joint kinematics in sub-elite golfers? J Sports Sci 2023; 41:1596-1604. [PMID: 37983261 DOI: 10.1080/02640414.2023.2285121] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Accepted: 11/11/2023] [Indexed: 11/22/2023]
Abstract
This study assessed the lead and trail arm peak and average extensor carpi ulnaris (ECU) muscle activity in association with tri-planar angular velocities of the lead and trail wrists during the golf swing. Fifteen sub-elite, male right-handed golfers (Mage = 34.7 years ±13.3, Mhandicap = 1.5 ± 2.2) were recruited to execute five shots each with their pitching wedge, 7-iron and driver clubs in an indoor golf simulator. Surface electromyography (EMG) sensors were placed over the ECU muscle belly and inertial measurement unit sensors were placed bi-laterally on the distal forearm and dorsum of the hand. There was a statistically greater recruitment of the trail ECU muscle during the downswing (p < 0.001) for all clubs. The lead ECU muscle was recruited more during the backswing (p < 0.001) and follow through (p < 0.024) phases. There were statistically different tri-planar movement patterns between the lead and trail wrist throughout all three phases of the golf swing. No significant relationships were found between downswing EMG data and clubhead kinematics at impact. In conclusion, differing wrist kinematics and associated muscle activity may contribute to the asymmetrical injury pattern seen clinically.
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Affiliation(s)
- Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, UK
- European Tour Health and Performance Institute, Virginia, UK
| | - Howie J Carson
- Human Performance Science Research Group, Institute for Sport, Physical Education and Health Sciences, Moray House School of Education and Sport, The University of Edinburgh, Edinburgh, UK
| | - Jim Richards
- Allied Health Research unit, Faculty of Allied Health and Wellbeing, University of Central Lancashire, Preston, UK
| | - Andrew Murray
- European Tour Health and Performance Institute, Virginia, UK
- Medical Commission, International Golf Federation, Lausanne, Switzerland
- UK Collaborating Centre for Illness and Injury Prevention in Sport - International Olympic Committee Research Centre, University of Edinburgh, UK
| | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, UK
- UK Collaborating Centre for Illness and Injury Prevention in Sport - International Olympic Committee Research Centre, University of Edinburgh, UK
- Usher Institute, University of Edinburgh, Edinburgh, UK
| | - Doug Campbell
- European Tour Health and Performance Institute, Virginia, UK
- Spire Leeds Hospital, Leeds, UK
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4
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Robinson PG, Creighton AP, Cheng J, Dines JS, Su EP, Gulotta LV, Padgett D, Demetracopoulos C, Hawkes R, Prather H, Press JM, Clement ND. Golfing after Orthopaedic Surgery: A longitudinal follow-up (GOLF) study protocol. Bone Jt Open 2023; 4:490-495. [PMID: 37400089 DOI: 10.1302/2633-1462.47.bjo-2022-0156.r1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/05/2023] Open
Abstract
Aims The primary aim of this prospective, multicentre study is to describe the rates of returning to golf following hip, knee, ankle, and shoulder arthroplasty in an active golfing population. Secondary aims will include determining the timing of return to golf, changes in ability, handicap, and mobility, and assessing joint-specific and health-related outcomes following surgery. Methods This is a multicentre, prospective, longitudinal study between the Hospital for Special Surgery, (New York City, New York, USA) and Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, (Edinburgh, UK). Both centres are high-volume arthroplasty centres, specializing in upper and lower limb arthroplasty. Patients undergoing hip, knee, ankle, or shoulder arthroplasty at either centre, and who report being golfers prior to arthroplasty, will be included. Patient-reported outcome measures will be obtained at six weeks, three months, six months, and 12 months. A two-year period of recruitment will be undertaken of arthroplasty patients at both sites. Conclusion The results of this prospective study will provide clinicians with accurate data to deliver to patients with regard to the likelihood of return to golf and timing of when they can expect to return to golf following their hip, knee, ankle, or shoulder arthroplasty, as well as their joint-specific functional outcomes. This will help patients to manage their postoperative expectations and plan their postoperative recovery pathway.
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Affiliation(s)
- Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- European Tour Performance Institute, Virginia Water, UK
| | | | - Jennifer Cheng
- Hospital for Special Surgery, New York City, New York, USA
| | - Joshua S Dines
- Hospital for Special Surgery, New York City, New York, USA
| | - Edwin P Su
- Hospital for Special Surgery, New York City, New York, USA
| | | | | | | | | | - Heidi Prather
- Hospital for Special Surgery, New York City, New York, USA
| | - Joel M Press
- Hospital for Special Surgery, New York City, New York, USA
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- European Tour Performance Institute, Virginia Water, UK
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Williamson TR, Robinson PG, Murray IR, Murray AD, McBirnie JM, Robinson CM, MacDonald DJ, Clement ND. Golf participation after rotator cuff repair: functional outcomes, rate of return and factors associated with return to play. Clin Shoulder Elb 2023:cise.2022.01361. [PMID: 37088878 DOI: 10.5397/cise.2022.01361] [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] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Accepted: 02/01/2023] [Indexed: 04/25/2023] Open
Abstract
Background Golf is a popular sport involving overhead activity and engagement of the rotator cuff (RC). This study aimed to determine to what level golfers were able to return to golf following RC repair, the barriers to them returning to golf and factors associated with their failure to return to golf. Methods Patients preoperatively identifying as golfers undergoing RC repair at the study centre from 2012 to 2020 were retrospectively followed up with to assess their golf-playing status, performance and frequency of play and functional and quality of life (QoL) outcomes. Results Forty-seven golfers (40 men [85.1%] and 7 women [14.9%]) with a mean age of 56.8 years met the inclusion criteria, and 80.1% were followed up with at a mean of 27.1 months postoperatively. Twenty-nine patients (76.3%) had returned to golf with a mean handicap change of +1.0 (P=0.291). Golf frequency decreased from a mean of 1.8 rounds per week preinjury to 1.5 rounds per week postoperatively (P=0.052). The EuroQol 5-dimension 5-level (EQ-5D-5L) index and visual analog scale (EQ-VAS) score were significantly greater in those returning to golf (P=0.024 and P=0.002), although functional outcome measures were not significantly different. The primary barriers to return were ipsilateral shoulder dysfunction (78%) and loss of the habit of play (22%). Conclusions Golfers were likely (76%) to return to golf following RC repair, including mostly to their premorbid performance level with little residual symptomatology. Return to golf was associated with a greater QoL. Persistent subjective shoulder dysfunction (78%) was the most common barrier to returning to golf. Level of evidence: Level IV.
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Affiliation(s)
- Thomas R Williamson
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, UK
- PGA European Tour Performance Institute, Virginia Water, UK
| | - Iain R Murray
- College of Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, UK
| | - Andrew D Murray
- PGA European Tour Performance Institute, Virginia Water, UK
- Medical and Scientific Department, The R&A, St. Andrews, UK
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6
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Pleasant HF, Robinson PG, Robinson CM, Nicholson JA. Delayed acromioclavicular joint reconstruction using a modern suspensory device does not increase the risk of fixation failure or major complications. J Shoulder Elbow Surg 2022; 31:2570-2577. [PMID: 35781084 DOI: 10.1016/j.jse.2022.05.020] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/15/2022] [Revised: 05/06/2022] [Accepted: 05/23/2022] [Indexed: 02/01/2023]
Abstract
BACKGROUND Management of displaced acromioclavicular joint (ACJ) injuries remains contentious. It is unclear if delayed vs. acute reconstruction has an increased risk of fixation failure and complications. The primary aim of this study was to compare complications of early vs. delayed reconstruction. The secondary aim was to determine modes of failure of ACJ reconstruction requiring revision surgery. METHODS A retrospective study was performed on all patients who underwent operative reconstruction of ACJ injuries over a 10-year period (Rockwood III-V) using suspensory devices with or without hamstring allograft. Reconstruction was classed as early (<12 weeks from injury) or delayed (≥12 weeks). Patient demographics, fixation method, and postoperative complications were noted, with 1-year follow-up a minimum requirement for inclusion. Patient-reported outcomes with the Disabilities of the Arm, Shoulder, and Hand score and EuroQol-5 Dimension were undertaken. Fixation failure was defined as loss of reduction requiring revision surgery. RESULTS A total of 104 patients were analyzed (n = 59 early and n = 45 delayed). The mean age was 42.0 (standard deviation: 11.2; 17-70 years); 84.6% were male and 15.4% were smokers. No difference was observed between fixation failure (P = .39) or deep infection (P = .13) with regard to acute vs. delayed reconstruction. No patient demographic or timing of surgery was predictive of fixation failure on regression modeling. Overall, 11 patients underwent revision surgery for loss of reduction and implant failure (n = 5 suture fatigue, n = 2 endobutton escape, n = 2 coracoid stress fracture, and n = 2 deep infection). The EuroQol-5 Dimension (P = .084) and Disabilities of the Arm, Shoulder, and Hand score (P = .062) were comparable for early and delayed groups respectively and below the minimal clinically important difference. CONCLUSION This study found that delayed surgical management of ACJ injuries using a modern device has comparable functional outcomes and is not associated with a higher incidence of fixation failure or major complications.
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Affiliation(s)
| | | | | | - Jamie A Nicholson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
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7
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Robinson PG, Lu H, Williamson T, Maempel JF, Murray I, MacDonald DJ, Hamilton DF, Gaston P. Do the outcomes of hip arthroscopy for femoroacetabular impingement change over time? Orthop Traumatol Surg Res 2022; 108:103157. [PMID: 34856404 DOI: 10.1016/j.otsr.2021.103157] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2021] [Revised: 11/05/2021] [Accepted: 11/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND The purpose of this study was to search for changes in functional outcomes of patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) between short and medium-term follow-up. Secondary aims included reporting rates of revision surgery and total hip arthroplasty (THA) at medium-term follow-up. HYPOTHESIS We hypothesised that patients' functional outcomes would improve between short and medium-term follow-up. PATIENTS AND METHODS Consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement with labral tears between February 2013 and June 2015 were included. Twelve item international hip outcome tool (iHOT-12) and EuroQol 5D-5L (EQ-5D) scores were collected preoperatively, at short-term and medium-term follow-up. Short-term scores were recorded at a minimum of one year postoperatively and medium-term scores at a minimum of five years postoperatively. Survivorship was assessed with Kaplan-Meier analysis. RESULTS Short-term outcome data (at median follow-up 1.6 year, Interquartile range [IQR] 1-2.5) was available for 70 of 87 patients (80.5%) and medium-term outcome data (at median follow-up of 6.5 years, IQR 6-7.1) was available for 68 patients (78.2%). Median age at the time of surgery was 31 years (IQR 25-37). The median iHOT-12 scores at short and medium-term follow-up were 72 (IQR 48.75-91.25) and 85.8 (IQR 66.7-96.7) respectively (p<0.001). Medium-term survivorship was 91.2%. Survivorship following labral repair was 94.2%, and 81.3% following labral debridement (p=0.09). DISCUSSION Patients undergoing hip arthroscopy for FAI reported continued improvement in iHOT-12 scores between short and medium-term follow-up. Medium-term survivorship following FAI surgery may be greater when the labrum is repaired, although comparisons are limited by their differing indications. Conversion to THA was low with just 4 patients (4.6%) undergoing or being listed for THA at final follow-up. LEVEL OF EVIDENCE IV, Case series.
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Affiliation(s)
| | - Helen Lu
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Tom Williamson
- Edinburgh Medical School, The University of Edinburgh, Edinburgh, UK
| | - Julian F Maempel
- Department of Trauma & Orthopaedics, Mater Dei Hospital, Msida, Malta
| | - Iain Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - David F Hamilton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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8
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Martin H, Robinson PG, Maempel JF, Hamilton D, Gaston P, Safran MR, Murray IR. Pre- and intraoperative decision-making challenges in hip arthroscopy for femoroacetabular impingement. Bone Joint J 2022; 104-B:532-540. [PMID: 35491576 DOI: 10.1302/0301-620x.104b5.bjj-2021-1553.r1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
There has been a marked increase in the number of hip arthroscopies performed over the past 16 years, primarily in the management of femoroacetabular impingement (FAI). Insights into the pathoanatomy of FAI, and high-level evidence supporting the clinical effectiveness of arthroscopy in the management of FAI, have fuelled this trend. Arthroscopic management of labral tears with repair may have superior results compared with debridement, and there is now emerging evidence to support reconstructive options where repair is not possible. In situations where an interportal capsulotomy is performed to facilitate access, data now support closure of the capsule in selective cases where there is an increased risk of postoperative instability. Preoperative planning is an integral component of bony corrective surgery in FAI, and this has evolved to include computer-planned resection. However, the benefit of this remains controversial. Hip instability is now widely accepted, and diagnostic criteria and treatment are becoming increasingly refined. Instability can also be present with FAI or develop as a result of FAI treatment. In this annotation, we outline major current controversies relating to decision-making in hip arthroscopy for FAI. Cite this article: Bone Joint J 2022;104-B(5):532-540.
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Affiliation(s)
- Hannah Martin
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | | | - David Hamilton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Paul Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
| | - Marc R Safran
- Department of Orthopaedic Surgery, Stanford University, Redwood City, California, USA
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, The University of Edinburgh, Edinburgh, UK
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Duncumb JW, Robinson PG, Williamson TR, Murray IR, Campbell D, Molyneux SG, Duckworth AD. Bone grafting for scaphoid nonunion surgery : a systematic review and meta-analysis. Bone Joint J 2022; 104-B:549-558. [PMID: 35491585 DOI: 10.1302/0301-620x.104b5.bjj-2021-1114.r1] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AIMS The purpose of this systematic review was to determine the rates of union for vascularized versus non-vascularized grafting techniques in the operative management of scaphoid nonunion. Secondary aims were to determine the effect of the fixation techniques used, the source of grafting, as well as the influence of fracture location (proximal pole) and avascular necrosis (AVN). METHODS A search of PubMed, MEDLINE, and Embase was performed in June 2021 using the Preferred Reporting Items for Systematic Review and Meta-Analyses statement and registered using the PROSPERO International prospective register of systematic reviews. The primary outcome was union rate. RESULTS There were 78 studies that met the inclusion criteria with a total of 7,671 patients (87.8% male, 12.2% female). The mean age was 27.9 years (SD 3.8) and the mean follow-up was 30.9 months (SD 25.9). The mean union rate was 88.7% (95% confidence interval (CI) 85.0 to 92.5) for non-vascularized grafts versus 87.5% (95% CI 82.8 to 92.2) for vascularized grafts (p = 0.685). Pooled analysis of trial data alone found a mean union rate of 82.4% (95% CI 66.9% to 97.9%) for non-vascularized grafts and 89.4% (95% CI 84.1% to 94.7%) for vascularized grafts (p = 0.780). No significant difference was observed in union rates between any of the fixation techniques used in the studies (p = 0.502). Distal radius and iliac crest graft source had comparable mean union rates (86.9% (95% CI 83.1 to 90.7) vs 87.6% (95% CI 82.2 to 92.9); p = 0.841). Studies that excluded patients with both proximal pole fractures and AVN (n = 14) had a mean union rate of 96.5% (95% CI 94.2 to 98.9) that was significantly greater than the mean union rate of 86.8% (95% CI 83.2 to 90.4) observed in the remaining studies (p < 0.001). CONCLUSION Current evidence suggests vascularized bone grafting does not yield significantly superior results to non-vascularized grafting in scaphoid nonunion management. However, potential selection bias lessens the certainty of these findings. The fixation type or source of the graft used was not found to influence union rates either. Sufficiently designed and powered prospective randomized controlled trials in this area are needed. Cite this article: Bone Joint J 2022;104-B(5):549-558.
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Affiliation(s)
- Joseph W Duncumb
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Tom R Williamson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | | | - Andrew D Duckworth
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Usher Institute, University of Edinburgh, Edinburgh, UK
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10
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Robinson PG, Kay RS, MacDonald D, Murray AD, Clement ND. Golfers have greater preoperative and equal postoperative function when undergoing total knee arthroplasty compared to non-golfers. Eur J Orthop Surg Traumatol 2022; 33:1083-1089. [PMID: 35362779 PMCID: PMC8973671 DOI: 10.1007/s00590-022-03253-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Accepted: 03/15/2022] [Indexed: 11/30/2022]
Abstract
Background Approximately 10% to 20% of patients with joint arthroplasties are golfers. The aim of this study was to assess if being a golfer is associated with functional outcomes, satisfaction or improvement in quality of life (QoL) compared to non-golfers following total knee arthroplasty. Methods All patients undergoing primary total knee arthroplasty (TKA) over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on postoperative function and health-related outcomes. Results The study cohort consisted of a total of 514 patients undergoing TKA. This included 223 (43.3%) male patients and 291 (56.7%) female patients, with an overall mean age of 70 (SD 9.5) years. The preoperative Oxford Knee Score (OKS) was significantly higher in golfers when adjusting for confounders (Diff 3.4 [95% CI 1 to 5.8], p = 0.006). There was no difference in postoperative outcomes between golfers and non-golfers. There was however a trend towards a higher Forgotten Joint Score (FJS) in the golfers (difference 9.3, 95% CI − 0.2 to 18.8, p = 0.056). Of the 48 patients who reported being golfers at the time of their surgery, 43 (89.6%) returned to golf and 88.4% of those were satisfied with their involvement in golf following surgery. Conclusions Golfers had better preoperative and equal postoperative knee specific function compared to non-golfers. The majority of golfers returned to golf by one year and were satisfied with their involvement in the game. Level of evidence III.
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Affiliation(s)
- P G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,PGA European Tour Performance Institute, Virginia Water, UK
| | - R S Kay
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK.
| | - D MacDonald
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - A D Murray
- PGA European Tour Performance Institute, Virginia Water, UK.,Sports and Exercise Medicine, University of Edinburgh, Edinburgh, UK.,Medical and Scientific Department, The R&A, St. Andrews, UK
| | - N D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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11
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Robinson PG. Editorial - Going forward, not straight. Community Dent Health 2022; 39:3. [PMID: 35235721 DOI: 10.1922/cdh_march22editorial01] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 02/03/2022] [Indexed: 06/14/2023]
Abstract
Welcome to the first issue of Community Dental Health to be published online only. The journal has been marching ahead now for many years and has reached unprecedented levels of recognition in several aspects of quality. Our Impact Factor (a measure of how often our papers are cited) has risen to its highest ever level of 1.349. A record 383 manuscripts were submitted last year, and as we can only publish 11% of this number, peer review and natural selection combine so that only the very best papers reach the readers.
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Khan ST, Robinson PG, MacDonald DJ, Murray AD, Murray IR, Macpherson GJ, Clement ND. Infographic: Total hip arthroplasty in golfers. Bone Jt Open 2022; 3:152-154. [PMID: 35172588 PMCID: PMC8886315 DOI: 10.1302/2633-1462.32.bjo-2022-0007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Affiliation(s)
- Shujaa T. Khan
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | - Patrick G. Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
- PGA European Tour Performance Institute, Virginia Water, UK
| | | | | | - Iain R. Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Nick D. Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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13
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Robinson PG, Khan S, MacDonald D, Murray IR, Macpherson GJ, Clement ND. Golfers have a greater improvement in their hip specific function compared to non-golfers after total hip arthroplasty, but less than three-quarters returned to golf. Bone Jt Open 2022; 3:145-151. [PMID: 35172585 PMCID: PMC8886316 DOI: 10.1302/2633-1462.32.bjo-2022-0002.r1] [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] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Abstract
AIMS Golf is a popular pursuit among those requiring total hip arthroplasty (THA). The aim of this study was to determine if participating in golf is associated with greater functional outcomes, satisfaction, or improvement in quality of life (QoL) compared to non-golfers. METHODS All patients undergoing primary THA over a one-year period at a single institution were included with one-year postoperative outcomes. Patients were retrospectively followed up to assess if they had been golfers at the time of their surgery. Multivariate linear regression analysis was performed to assess the independent association of preoperative golfing status on outcomes. RESULTS The study cohort consisted of a total of 308 patients undergoing THA, of whom 44 were golfers (14%). This included 120 male patients (39%) and 188 female patients (61%), with an overall mean age of 67.8 years (SD 11.6). Golfers had a greater mean postoperative Oxford Hip Score (OHS) (3.7 (95% confidence interval (CI) 1.9 to 5.5); p < 0.001) and EuroQol visual analogue scale (5.5 (95% CI 0.1 to 11.9); p = 0.039). However, there were no differences in EuroQoL five-dimension score (p = 0.124), pain visual analogue scale (p = 0.505), or Forgotten Joint Score (p = 0.215). When adjusting for confounders, golfers had a greater improvement in their Oxford Hip Score (2.7 (95% CI 0.2 to 5.3); p < 0.001) compared to non-golfers. Of the 44 patients who reported being golfers at the time of their surgery, 32 (72.7%) returned to golf and 84.4% of those were satisfied with their involvement in golf following surgery. Those who returned to golf were more likely to be male (p = 0.039) and had higher (better) preoperative health-related QoL (p = 0.040) and hip-related functional scores (p = 0.026). CONCLUSION Golfers had a greater improvement in their hip-specific function compared to non-golfers after THA. However, less than three-quarters of patients return to golf, with male patients and those who had greater preoperative QoL or hip-related function being more likely to return to play. Cite this article: Bone Jt Open 2022;3(2):145-151.
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Affiliation(s)
- Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,PGA European Tour Performance Institute, Virginia Water, UK
| | - Shujaa Khan
- Edinburgh Medical School, University of Edinburgh, Edinburgh, UK
| | | | - Iain R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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14
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Robinson PG, Williamson TR, Creighton AP, Cheng J, Murray AD, Prather H, Dines JS, Gulotta LV, Su EP, Press JM, Hawkes R, Clement ND. Rate and Timing of Return to Golf After Hip, Knee, or Shoulder Arthroplasty: A Systematic Review and Meta-analysis. Am J Sports Med 2022; 51:1644-1651. [PMID: 35019735 DOI: 10.1177/03635465211064292] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [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 The physical and mental health benefits of golf are well recognized, and as a moderate-intensity activity, it is an ideal sport for patients after joint arthroplasty. PURPOSE To assess the rate and timing of returning to golf and the factors associated with these after hip, knee, or shoulder arthroplasty. STUDY DESIGN Meta-analysis; Level of evidence, 4. METHODS A search of PubMed and Medline was performed in March 2021 in line with the 2009 PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) statement. Search terms included sport, golf, and arthroplasty. The criterion for inclusion was any published research article studying return to golf after arthroplasty. Random-effects modeling was used to measure rates of returning to golf for each type of arthroplasty. RESULTS A total of 23 studies were included for review. All studies were retrospective in their methodology. The mean age of patients was 66.8 years (SD, 3.37). Four studies reported on hip arthroplasty, 6 on knee arthroplasty, and 13 on shoulder arthroplasty. Among 13 studies, the mean rate of returning to golf was 80% (95% CI, 70%-89.9%). Hip, knee, and shoulder arthroplasty had mean return rates of 90% (95% CI, 82%-98%), 70% (95% CI, 39%-100%), and 80% (95% CI, 68%-92%), respectively. Among 9 studies, the mean time to return to golf was 4.4 months (95% CI, 3.2-6). Change in handicap was reported in 8 studies (35%) with a mean change of -0.1 (95% CI, -2.4 to +2.2). There were no studies presenting factors associated with return to golf. CONCLUSION This is the first meta-analysis of returning to golf after joint arthroplasty. The study reports a high rate of returning to golf, which was greatest after hip arthroplasty. However, the study highlights the paucity of prospective data on demographic, surgical, and golf-specific outcomes after arthroplasty. Future prospective studies are required to eliminate response bias and accurately capture golf and patient-specific outcomes.
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Affiliation(s)
- Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,European Tour Performance Institute, Virginia Water, Surrey, UK
| | - Tom R Williamson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Andrew P Creighton
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Jennifer Cheng
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Andrew D Murray
- European Tour Performance Institute, Virginia Water, Surrey, UK.,Public Health and Medical Department, The R&A, St Andrews, UK.,Department of Sports and Exercise/Physical Activity for Health, University of Edinburgh, Edinburgh, UK
| | - Heidi Prather
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | - Joshua S Dines
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Lawrence V Gulotta
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Edwin P Su
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA
| | - Joel M Press
- Department of Physiatry, Hospital for Special Surgery, New York, New York, USA
| | | | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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15
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Robinson PG, Williamson TR, Murray IR, Maempel JF, MacDonald DJ, Hamilton DF, Gaston P. Preoperative morbidity and joint awareness while awaiting hip arthroscopy for femoroacetabular impingement. J Exp Orthop 2021; 8:113. [PMID: 34862946 PMCID: PMC8643374 DOI: 10.1186/s40634-021-00431-1] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2021] [Accepted: 11/16/2021] [Indexed: 12/04/2022] Open
Abstract
Purpose The Forgotten Joint Score (FJS-12) is a valid tool in the evaluation of patients undergoing hip arthroscopy, assessing the unique concept of joint awareness in the setting of a patient’s hip pathology. The preoperative burden on patients’ mental wellbeing of impaired joint function or symptoms is well established. The purpose of this study was to determine patients’ awareness of their hip joint whilst awaiting hip arthroscopy for femoroacetabular impingement, to explore any association between joint awareness and mental health status, and to determine whether this relates to time spent waiting for arthroscopy preoperatively. Methods A prospective database of patients undergoing hip arthroscopy between January 2018 and November 2020 was analysed. All patients with a diagnosis of femoroacetabular impingement (FAI) undergoing arthroscopic treatment were included. Questionnaires included the FJS-12, twelve item international hip outcome tool (iHOT-12), EuroQol 5D-5L (EQ-5D-5L) and the Tegner activity score. Pearson’s correlation coefficient was used to assess relationships between continuous variables. Results Preoperative functional outcomes were completed by 81 patients (97.5%) prior to undergoing hip arthroscopy. Median preoperative FJS-12 score was 16.67 (IQR 8.33 – 29.68). Forty-four patients reported any level of anxiety/depression preoperatively (54.3%). Preoperative FJS-12 showed a significant negative correlation with worsening mental health status (r = − 0.359, p < 0.001), and a significant positive correlation with EQ-5D-5L (r = 0.445, p < 0.001). The duration of symptoms or time on the waiting list did not correlate with increased joint awareness or worsened mental health. Conclusion Joint awareness is high when awaiting hip arthroscopy for FAI. Increasing levels of joint awareness correlate with poorer mental health status and poorer quality of life measures, however these parameters do not seem to be associated with increased duration of symptoms prior to surgery or time on the waiting list for surgery.
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Affiliation(s)
- P G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - T R Williamson
- Edinburgh Medical School, The University of Edinburgh, 47 Little France Crescent, Edinburgh, EH16 4TJ, UK.
| | - I R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Department of Orthopaedic Surgery, Stanford University, Redwood, California, USA
| | - J F Maempel
- Department of Trauma & Orthopaedics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - D J MacDonald
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - D F Hamilton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - P Gaston
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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16
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Robinson PG, MacDonald DJ, Macpherson GJ, Patton JT, Clement ND. Changes and thresholds in the Forgotten Joint Score after total hip arthroplasty : minimal clinically important difference, minimal important and detectable changes, and patient-acceptable symptom state. Bone Joint J 2021; 103-B:1759-1765. [PMID: 34847716 DOI: 10.1302/0301-620x.103b12.bjj-2021-0384.r1] [Citation(s) in RCA: 4] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2023]
Abstract
AIMS The aim of this study was to identify the minimal clinically important difference (MCID), minimal important change (MIC), minimal detectable change (MDC), and patient-acceptable symptom state (PASS) in the Forgotten Joint Score (FJS) according to patient satisfaction six months following total hip arthroplasty (THA) in a UK population. METHODS During a one-year period, 461 patients underwent a primary THA and completed preoperative and six-month FJS, with a mean age of 67.2 years (22 to 93). At six months, patient satisfaction was recorded as very satisfied, satisfied, neutral, dissatisfied, or very dissatisfied. The difference between patients recording neutral (n = 31) and satisfied (n = 101) was used to define the MCID. MIC for a cohort was defined as the change in the FJS for those patients declaring their outcome as satisfied, whereas receiver operating characteristic curve analysis was used to determine the MIC for an individual and the PASS. Distribution-based methodology was used to calculate the MDC. RESULTS Using satisfaction as the anchor, the MCID for the FJS was 8.1 (95% confidence interval (CI) 3.7 to 15.9; p = 0.040), which was affirmed when adjusting for confounding. The MIC for the FJS for a cohort of patients was 17.7 (95% CI 13.7 to 21.7) and for an individual patient was 18. The MDC90 for the FJS was eight, meaning that 90% of patients scoring more than this will have experienced a real change that is beyond measurement error. The PASS threshold for the FJS was defined as 29. CONCLUSION The MCID and MIC can be used respectively to assess whether there is a clinical difference between two groups, or whether a cohort or patient has had a meaningful change in their FJS. Both values were greater than measurement error (MDC90), suggesting a real change. The PASS threshold for the postoperative FJS can be used as a marker of achieving patient satisfaction following THA. Cite this article: Bone Joint J 2021;103-B(12):1759-1765.
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Affiliation(s)
| | - Deborah J MacDonald
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,Edinburgh Orthopaedics, University of Edinburgh, Edinburgh, UK
| | | | - James T Patton
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Nick D Clement
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
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17
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Yapp LZ, Robinson PG, Clement ND, Scott CEH. Total Knee Arthroplasty and Intra-Articular Pressure Sensors: Can They Assist Surgeons with Intra-Operative Decisions? Curr Rev Musculoskelet Med 2021; 14:361-368. [PMID: 34962638 PMCID: PMC8733123 DOI: 10.1007/s12178-021-09724-5] [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] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Soft tissue imbalance, presenting as instability or stiffness, is an important cause of revision total knee arthroplasty (TKA). Traditional methods of determining soft tissue balance of the knee lack precision and are not reliable between operators. Use of intra-operative pressure sensors offers the potential to identify and avoid soft tissue imbalance following TKA. This review aims to summarise the literature supporting the clinical indication for the use of intra-articular pressure sensors during TKA. RECENT FINDINGS Analytical validation studies suggest that intra-operative pressure sensors demonstrate 'moderate' to 'good' intra-observer reliability and 'good' to 'excellent' interobserver reliability throughout the flexion arc. However, there are important errors associated with measurements when devices are used out-with the stated guidelines and clinicians should be aware of the limitations of these devices in isolation. Current evidence regarding patient benefit is conflicting. Despite positive early results, several prospective studies have subsequently failed to demonstrate significant differences in overall survival, satisfaction, and patient-reported outcome measures within 1 year of surgery. Surgeon-defined soft tissue stability appears to be significantly different from the absolute pressures measured by the intra-operative sensor. Whilst it could be argued that this confirms the need for intra-articular sensor guidance in TKA; the optimal 'target' balance remains unclear and the relationship with outcome in patients is not determined. Future research should (1) identify a suitable reference standard for comparison; (2) improve the accuracy of the sensor outputs; and (3) demonstrate that sensor-assisted TKA leads to patient benefit in patient-reported outcome measures and/or enhanced implant survival.
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Affiliation(s)
- Liam Z. Yapp
- Department of Orthopaedics, Deanery of Clinical Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SY UK
| | - Patrick G. Robinson
- Department of Orthopaedics, Deanery of Clinical Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SY UK
| | - Nicholas D. Clement
- Department of Orthopaedics, Deanery of Clinical Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SY UK
| | - Chloe E. H. Scott
- Department of Orthopaedics, Deanery of Clinical Sciences, University of Edinburgh, Chancellors Building, 49 Little France Crescent, Edinburgh, EH16 4SB UK
- Department of Trauma & Orthopaedic Surgery, Royal Infirmary of Edinburgh, NHS Lothian, 51 Little France Crescent, Edinburgh, EH16 4SY UK
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18
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Robinson PG, Murray A, Sheer V, Close G, Kinane DF. Pilot evaluation of risk assessment and enhanced protocols regarding contacts at an international professional golf event. BMJ Open Sport Exerc Med 2021; 7:e001127. [PMID: 34466271 PMCID: PMC8365803 DOI: 10.1136/bmjsem-2021-001127] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [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] [Accepted: 08/02/2021] [Indexed: 01/30/2023] Open
Abstract
Objectives The aim of this study was to assess whether a risk assessment and managed risk approach to contact tracing was practical and feasible at the Gran Canaria Lopesan Open 2021 and could inform further pilot work regarding disease transmission during elite sporting events. Methods This prospective cohort study included all international attendees. All participants required a minimum of one negative reverse transcriptase PCR (RT-PCR) test prior to travelling to each tournament. High-risk contacts were isolated for 10 days. Moderate-risk contacts received education regarding enhanced medical surveillance, had daily rapid antigen testing for 5 days, with RT-PCR day 5, mandated mask use and access to outside space for work purposes only. Low-risk contacts received rapid antigen testing every 48 hours and PCR testing on day 5. Results A total of 550 persons were accredited and were required to undergo RT-PCR testing before the event. Two of these tests were positive (0.36%). Of these, case 1 had 1 high, 23 moderate and 48 low-risk contacts. Case 2 did not have any significant travel history within 2 days of positive test and had one high-risk contact. There were no further positive tests on site in the wider cohort of attendees, from a total of 872 RT-PCR and 198 rapid antigen tests. Conclusions This pilot study showed it is practical, feasible and well accepted to provide enhanced (daily) virus testing and risk-mitigating measures at a professional golf event. Further study is required to assess the efficacy of these interventions; however, no transmission was found in this pilot study.
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Affiliation(s)
- Patrick G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,European Tour Performance Institute, Virginia Water, UK
| | - Andrew Murray
- European Tour Performance Institute, Virginia Water, UK.,Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK.,Sport and Exercise, University of Edinburgh, Edinburgh, UK
| | - Volker Sheer
- European Tour Performance Institute, Virginia Water, UK.,Health Science Department, Universidad a Distancia de Madrid (UDIMA), Madrid, Spain.,Ultra Sports Science Foundation, Pierre Benite, France
| | - Graeme Close
- European Tour Performance Institute, Virginia Water, UK.,Research Institute for Sport and Exercise Sciences, Liverpool John Moores University, Liverpool, UK
| | - Denis F Kinane
- School of Dental Medicine, University of Bern, Bern, Switzerland.,Medical and Scientific Department, Cignpost Diagnostics, Farnborough, UK
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19
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Robinson PG, Murray A, Close G, Kinane DF. Assessing the risk of SARS-CoV-2 transmission in international professional golf. BMJ Open Sport Exerc Med 2021; 7:e001109. [PMID: 34221443 PMCID: PMC8212154 DOI: 10.1136/bmjsem-2021-001109] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [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] [Accepted: 06/07/2021] [Indexed: 02/06/2023] Open
Abstract
Objectives There is no published data on the incidence or risk of SARS-CoV-2 transmission when playing golf, a sport played outdoors where social distancing is possible. The purpose of this prospective study was to report incidence and transmission regarding SARS-CoV-2, of professional golfers competing on the PGA European Tour across 23 events in 11 countries. Methods Daily symptom and temperature checks and weekly reverse transcriptase PCR (RT-PCR) screening were performed to determine potential carriage of SARS-CoV-2. Onset and type of symptomology were analysed. Gene expression and cycle thresholds (Cts) were reviewed for all positive cases. Repeat PCR testing was performed on all positive players. RT-PCR analysis included human housekeeping genes and various RNA genes specific for SARS-CoV-2. Results During the study period, there were 2900 RT-PCR tests performed on 195 professional golfers competing on the European Tour. Four players tested positive on-site during the study period (0.14% of tests; positive results were declared with Ct <40). Two positive tests were returned as part of routine protocols, while two reported a history of close contact with an individual who had tested positive for SARS-CoV-2 and were isolated and target tested. All were asymptomatic at time of testing, with three developing symptoms subsequently. None required hospital admission. There was no transmission from player to player. Conclusion Golf is an outdoor sport where social distancing is possible, meaning risks can be low if guidance is followed by participants. Risk of transmission of SARS-CoV-2 can be mitigated by highly accurate RT-PCR testing of participants and by setting up a safe bubble that includes testing players and support staff, as well as all persons coming into contact with them during the course of the tournament, for example, drivers and hotel staff. This report can also provide reassurance for participants and policy makers regarding community golf, which can be encouraged for the health benefits it provides, in a relatively low-risk environment, with minimal risk of transmission by observing sensible viral hygiene protocols.
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Affiliation(s)
- Patrick G Robinson
- Department of Trauma & Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,European Tour Performance Institute, Virginia Water, UK
| | - Andrew Murray
- European Tour Performance Institute, Virginia Water, UK.,Department of Sports and Exercise/ Physical Activity for Health Research Centre, University of Edinburgh, Edinburgh, UK
| | - Graeme Close
- Department of Human Physiology, Liverpool John Moores University Faculty of Science, Liverpool, UK
| | - Denis F Kinane
- School of Dental Medicine, University of Bern, Bern, Switzerland.,Medical and Scientific Department, Cignpost Diagnostics, Farnborough, UK
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20
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Robinson PG, Rankin CS, Murray IR, Maempel JF, Gaston P, Hamilton DF. The forgotten joint score-12 is a valid and responsive outcome tool for measuring success following hip arthroscopy for femoroacetabular impingement syndrome. Knee Surg Sports Traumatol Arthrosc 2021; 29:1378-1384. [PMID: 32691092 PMCID: PMC8038977 DOI: 10.1007/s00167-020-06138-7] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [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: 04/22/2020] [Accepted: 06/26/2020] [Indexed: 11/13/2022]
Abstract
PURPOSE The forgotten joint score-12 (FJS-12) is an outcome questionnaire designed to evaluate joint awareness. The responsiveness and validity of the English language version of the FJS-12 in patients undergoing hip arthroscopy for femoroacetabular impingement (FAI) is not known. METHODS Consecutive patients undergoing hip arthroscopy for a diagnosis of FAI were prospectively followed up over a 1 year period. Patients completed preoperative and postoperative FJS-12, EuroQol 5 Dimension (EQ-5D-5L), and the 12-item international hip outcome tool (iHOT-12). We evaluated construct validity with Spearman correlation coefficients for the FJS-12, and responsiveness by way of effect size and ceiling effects. RESULTS Forty-six patients underwent hip arthroscopy, of which 42 (91%) completed post-operative PROMs at 1 year follow-up. Construct validity was strong with the iHOT-12 (r = 0.87) and also the EQ-5D-5L (r = 0.83). The median postoperative FJS score was 50.2 (IQR 64). The mean change in score for the FJS-12 was 31 points (SD 31) (p < 0.001), with an effect size (Cohen's d) of 1.16. Preoperatively, three patients scored the lowest possible value resulting in a floor effect of 7.1%. Similarly, only three patients (7.1%) scored the best possible score post-operatively. CONCLUSION This is the first evaluation of the joint awareness concept in the English language version of the FJS-12 following hip arthroscopy for FAI. The FJS-12 is a valid and responsive tool for the assessment of this cohort of patients. LEVEL OF EVIDENCE II.
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Affiliation(s)
- Patrick G. Robinson
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - C. S. Rankin
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - I. R. Murray
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - J. F. Maempel
- grid.413249.90000 0004 0385 0051Department of Trauma and Orthopaedics, Royal Prince Alfred Hospital, Camperdown, NSW Australia
| | - P. Gaston
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
| | - D. F. Hamilton
- grid.4305.20000 0004 1936 7988Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA UK
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21
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Clement ND, Hall AJ, Makaram NS, Robinson PG, Patton RFL, Moran M, Macpherson GJ, Duckworth AD, Jenkins PJ. IMPACT-Restart: the influence of COVID-19 on postoperative mortality and risk factors associated with SARS-CoV-2 infection after orthopaedic and trauma surgery. Bone Joint J 2020; 102-B:1774-1781. [PMID: 33249904 DOI: 10.1302/0301-620x.102b12.bjj-2020-1395.r2] [Citation(s) in RCA: 53] [Impact Index Per Article: 13.3] [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: 12/15/2022]
Abstract
AIMS The primary aim of this study was to assess the independent association of the coronavirus disease 2019 (COVID-19) on postoperative mortality for patients undergoing orthopaedic and trauma surgery. The secondary aim was to identify factors that were associated with developing COVID-19 during the postoperative period. METHODS A multicentre retrospective study was conducted of all patients presenting to nine centres over a 50-day period during the COVID-19 pandemic (1 March 2020 to 19 April 2020) with a minimum of 50 days follow-up. Patient demographics, American Society of Anesthesiologists (ASA) grade, priority (urgent or elective), procedure type, COVID-19 status, and postoperative mortality were recorded. RESULTS During the study period, 1,659 procedures were performed in 1,569 patients. There were 68 (4.3%) patients who were diagnosed with COVID-19. There were 85 (5.4%) deaths postoperatively. Patients who had COVID-19 had a significantly lower survival rate when compared with those without a proven SARS-CoV-2 infection (67.6% vs 95.8%, p < 0.001). When adjusting for confounding variables (older age (p < 0.001), female sex (p = 0.004), hip fracture (p = 0.003), and increasing ASA grade (p < 0.001)) a diagnosis of COVID-19 was associated with an increased mortality risk (hazard ratio 1.89, 95% confidence interval (CI) 1.14 to 3.12; p = 0.014). A total of 62 patients developed COVID-19 postoperatively, of which two were in the elective and 60 were in the urgent group. Patients aged > 77 years (odds ratio (OR) 3.16; p = 0.001), with increasing ASA grade (OR 2.74; p < 0.001), sustaining a hip (OR 4.56; p = 0.008) or periprosthetic fracture (OR 14.70; p < 0.001) were more likely to develop COVID-19 postoperatively. CONCLUSION Perioperative COVID-19 nearly doubled the background postoperative mortality risk following surgery. Patients at risk of developing COVID-19 postoperatively (patients > 77 years, increasing morbidity, sustaining a hip or periprosthetic fracture) may benefit from perioperative shielding. Cite this article: Bone Joint J 2020;102-B(12):1774-1781.
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Affiliation(s)
| | - Andrew James Hall
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | - Navnit S Makaram
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Robyn F L Patton
- Biomedical Sciences, Medicine and Veterinary Medicine, University of Edinburgh, Edinburgh, UK
| | - Matthew Moran
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK
| | | | - Andrew D Duckworth
- Department of Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, UK.,University of Edinburgh, Edinburgh, UK
| | - Paul J Jenkins
- Department of Orthopaedics, Glasgow Royal Infirmary, Glasgow, UK
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Robinson PG, Williamson T, Murray IR, Al-Hourani K, White TO. Sporting participation following the operative management of chondral defects of the knee at mid-term follow up: a systematic review and meta-analysis. J Exp Orthop 2020; 7:76. [PMID: 33025212 PMCID: PMC7538489 DOI: 10.1186/s40634-020-00295-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [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: 08/26/2020] [Accepted: 09/23/2020] [Indexed: 01/28/2023] Open
Abstract
PURPOSE The purpose of this study was to perform a systematic review of the reparticipation in sport at mid-term follow up in athletes who underwent biologic treatment of chondral defects in the knee and compare the rates amongst different biologic procedures. METHODS A search of PubMed/Medline and Embase was performed in May 2020 in keeping with Preferred Reporting Items for Systematic Review and Meta-Analysis (PRISMA) guidelines. The criteria for inclusion were observational, published research articles studying the outcomes and rates of participation in sport following biologic treatments of the knee with a minimum mean/median follow up of 5 years. Interventions included microfracture, osteochondral autograft transfer (OAT), autologous chondrocyte implantation (ACI), matrix-induced autologous chondrocyte implantation (MACI), osteochondral allograft, or platelet rich plasma (PRP) and peripheral blood stem cells (PBSC). A random effects model of head-to-head evidence was used to determine rates of sporting participation following each intervention. RESULTS There were twenty-nine studies which met the inclusion criteria with a total of 1276 patients (67% male, 33% female). The mean age was 32.8 years (13-69, SD 5.7) and the mean follow up was 89 months (SD 42.4). The number of studies reporting OAT was 8 (27.6%), ACI was 6 (20.7%), MACI was 7 (24.1%), microfracture was 5 (17.2%), osteochondral allograft was 4 (13.8%), and one study (3.4%) reported on PRP and PBSC. The overall return to any level of sport was 80%, with 58.6% returning to preinjury levels. PRP and PBSC (100%) and OAT (84.4%) had the highest rates of sporting participation, followed by allograft (83.9%) and ACI (80.7%). The lowest rates of participation were seen following MACI (74%) and microfracture (64.2%). CONCLUSIONS High rates of re-participation in sport are sustained for at least 5 years following biologic intervention for chondral injuries in the knee. Where possible, OAT should be considered as the treatment of choice when prolonged participation in sport is a priority for patients. However, MACI may achieve the highest probability of returning to the same pre-injury sporting level. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- P G Robinson
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland.
| | - T Williamson
- University of Edinburgh Medical School, Edinburgh, Scotland
| | - I R Murray
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - K Al-Hourani
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | - T O White
- Edinburgh Orthopaedics, Royal Infirmary of Edinburgh, Edinburgh, Scotland
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Robinson PG, Maempel JF, Murray IR, Rankin CS, Hamilton DF, Gaston P. Responsiveness and ceiling effects of the English version of the 12-item International Hip Outcome Tool following hip arthroscopy at minimum one-year follow-up. Bone Joint J 2020; 102-B:1010-1015. [PMID: 32731826 DOI: 10.1302/0301-620x.102b8.bjj-2020-0074.r1] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [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: 11/05/2022]
Abstract
AIMS Responsiveness and ceiling effects are key properties of an outcome score. No such data have been reported for the original English version of the International Hip Outcome Tool 12 (iHOT-12) at a follow-up of more than four months. The aim of this study was to identify the responsiveness and ceiling effects of the English version iHOT-12 in a series of patients undergoing hip arthroscopy for intra-articular hip pathology at a minimum of one year postoperatively. METHODS A total of 171 consecutive patients undergoing hip arthroscopy with a diagnosis of femoroacetabular impingement (FAI) under the care of a single surgeon between January 2013 and March 2017 were included. iHOT-12 and EuroQol 5D-5L (EQ-5D-5L) scores were available pre- and postoperatively. Effect size and ceiling effects for the iHOT-12 were calculated with subgroup analysis. RESULTS A total of 122 patients (71.3%) completed postoperative PROMs scores with median follow-up of 24.3 months (interquartile range (IQR) 17.2 to 33.5). The median total cohort iHOT-12 score improved significantly from 31.0 (IQR 20 to 58) preoperatively to 72.5 (IQR 47 to 90) postoperatively (p < 0.001). The effect size (Cohen's d) was 1.59. In all, 33 patients (27%) scored within ten points (10%) of the maximum score and 38 patients (31.1%) scored within the previously reported minimal clinically important difference (MCID) of the maximum score. Furthermore, nine (47%) male patients aged < 30 years scored within 10% of the maximum score and ten (53%) scored within the previously reported MCID of the maximum score. CONCLUSION There is a previously unreported ceiling effect of the iHOT-12 at a minimum one-year follow-up which is particularly marked in young, male patients following hip arthroscopy for FAI. This tool may not have the maximum measurement required to capture the true outcome following this procedure. Cite this article: Bone Joint J 2020;102-B(8):1010-1015.
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Affiliation(s)
- Patrick G Robinson
- Trauma and Orthopaedic Department, University of Edinburgh, Edinburgh, UK
| | - Julian F Maempel
- Department of Trauma and Orthopaedics, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Iain R Murray
- Trauma and Orthopaedic Department, University of Edinburgh, Edinburgh, UK
| | - Conor S Rankin
- Trauma and Orthopaedic Department, University of Edinburgh, Edinburgh, UK
| | - David F Hamilton
- Trauma and Orthopaedic Department, University of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Trauma and Orthopaedic Department, University of Edinburgh, Edinburgh, UK
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Robinson PG, Maempel JF, Rankin CS, Gaston P, Hamilton DF. Evaluation of the patient acceptable symptom state following hip arthroscopy using the 12 item international hip outcome tool. BMC Musculoskelet Disord 2020; 21:5. [PMID: 31900150 PMCID: PMC6942269 DOI: 10.1186/s12891-019-3026-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [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: 11/06/2019] [Accepted: 12/24/2019] [Indexed: 12/02/2022] Open
Abstract
Background The International Hip Outcome Tool 12 (iHOT-12) is a shorter version of the iHOT-33 which measures health related quality of life following treatment of hip disorders in young, active patients. The purpose of this study was identify a PASS threshold for a UK population undergoing hip arthroscopy for intra-articular hip pathology. Methods Data was identified retrospectively from a prospective database of patients undergoing hip arthroscopy under the care of a single surgeon within the date range January 2013 to March 2017. All patients with a diagnosis of femoroacetabular impingment (FAI) undergoing arthroscopic treatment were included. iHOT-12, EuroQol 5D-5 L (EQ-5D-5 L) and a satisfaction questionnaire were available pre and post-operatively. PASS was calculated using an anchor-based approach and receiver operator characteristic (ROC) analysis. Results 171 patients underwent hip arthroscopy in the study period. Linked longitudinal follow-up data was available for 122 patients (71.3%) at a median of 24.3 months (740 days, interquartile range 576–1047). The PASS threshold for the iHOT-12 was 59.5 (sensitivity 81.1%, specificity 83.9%; area under the curve (AUC) 0.92, 95% CI 0.87–0.97). 64% of patients achieved this score. The median postoperative iHOT-12 score was 72.5 (IQR 44) and the mean change in score was 35 (SD 25, p < 0.001). The EQ-5D Index improved by 0.18 (SD 0.25, p < 0.001) and there was a mean change of 7.67 (SD 24.82) on the EQ-5D VAS (p = 0.001). Conclusions We report a PASS threshold of the iHOT-12 following hip arthroscopy for FAI as a measurable benchmark for clinicians using this outcome measure.
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Affiliation(s)
- Patrick G Robinson
- Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland.
| | - Julian F Maempel
- Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland
| | - Conor S Rankin
- Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland
| | - Paul Gaston
- Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland
| | - David F Hamilton
- Trauma and Orthopaedic Department, University of Edinburgh, 51 Little France Crescent, Edinburgh, EH16 4SA, Scotland
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Abstract
CASE A 52-year-old man underwent right total hip replacement with a 32-mm BIOLOX delta ceramic head with a polyethylene liner. At 8 months, he fell onto his right hip. Radiographs at the time were unremarkable. One month later, he noticed a sharp pain and a sensation of grinding in his right hip; radiographs of the hip showed a fracture of the ceramic head. CONCLUSIONS This case further demonstrates that fourth-generation ceramic heads can fracture, and delays in catastrophic failure of ceramics in total hip arthroplasty (THA) following trauma may be secondary to the "slow crack growth" hypothesis.
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Affiliation(s)
| | - P G Robinson
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, United Kingdom
| | - N Beattie
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, United Kingdom
| | - P Gaston
- Department of Trauma and Orthopaedic Surgery, Royal Infirmary of Edinburgh, United Kingdom
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Robinson PG, Murray IR, Maempel J, Rankin CS, Hamilton D, Gaston P. Use of Biologics as an Adjunct Therapy to Arthroscopic Surgery for the Treatment of Femoroacetabular Impingement: A Systematic Review. Orthop J Sports Med 2019; 7:2325967119890673. [PMID: 31909055 PMCID: PMC6937539 DOI: 10.1177/2325967119890673] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND There has been a recent increase in the use of biologics in hip arthroscopy to assist in the management of femoroacetabular impingement (FAI). PURPOSE To analyze the current use of biologics for the treatment of FAI and its associated lesions. STUDY DESIGN Systematic review; Level of evidence, 4. METHODS A search of the PubMed, Medline, and EMBASE databases was performed in March 2019 with use of the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. The criterion for inclusion was observational, published research articles studying the therapeutic use of biologics as an adjuvant therapy during arthroscopic surgery for FAI; treatments included bone marrow aspirate concentrate, mesenchymal stem cells (MSCs), platelet-rich plasma (PRP), hyaluronic acid, growth factors, and autologous chondrocyte implantation (ACI) or autologous matrix-induced chondrogenesis (AMIC). RESULTS There were 9 studies that met the inclusion criteria, and a total of 674 patients were included across all studies. FAI was studied in all articles. Further, 7 studies (78%) also analyzed chondral injuries, and 3 studies also analyzed labral tears (33%). ACI or AMIC was used in 56% of studies and showed superior functional outcomes at short- and midterm follow-up versus debridement or microfracture. PRP did not improve the outcome of labral repairs at short-term follow-up. CONCLUSION The current literature regarding biologic adjuncts in hip arthroscopy is varied in quality, with only one level 1 study. The use of ACI/AMIC for medium-sized chondral lesions showed promising results in individual studies; however, these were of lower quality. To enable comparisons among future studies, investigators must ensure accuracy in the reporting of biologic preparations and formulations used and homogeneity in the type and severity of lesion treated.
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Affiliation(s)
- Patrick G. Robinson
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Iain R. Murray
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Julian Maempel
- Department of Orthopaedic Surgery, The Royal Melbourne Hospital, Parkville, Victoria, Australia
| | - Conor S. Rankin
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - David Hamilton
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
| | - Paul Gaston
- Department of Trauma and Orthopaedic Surgery, University of Edinburgh, Edinburgh, UK
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Robinson PG, Clement ND, Hamilton D, Blyth MJG, Haddad FS, Patton JT. A systematic review of robotic-assisted unicompartmental knee arthroplasty: prosthesis design and type should be reported. Bone Joint J 2019; 101-B:838-847. [PMID: 31256672 DOI: 10.1302/0301-620x.101b7.bjj-2018-1317.r1] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [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: 11/05/2022]
Abstract
AIMS Robotic-assisted unicompartmental knee arthroplasty (UKA) promises accurate implant placement with the potential of improved survival and functional outcomes. The aim of this study was to present the current evidence for robotic-assisted UKA and describe the outcome in terms of implant positioning, range of movement (ROM), function and survival, and the types of robot and implants that are currently used. MATERIALS AND METHODS A search of PubMed and Medline was performed in October 2018 in line with the Preferred Reporting Items for Systematic Review and Meta-Analysis statement. Search terms included "robotic", "knee", and "surgery". The criteria for inclusion was any study describing the use of robotic UKA and reporting implant positioning, ROM, function, and survival for clinical, cadaveric, or dry bone studies. RESULTS A total of 528 articles were initially identified from the databases and reference lists. Following full text screening, 38 studies that satisfied the inclusion criteria were included. In all, 20 studies reported on implant positioning, 18 on functional outcomes, 16 on survivorship, and six on ROM. The Mako (Stryker, Mahwah, New Jersey) robot was used in 32 studies (84%), the BlueBelt Navio (Blue Belt Technologies, Plymouth, Minnesota) in three (8%), the Sculptor RGA (Stanmore Implants, Borehamwood United Kingdom) in two (5%), and the Acrobot (The Acrobot Co. Ltd., London, United Kingdom) in one study (3%). The most commonly used implant was the Restoris MCK (Stryker). Nine studies (24%) did not report the implant that was used. The pooled survivorship at six years follow-up was 96%. However, when assessing survival according to implant design, survivorship of an inlay (all-polyethylene) tibial implant was 89%, whereas that of an onlay (metal-backed) implant was 97% at six years (odds ratio 3.66, 95% confidence interval 20.7 to 6.46, p < 0.001). CONCLUSION There is little description of the choice of implant when reporting robotic-assisted UKA, which is essential when assessing survivorship, in the literature. Implant positioning with robotic-assisted UKA is more accurate and more reproducible than that performed manually and may offer better functional outcomes, but whether this translates into improved implant survival in the mid- to longer-term remains to be seen. Cite this article: Bone Joint J 2019;101-B:838-847.
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Affiliation(s)
| | - N D Clement
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - D Hamilton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - M J G Blyth
- Glasgow Royal Infirmary Orthopaedic Research Unit, Glasgow, UK
| | - Fares S Haddad
- University College London Hospitals, The Princess Grace Hospital, and The NIHR Biomedical Research Centre at UCLH, London, UK
| | - J T Patton
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
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Robinson PG, Murray IR, West CC, Goudie EB, Yong LY, White TO, LaPrade RF. Reporting of Mesenchymal Stem Cell Preparation Protocols and Composition: A Systematic Review of the Clinical Orthopaedic Literature. Am J Sports Med 2019; 47:991-1000. [PMID: 29554460 DOI: 10.1177/0363546518758667] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [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 Mesenchymal stem cells (MSCs) are increasingly being used in the treatment of a wide variety of sports-related conditions. Despite this enthusiasm, the biological properties of MSCs and their effects on musculoskeletal tissue healing remain poorly understood. MSC-based strategies encompass cell populations with heterogeneous phenotypes isolated from multiple tissues and using different methods. Therefore, comprehensive reporting of the source, preparation methods, and characteristics of MSC strategies is essential to enable interpretation of results. PURPOSE To perform a systematic review of levels of reporting of key variables in MSC preparation and composition for clinical studies evaluating MSC-based therapies in the treatment of musculoskeletal conditions. STUDY DESIGN Systematic review. METHODS A systematic review of the clinical orthopaedic and sports medicine literature from 2002 to 2017 was performed. The following inclusion criteria were used: human clinical trials, published in the English language, involving the administration of MSC-based therapies for orthopaedic or sports medicine applications. In vitro or ex vivo studies, editorials, letters to the editor, and studies relating to cosmetic, neurological, or dental applications were excluded. RESULTS Of the 1259 studies identified on the initial search, 36 studies were found to satisfy the inclusion criteria for analysis on comprehensive review. Fifty-seven percent of studies evaluated bone marrow-derived MSCs, 41% evaluated adipose-derived MSCs, and 2% evaluated synovium-derived MSCs. Considerable deficiencies in the reporting of key variables, including the details of stem cell processing, culture conditions, and the characteristics of cell populations delivered, were noted. Overall, studies reported only 52% (range, 30%-80%) of variables that may critically influence outcome. No study provided adequate information relating to all of these variables. CONCLUSION All existing clinical studies evaluating MSCs for orthopaedic or sports medicine applications are limited by inadequate reporting of both preparation protocols and composition. Deficient reporting of the variables that may critically influence outcome precludes interpretation, prevents others from reproducing experimental conditions, and makes comparisons across studies difficult. We encourage the adoption of emerging minimum reporting standards for clinical studies evaluating the use of MSCs in orthopaedics.
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Affiliation(s)
| | - Iain R Murray
- Department of Trauma and Orthopaedics, University of Edinburgh, UK.,Scottish Centre for Regenerative Medicine, University of Edinburgh, UK
| | | | - Ewan B Goudie
- Department of Trauma and Orthopaedics, University of Edinburgh, UK
| | - Li Y Yong
- Scottish Centre for Regenerative Medicine, University of Edinburgh, UK
| | - Timothy O White
- Department of Trauma and Orthopaedics, University of Edinburgh, UK
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Robinson PG. Public Health at Christmas. Community Dent Health 2018; 35:195-196. [PMID: 30507081 DOI: 10.1922/cdhrobinson2018deced02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Last Christmas the The TaxPayers' Alliance (2018) released its 'Nanny State approved Christmas lunch'. The Alliance claimed to have followed NHS nutritional guidelines to calculate "what a public health puritan approved Christmas lunch would look like". The lunch was suitably austere, comprising amongst (not many) other things, 125 grams of turkey, half a serving of boiled potatoes and 25 grams of sprouts. Dessert was frugal too, with only a tenth of a serving of Christmas pudding and 15 ml of brandy cream, although the 45 grams of cheese and 30 grams of pate have got me looking forward to December already. We haven't even got to the alcohol yet; where we were apparently limited to three quarters of a glass of wine and a quarter of a glass each of Champagne, gin and tonic, port and brandy (Other menus are available for readers with different culinary traditions and religious beliefs).
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Murray IR, Robinson PG, Goudie EB, Duckworth AD, Clark K, Robinson CM. Open Reduction and Tunneled Suspensory Device Fixation Compared with Nonoperative Treatment for Type-III and Type-IV Acromioclavicular Joint Dislocations: The ACORN Prospective, Randomized Controlled Trial. J Bone Joint Surg Am 2018; 100:1912-1918. [PMID: 30480595 DOI: 10.2106/jbjs.18.00412] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Nonoperative management of complete acromioclavicular (AC) joint dislocation has yielded reasonable results, although patients may report dissatisfaction with the outcome. The purpose of this prospective, randomized, controlled trial was to compare patient outcome following nonoperative care versus operative treatment with open reduction and tunneled suspension device (ORTSD) fixation for acute, type-III or IV disruptions of the AC joint. METHODS Sixty patients aged 16 to 35 years with an acute type-III or IV disruption of the AC joint were randomized to receive ORTSD fixation or nonoperative treatment, following a power analysis to determine sample size. Functional outcomes were assessed with use of the Disabilities of the Arm, Shoulder and Hand (DASH) as the primary outcome measure and the Oxford Shoulder Scores (OSS) and Short Form (SF-12) as secondary outcome measures at 6 weeks, 3 months, 6 months, and 1 year after treatment. Reduction was evaluated with use of radiographs. Any complications were noted at each assessment. The economic implication of each treatment was evaluated. RESULTS ORTSD and nonoperative groups were similar with regard to demographics at baseline. The mean degree of radiographic displacement was significantly less in patients following ORTSD fixation (1.75 mm) compared with patients who received nonoperative treatment (10.61 mm, p < 0.0001). At 1 year postoperatively, the mean DASH score was 4.67 in the nonoperative treatment group and 5.63 in the ORTSD group, and the mean OSS was 45.72 and 45.63, respectively. Patients managed with ORTSD fixation had inferior DASH scores at 6 weeks (p < 0.01). There were 5 patients who experienced failed nonoperative treatment and subsequently underwent a surgical procedure. ORTSD fixation (£3,359.73) was associated with significantly higher costs than nonoperative treatment (£796.22, p < 0.0001). CONCLUSIONS ORTSD fixation confers no functional benefit over nonoperative treatment at 1 year following type-III or IV disruptions of the AC joint. Although patients managed nonoperatively generally recovered faster, a substantial group of patients remained dissatisfied following nonoperative treatment and required delayed surgical reconstruction. We were unable to identify any demographic or injury-related factors that predicted a poorer outcome in these patients. LEVEL OF EVIDENCE Therapeutic Level I. See Instructions for Authors for a complete description of levels of evidence.
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Affiliation(s)
- Iain R Murray
- The University of Edinburgh, Edinburgh, United Kingdom.,Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Patrick G Robinson
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Ewan B Goudie
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Andrew D Duckworth
- The University of Edinburgh, Edinburgh, United Kingdom.,Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - Kathryn Clark
- Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
| | - C Michael Robinson
- The University of Edinburgh, Edinburgh, United Kingdom.,Edinburgh Shoulder Clinic, Royal Infirmary of Edinburgh, Edinburgh, United Kingdom
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31
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Robinson PG, Murray IR, Duckworth AD, Hawkes R, Glover D, Tilley NR, Hillman R, Oliver CW, Murray AD. Systematic review of musculoskeletal injuries in professional golfers. Br J Sports Med 2018; 53:13-18. [PMID: 30366967 DOI: 10.1136/bjsports-2018-099572] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [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: 10/01/2018] [Indexed: 11/04/2022]
Abstract
OBJECTIVE The distribution of injuries affecting professional golfers is yet to be fully understood. We performed a systematic review of the clinical literature to establish the epidemiology of musculoskeletal injuries affecting professional golfers. DESIGN Systematic review. DATA SOURCES Searched databases in July 2018 were PubMed, SPORTDiscus and Embase. ELIGIBILITY CRITERIA Published observational research articles relating to the incidence or prevalence of musculoskeletal injuries in professional golfers, which were written in the English language and not restricted by age or gender. RESULTS Of the 1863 studies identified on the initial search, 5 studies were found to satisfy the inclusion criteria for analysis. The mean age of the golfers in these studies was 34.8 (±3.6) years. The gender of patients in included studies compromised 72% males and 28% females. Four studies reported that lumbar spine injuries were the most common (range 22%-34%). Excluding injuries to the spine (lumbar, thoracic and cervical), the hand/wrist was the next most common region of injury (range 6%-37%). The quality of the studies was relatively poor with no study satisfying >50% of the quality assessment tool questions and only one study giving a clear definition of how they defined injury. CONCLUSION There is a paucity of well-designed epidemiological studies evaluating musculoskeletal injuries affecting professional golfers. Injuries to the spine are the most frequently affected region, followed by the hand/wrist. This study has identified targeted areas of future research that aims to improve the management of injuries among professional golfers.
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Affiliation(s)
- Patrick G Robinson
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - Iain R Murray
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - Andrew D Duckworth
- Department of Orthopaedics and Trauma, University of Edinburgh, Edinburgh, UK
| | - Roger Hawkes
- European Tour Performance Institute, Virginia Water, UK
| | - Danny Glover
- European Tour Performance Institute, Virginia Water, UK
| | | | - Rob Hillman
- European Tour Performance Institute, Virginia Water, UK
| | - Christopher W Oliver
- Department of Sports and Exercise/Physical Activity for Health, University of Edinburgh, Edinburgh, UK
| | - Andrew D Murray
- European Tour Performance Institute, Virginia Water, UK.,Department of Sports and Exercise/Physical Activity for Health, University of Edinburgh, Edinburgh, UK
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Robinson PG. A UK and Partisan view of Brexit and Dental Public Health. Community Dent Health 2018; 35:130-131. [PMID: 30178949 DOI: 10.1922/cdh_robinson02] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
I walked to work on 24th June 2016, reeling from the news that the UK referendum had shown a small but decisive majority in favour of leaving the European Union. I only knew of one person who had voted for Brexit! I had seen a few Leave posters up whilst out cycling and the opinion polls showed only a small difference, but none the less, I was hugely surprised. A neighbour reassured me that a deal would be struck so that we would fi nd a nice arrangement amounting to a modest change, but the last two years have shown the value of his insights.
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Baker SR, Foster Page L, Thomson WM, Broomhead T, Bekes K, Benson PE, Aguilar-Diaz F, Do L, Hirsch C, Marshman Z, McGrath C, Mohamed A, Robinson PG, Traebert J, Turton B, Gibson BJ. Structural Determinants and Children's Oral Health: A Cross-National Study. J Dent Res 2018; 97:1129-1136. [PMID: 29608864 DOI: 10.1177/0022034518767401] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
Much research on children's oral health has focused on proximal determinants at the expense of distal (upstream) factors. Yet, such upstream factors-the so-called structural determinants of health-play a crucial role. Children's lives, and in turn their health, are shaped by politics, economic forces, and social and public policies. The aim of this study was to examine the relationship between children's clinical (number of decayed, missing, and filled teeth) and self-reported oral health (oral health-related quality of life) and 4 key structural determinants (governance, macroeconomic policy, public policy, and social policy) as outlined in the World Health Organization's Commission for Social Determinants of Health framework. Secondary data analyses were carried out using subnational epidemiological samples of 8- to 15-y-olds in 11 countries ( N = 6,648): Australia (372), New Zealand (three samples; 352, 202, 429), Brunei (423), Cambodia (423), Hong Kong (542), Malaysia (439), Thailand (261, 506), United Kingdom (88, 374), Germany (1498), Mexico (335), and Brazil (404). The results indicated that the type of political regime, amount of governance (e.g., rule of law, accountability), gross domestic product per capita, employment ratio, income inequality, type of welfare regime, human development index, government expenditure on health, and out-of-pocket (private) health expenditure by citizens were all associated with children's oral health. The structural determinants accounted for between 5% and 21% of the variance in children's oral health quality-of-life scores. These findings bring attention to the upstream or structural determinants as an understudied area but one that could reap huge rewards for public health dentistry research and the oral health inequalities policy agenda.
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Affiliation(s)
- S R Baker
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | - L Foster Page
- 2 Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - W M Thomson
- 2 Department of Oral Sciences, Sir John Walsh Research Institute, Faculty of Dentistry, University of Otago, Otago, New Zealand
| | - T Broomhead
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | - K Bekes
- 3 Department of Paediatric Dentistry, School of Dentistry, Medical University of Vienna, Vienna, Austria
| | - P E Benson
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | - F Aguilar-Diaz
- 4 Department of Public Health, National Autonomous University of Mexico León Unit, León, Guanajuato, México
| | - L Do
- 5 Australian Research Centre for Population Oral Health, The University of Adelaide, Adelaide, Australia
| | - C Hirsch
- 6 Department of Paediatric Dentistry, University of Leipzig, Leipzig, Germany
| | - Z Marshman
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
| | - C McGrath
- 7 Periodontology & Public Health, Faculty of Dentistry, University of Hong Kong, Hong Kong
| | - A Mohamed
- 8 Department of Dental Services, Ministry of Health, Brunei Darussalam
| | - P G Robinson
- 9 Bristol Dental School, The University of Bristol, Bristol, UK
| | - J Traebert
- 10 Postgraduate Program in Health Sciences, University of Southern Santa Catarina, Santa Catarina, Brazil
| | - B Turton
- 11 Department of Dentistry, University of Puthisastra, Phnom Penh, Cambodia
| | - B J Gibson
- 1 Unit of Dental Public Health, School of Clinical Dentistry, Claremont Crescent, University of Sheffield, Sheffield, UK
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Murray IR, Robinson PG, West CC, Goudie EB, Yong LY, White TO, LaPrade RF. Reporting Standards in Clinical Studies Evaluating Bone Marrow Aspirate Concentrate: A Systematic Review. Arthroscopy 2018; 34:1366-1375. [PMID: 29395555 DOI: 10.1016/j.arthro.2017.11.036] [Citation(s) in RCA: 37] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2017] [Revised: 11/28/2017] [Accepted: 11/29/2017] [Indexed: 02/02/2023]
Abstract
PURPOSE To perform a systematic review of clinical studies evaluating bone marrow aspirate concentrate (BMAC) in the treatment of musculoskeletal pathology to compare levels of reporting with recently published minimum standards. METHODS A systematic review of the clinical literature from August 2002 to August 2017 was performed. Human clinical studies published in English and involving the administration of BMAC for musculoskeletal applications were included. Studies evaluating non-concentrated preparations of bone marrow aspirate or preparations of laboratory cultured cells were excluded. Studies evaluating the treatment of dental or maxillofacial conditions were excluded. Similarly, in vitro studies, editorials, letters to the editor, and reviews were excluded. Levels of reporting were compared with previously published minimum standards agreed on through an international Delphi consensus process. RESULTS Of 1,580 studies identified on the initial search, 46 satisfied the criteria for inclusion. Considerable deficiencies in reporting of key variables including the details of BMAC preparation and composition were noted. Studies reported information on only 42% (range, 25%-60%) of the variables included within established minimum reporting standards. No study provided adequate information to enable the precise replication of preparation protocols and accurate characterization of the BMAC formulation delivered. CONCLUSIONS We found that all existing clinical studies in the literature evaluating BMAC for orthopaedic or sports medicine applications are limited by inadequate reporting of both preparation protocols and composition. Deficient reporting of the variables that may critically influence outcomes precludes interpretation, prevents other researchers from reproducing experimental conditions, and makes comparisons across studies difficult. We encourage the adoption of emerging minimum reporting standards for clinical studies evaluating the use of mesenchymal stem cells in orthopaedics. LEVEL OF EVIDENCE Level IV, systematic review of Level I through IV studies.
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Affiliation(s)
- Iain R Murray
- University of Edinburgh, Edinburgh, Scotland; Royal Infirmary of Edinburgh, Edinburgh, Scotland
| | | | | | | | - Li Y Yong
- University of Edinburgh, Edinburgh, Scotland
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Robinson PG, Rankin CS, Lavery J, Anthony I, Blyth M, Jones B. The validity and reliability of the modified forgotten joint score. J Orthop 2018; 15:480-485. [PMID: 29881181 DOI: 10.1016/j.jor.2018.03.029] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [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: 02/03/2018] [Accepted: 03/25/2018] [Indexed: 10/17/2022] Open
Abstract
We aim to validate the "Modified Forgotten Joint Score" (MFJS) as a new patient-reported outcome measure (PROM) in hip and knee arthroplasty, against the UK's gold standard Oxford Hip and Knee Scores (OHS/OKS). The original Forgotten Joint Score (FJS) (12 items) was created to assess post-arthroplasty joint awareness. We modified the FJS to 10-items to improve its reliability. Postal questionnaires were sent out to 400 total hip or knee replacement (THR/TKR) patients who were 1-2 years' post-op, along with the OHS/OKS. Data, collected from the 212 returned questionnaires (53% response rate), was analysed in relation to construct and content validity. A sub-cohort of 77 patients took part in a test-retest repeatability study, to assess reliability of the MFJS. The MFJS proved to have an increased discriminatory power in high-performing patients in comparison to the OHS and OKS. 30.8% of TKR patients (n = 131) scored highly (87.5% or more) in the OKS compared to just 7.69% in the MFJS TKR patients. The MFJS proved to have increased test-retest repeatability, based upon its intra-class correlation coefficient of 0.968 compared to the Oxford's 0.845, p < 0.001. The MFJS is a more relevant tool, compared to the FJS, with greater discrimination in the assessment of well performing hip and knee arthroplasties in comparison to the OHS/OKS.
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Affiliation(s)
| | - Conor S Rankin
- University of Edinburgh, 3/2f2 Warrender Park Terrace, Edinburgh, EH9 1JA, UK
| | - Jonathan Lavery
- Glasgow Royal Infirmary Orthopaedic Research Department, Glasgow, UK
| | - Iain Anthony
- Glasgow Royal Infirmary Orthopaedic Research Department, Glasgow, UK
| | - Mark Blyth
- Glasgow Royal Infirmary Orthopaedic Research Department, Glasgow, UK
| | - Bryn Jones
- Glasgow Royal Infirmary Orthopaedic Research Department, Glasgow, UK
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Dyer TA, Owens J, Robinson PG. The acceptability of healthcare: from satisfaction to trust. Community Dent Health 2017; 33:242-251. [PMID: 28537359 DOI: 10.1922/cdh_3902dyer10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 11/27/2015] [Accepted: 05/02/2016] [Indexed: 11/11/2022]
Abstract
The assessment of healthcare quality increasingly emphasises lay acceptability, as evidenced by the emergence of patient satisfaction and patient-centred care in the literature and in policy. In this paper we aim to provide a conceptual overview of acceptability and propose ways to enhance its assessment. Firstly, we map how acceptability's importance in quality assessments has increased and how the term acceptability has been used as synonymous with patient satisfaction, despite it being a broader concept. We then critique the concept of patient satisfaction and its measurement and challenge its use as an indicator of acceptability and quality. By drawing on our research and those of others, the second half of the paper describes how trust in clinicians and health services has emerged as a related concept, including a theoretical discussion of trust in healthcare outlining how it can be built, undermined and abused. We propose trust as an alternative indicator of acceptability in healthcare quality and review its measurement. Finally, we consider how healthcare policy may impact on trust and make recommendations for future research.
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Affiliation(s)
- T A Dyer
- Dental Public Health, University of Sheffield, Sheffield, UK
| | - J Owens
- Dental Public Health, University of Sheffield, Sheffield, UK
| | - P G Robinson
- Oral and Dental Sciences, University of Bristol, Bristol, UK
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Zijlstra-Shaw S, Roberts T, Robinson PG. Evaluation of an assessment system for professionalism amongst dental students. Eur J Dent Educ 2017; 21:e89-e100. [PMID: 27440069 DOI: 10.1111/eje.12226] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/20/2016] [Indexed: 06/06/2023]
Abstract
INTRODUCTION Dental professionalism is an essential requirement to practice dentistry that covers both abilities and personal qualities. Therefore, a programme of assessment that promotes personal and professional development throughout the undergraduate dental education course is needed. This study aimed to develop and validate a system to assess dental students' professionalism based on a previously developed conceptual framework. METHODS Using the framework, an assessment programme was designed to encourage students to reflect on and explain their observed behaviours with appropriate feedback. The programme was panel-tested and then administered to a cohort of senior dental students. Internal reliability criterion validity and construct validity were evaluated quantitatively, whilst the usefulness of the programme was evaluated qualitatively. RESULTS Mean of student, staff and agreed grades was similar, and there were no floor or ceiling effects. All item-total correlations were >0.6 and Cronbach's alpha = 0.95 indicating acceptable internal reliability. All items correlated significantly with global ratings indicating good criterion validity. All hypothesized correlations were significant, and grades were not related to age or gender. Qualitative data produced three themes: assessment process, educational value and suggestions for improvement. CONCLUSION The assessment programme has good internal reliability and validity and suggests that basing an assessment system around the explicit theoretical model is a valuable educational tool.
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Affiliation(s)
- S Zijlstra-Shaw
- Academic Unit of Primary Dental Care, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - T Roberts
- Leeds Institute of Medical Education, University of Leeds, Leeds, UK
| | - P G Robinson
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
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Worsley DJ, Robinson PG, Marshman Z. Access to urgent dental care: a scoping review. Community Dent Health 2017; 34:19-26. [PMID: 28561553 DOI: 10.1922/cdh_4038worsley08] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 07/29/2016] [Accepted: 10/10/2016] [Indexed: 11/11/2022]
Abstract
Objective To summarise the literature on urgent dental care and to identify research priorities on the organisation and delivery of urgent dental services. Basic research design Scoping review using Andersen's behavioural model of health service utilisation for a framework analysis of the data. Main outcome measures Gaps in the literature, defined as those factors and interactions identified by Andersen's model as having a contributory role in access to health services that were not evident in the source papers. Results Fifty-six papers met the inclusion criteria for the review. The factors most often considered were; demographic, socioeconomic, perceived and evaluated need, and health behaviours. Patient outcomes of evaluated health and quality of life following urgent dental care were the least studied variables, with the exception of patient satisfaction. No studies were identified on community values/norms of people accessing urgent dental care, on health economic evaluations or on studies of how urgent dental services mitigate use of other medical services. No studies were identified on urgent need for populations living in water fluoridated areas or on the relationship between service design and efficient or effective access as measured by patient outcomes. Conclusion Future research on patient outcomes and the comparison of different service models for urgent dental care through measures of equity, effectiveness and efficiency of access are needed to inform future policy and organisation of these services.
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Affiliation(s)
| | - P G Robinson
- Bristol School of Oral and Dental Sciences, Bristol, UK
| | - Z Marshman
- School of Clinical Dentistry, Sheffield, UK
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Robinson PG, Macey ARM, Johnston IS, Macey AC. How to apply a cast for forearm fractures. BMJ 2017; 356:i6081. [PMID: 31055290 DOI: 10.1136/sbmj.i6081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Affiliation(s)
| | - A R M Macey
- South Glasgow University Hospital, Glasgow, UK
| | | | - A C Macey
- Sligo General Hospital, Sligo, Republic of Ireland
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Abstract
This paper, by means of a quality framework, reviews health services research in relation to people with HIV infection. The relevance of oral health care services to people’s needs is considered in terms of the goal of health services to reduce the burden of disease on the everyday life of the population. Dental services may therefore have a role in primary prevention in the HIV epidemic, passing on information about HIV and promoting health through the early diagnosis and treatment of oral disease. Effectiveness research of oral health care in HIV assesses the usefulness of oral diagnosis, whether care is safe, and whether treatment is clinically effective. Few data are available on the efficiency of services. People with HIV still have problems accessing dental care, due to the volume of care available in relation to their need and acceptability of care. Access problems in the US are compounded by social inequality. Health services research data are particularly sparse in resource-poor countries, and there is a need to translate the available information into treatment guidelines appropriate to these settings. The research community and funding agencies should place greater emphasis on the quality of oral health services for people with HIV.
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Affiliation(s)
- P G Robinson
- Dept. of Oral Health and Development, School of Clinical Dentistry, University of Sheffield, Claremont Crescent, Sheffield S10 2TA, UK.
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Abstract
The workshop addressed the following questions with respect to periodontal diseases and bacterial infections seen in HIV infection: (1) What is linear gingival erythema? Is it prevalent only in HIV disease? A crude Delphi technique was used to ascertain whether LGE existed, but a consensus could not be reached. It was agreed that a diagnosis of LGE should be considered only if the lesion persists after removal of plaque in the initial visit. (2) Do periodontal pockets contribute to viremia in HIV infection? At present, the data are not available to answer this question. (3) Do anti-viral drugs reach the sulcular fluid in significant concentrations? No one at the workshop was aware of data that could answer this question. (4) Does concurrent tuberculosis infection modify the oral manifestations of HIV infection? Though analysis of data from the developing countries does suggest an association between tuberculosis and oral candidiasis, more data and multivariate analysis considering immunosuppression as a confounding factor are necessary, for any conclusions to be derived. (5) What pathogens are involved in periodontal diseases in HIV infection? Periodontal disease may be initiated by conventional periodontal pathogens. But the progression and tissue destruction depend upon the presence of typical and atypical micro-organisms, including viruses, their by-products, increased secretion of potentially destructive inflammatory mediators, and overwhelming host response. (6) How can we diagnose the diseases seen in HIV infection? The answer can be obtained only with data from controlled and blinded studies. It is necessary to design collaborative multi-center longitudinal studies. The results obtained from such large sample sizes can contribute eventually to interpretation of the outcome.
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Affiliation(s)
- M Umadevi
- Department of Oral and Maxillofacial-Pathology, Ragas Dental College and Hospital, Chennai, India
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Hulme C, Robinson PG, Saloniki EC, Vinall-Collier K, Baxter PD, Douglas G, Gibson B, Godson JH, Meads D, Pavitt SH. Shaping dental contract reform: a clinical and cost-effective analysis of incentive-driven commissioning for improved oral health in primary dental care. BMJ Open 2016; 6:e013549. [PMID: 27609858 PMCID: PMC5020665 DOI: 10.1136/bmjopen-2016-013549] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To evaluate the clinical and cost-effectiveness of a new blended dental contract incentivising improved oral health compared with a traditional dental contract based on units of dental activity (UDAs). DESIGN Non-randomised controlled study. SETTING Six UK primary care dental practices, three working under a new blended dental contract; three matched practices under a traditional contract. PARTICIPANTS 550 new adult patients. INTERVENTIONS A new blended/incentive-driven primary care dentistry contract and service delivery model versus the traditional contract based on UDAs. MAIN OUTCOME MEASURES Primary outcome was as follows: percentage of sites with gingival bleeding on probing. Secondary outcomes were as follows: extracted and filled teeth (%), caries (International Caries Detection and Assessment System (ICDAS)), oral health-related quality of life (Oral Health Impact Profile-14 (OHIP-14)). Incremental cost-effective ratios used OHIP-14 and quality adjusted life years (QALYs) derived from the EQ-5D-3L. RESULTS At 24 months, 291/550 (53%) patients returned for final assessment; those lost to follow-up attended 6.46 appointments on average (SD 4.80). The primary outcome favoured patients in the blended contract group. Extractions and fillings were more frequent in this group. Blended contracts were financially attractive for the dental provider but carried a higher cost for the service commissioner. Differences in generic health-related quality of life were negligible. Positive changes over time in oral health-related quality of life in both groups were statistically significant. CONCLUSIONS This is the first UK study to assess the clinical and cost-effectiveness of a blended contract in primary care dentistry. Although the primary outcome favoured the blended contract, the results are limited because 47% patients did not attend at 24 months. This is consistent with 39% of adults not being regular attenders and 27% only visiting their dentist when they have a problem. Promotion of appropriate attendance, especially among those with high need, necessitates being factored into recruitment strategies of future studies.
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Affiliation(s)
- C Hulme
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - P G Robinson
- School of Oral and Dental Sciences, University of Bristol, Bristol, UK
| | - E C Saloniki
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - P D Baxter
- Division of Epidemiology & Biostatistics, Leeds Institute of Cardiovascular & Metabolic Medicine, University of Leeds, Leeds, UK
| | - G Douglas
- School of Dentistry, University of Leeds, Leeds, UK
| | - B Gibson
- Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, Sheffield, UK
| | - J H Godson
- School of Dentistry, University of Leeds, Leeds, UK
| | - D Meads
- Academic Unit of Health Economics, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - S H Pavitt
- Director of the Dental Translational and Clinical Research Unit, School of Dentistry, University of Leeds, Leeds, UK
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Robinson PG. Choosing a measure of Health Related Quality of Life. Community Dent Health 2016; 33:107-115. [PMID: 27352464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
This paper provides practical advice on the choice of health related quality of life measures. It starts by making explicit a series of underlying assumptions and then advises on selecting a measure as a trade-off between three sets of conditions: The purpose of collecting HQoL information, which considers the objectives of the study, the level of analysis, the population to be studied and the audience to whom the data will be presented. The qualities of the measure, including the need for a strong conceptual basis, pragmatic considerations, face and content validity, adequate psychometric properties and for the measure to be acceptable to the people participating in the study. The use of the measure, including the mode of administration and resource requirements. An earlier version of this paper was published as Robinson, P.G. (2016): Wahl der messinstrumente zur ermittlung der gesundheitsbezogenen lebensqualitat. In: Kovacs, L., Kipke, R., Lutz, R. (eds) Lebensqualitat in der medizin. Wiesbaden: Springer VS, pp201-222.
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Koyio L, Ranganathan K, Kattappagari KK, Williams DM, Robinson PG. Oral health needs assessment world-wide in relation to HIV. Themes: Oral health needs and inequalities, oral health promotion, co-ordinating research and enhancing dissemination in relation to HIV- a workshop report. Oral Dis 2016; 22 Suppl 1:199-205. [DOI: 10.1111/odi.12433] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2015] [Revised: 12/20/2015] [Accepted: 12/23/2015] [Indexed: 11/27/2022]
Affiliation(s)
- L Koyio
- Ministry of Health; Nairobi Kenya
| | | | | | - DM Williams
- Bart's and The London School of Medicine and Dentistry; London UK
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Worsley DJ, Marshman Z, Robinson PG, Jones K. Evaluation of the telephone and clinical NHS urgent dental service in Sheffield. Community Dent Health 2016; 33:9-14. [PMID: 27149767] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
OBJECTIVE Evaluate an NHS in- and out-of-hours urgent dental service (UDS) including both a telephone triage provider (TTP) and a sole clinical provider (CP) using a quality framework. BASIC RESEARCH DESIGN Analysis of activity and patient experience data. MAIN OUTCOME MEASURES Ratio of volume of services to activity provided; distance and time travelled; appropriateness of referrals and treatments; equity of utilisation; patient experience; cost per patient. RESULTS Almost all calls (96.6%) to the TTP were answered within 60 seconds and of people referred to the CP 96.0% needed treatment. Proportionately more people from deprived areas used the TTP. Highest utilisation of the TTP was by people aged 20 to 44 years and lowest was by people over 54 years. Cost per patient utilising the TTP was £5.06. Of the available appointments provided by the CP, 90.9% were booked the TTP. Travel time to the CP was less than 30 minutes for 78.0% of patients. Of treatments provided, 77.9% were clinical interventions and 18.1% were prescription only. Proportionately more people from deprived areas attended the CP. Highest utilisation was by people aged 20 to 44 years and lowest by people over 54 years. Nearly half (47.0%) of those attending reported they did not have a dentist. There was a high level of patient satisfaction. Cost per course of treatment at the CP was £67.41. CONCLUSION Overall the UDS provided a high quality service in line with Maxwell's dimensions of quality. Timely advice and treatment was provided with high levels of patient satisfaction with the CP. Comparison with other urgent dental service models would determine the relative efficiency of the UDS.
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Affiliation(s)
- S J Challacombe
- Co-Chairpersons of 7th World Workshop on Oral Health & Disease in AIDS, UK.,King's College London, UK
| | - A R Tappuni
- Co-Chairpersons of 7th World Workshop on Oral Health & Disease in AIDS, UK.,Queen Mary University of London, UK
| | - K Ranganathan
- Co-Chairpersons of 7th World Workshop on Oral Health & Disease in AIDS, UK.,Ragas Dental College, Chennai, India
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Eaton KA, Holland GR, Giannobile WV, Hancocks S, Robinson PG, Lynch CD. How is research publishing going to progress in the next 20 years? Transcription of session for editors, associate editors, publishers and others with an interest in scientific publishing held at IADR meeting in Seattle on Wednesday, 20 March 2013. Eur J Dent Educ 2014; 18:e25-e33. [PMID: 24750223 DOI: 10.1111/eje.12089] [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] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
On March 20th 2013, a one-hour session for Editors, Associate Editors, Publishers and others with an interest in scientific publishing was held at the IADR International Session in Seattle. Organised by Kenneth Eaton and Chris Lynch (Chair and Secretary, respectively, of the British Dental Editors Forum), the meeting sought to bring together leading international experts in dental publishing, as well as authors, reviewers and students engaged in research. The meeting was an overwhelming success, with more than 100 attendees. A panel involving four leading dental editors led a discussion on anticipated developments in publishing dental research with much involvement and contribution from audience members. This was the third such meeting held at the IADR for Editors, Associate Editors, Publishers and others with an interest in scientific publishing. A follow up session will take place in Cape Town on 25 June 2014 as part of the annual IADR meeting. The transcript of the meeting is reproduced in this article. Where possible speakers are identified by name. At the first time of mention their role/ position is also stated, thereafter only their name appears. We are grateful to Stephen Hancocks Ltd for their generous sponsorship of this event. For those who were not able to attend the authors hope this article gives a flavour of the discussions and will encourage colleagues to attend future events. Involvement is open to Editors, Associate Editors, Publishers and others with an interest in scientific publishing. It is a very open group and all those with an interest will be welcome to join in.
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Affiliation(s)
- K A Eaton
- University College London Eastman Dental and King's College, London Dental Institutes, University of Kent Chairman, Ashford, UK
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Robinson PG, Eaton KA. The challenges of scientific publishing. Community Dent Health 2013; 30:130-131. [PMID: 24151783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/02/2023]
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Shields DW, Robinson PG. Iliopsoas abscess masquerading as 'sciatica'. BMJ Case Rep 2012; 2012:bcr2012007419. [PMID: 23264154 PMCID: PMC4543943 DOI: 10.1136/bcr-2012-007419] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2012] [Revised: 09/19/2012] [Accepted: 11/13/2012] [Indexed: 11/04/2022] Open
Abstract
A 35-year-old woman of Indian origin presented with a 5-month history of lower back pain, radiating down the back of her right leg in distribution of the sciatic nerve. Referral was made to the spinal clinic querying sciatica, but a deterioration in her symptoms developed, and the patient presented to the Accident and Emergency department. She was significantly tender at right sacroiliac joint and had positive psoas sign. The MRI scan showed a large iliopsoas abscess causing bony destruction, and extended culture was positive for mycobacterium tuberculosis. The patient was initially diagnosed with sciatica yet had a positive psoas sign and a painful sacrum. It is important that primary physicians are aware of the relations the iliopsoas muscle and the potential effect an abscess can have here. A sinister underlying cause of a patient's sciatic distribution of pain should be excluded before accepting a diagnosis of mechanical back pain.
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Affiliation(s)
- D W Shields
- Department of Trauma and Orthopaedics, Royal Victoria Infirmary, Newcastle-Upon-Tyne, Tyne and Wear, UK.
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Abstract
Sense of coherence (SOC) has been related to oral health behaviors and oral-health-related quality of life (OHRQoL) in observational studies. This cluster-randomized trial aimed to test the effect of an intervention to enhance SOC on OHRQoL in children. Twelve primary schools were randomly allocated to intervention and control groups. The intervention was comprised of 7 sessions over 2 mos, focusing on child participation and empowerment. The first 4 sessions were classroom activities, and the last 3 involved working on healthy school projects. Trained teachers who received a one-day course delivered the intervention. Socio-demographic and clinical data, together with self-reported measures of OHRQoL, SOC, and oral health beliefs, were obtained from 261 total 10- to 12-year-olds (133 in the intervention and 128 in the control groups). Data were collected at baseline, 2 wks after the intervention, and at three-month follow-up. Mixed-effects models indicated that the intervention increased SOC and improved OHRQoL, together with oral health beliefs and gingival health. The findings offer experimental evidence that OHRQoL can be influenced by SOC. SOC may also provide an avenue for oral health promotion (Australian New Zealand Clinical Trials Registry ACTRN12612000547842).
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Affiliation(s)
- O Nammontri
- Unit of Dental Public Health, School of Clinical Dentistry, University of Sheffield, UK
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