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Floyd SB, Oostdyk A, Cozad M, Brooks JM, Siffri P, Burnikel B. Assessing the Patient-Perceived Monetary Value of Patient-Reported Outcome Improvement for Patients With Chronic Knee Conditions. J Patient Cent Res Rev 2021; 8:98-106. [PMID: 33898641 PMCID: PMC8060045] [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] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/12/2023] Open
Abstract
PURPOSE The high cost of orthopaedic care has attracted criticism in the current value-based health care environment. The objective of this work was to assess the properties of a willingness to pay (WTP)-based approach to estimate the monetary value that patients place on health improvements in chronic knee conditions following orthopaedic treatment. METHODS A sample of patients with a chronic knee condition were surveyed between January and May of 2018 at a large orthopaedic practice. Each patient provided their WTP for restoration to ideal knee health and completed the Single Assessment Numerical Evaluation (SANE) to describe their baseline knee state. Average WTP was calculated for the total sample and stratified by income, age, and baseline SANE (for which 0 is the worst and 100 is the best) levels. The patient-perceived monetary value of each unit of SANE improvement was assessed. RESULTS The study sample included 86 patients seeking orthopaedic care for a chronic knee condition. Mean baseline SANE score was 45.5 (standard deviation: 25.0). Mean WTP to obtain ideal knee function from baseline was $18,704 (standard deviation: $18,040). For the full sample, patients valued a 1-unit improvement in SANE score at $291.1 (β: 291.1; P<0.05). The amount of money patients were willing to pay to achieve ideal knee function varied with age, income, and baseline knee state. CONCLUSIONS Patients appear to highly value improvement in chronic knee conditions. Willingness-to-pay survey results appear to track expected variation in patient outcome valuation by income and baseline knee condition and could be a valuable approach to assess value-based care in orthopaedics.
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Affiliation(s)
- Sarah B Floyd
- Department of Public Health Sciences, Clemson University, Clemson, SC
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
| | - Alicia Oostdyk
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - Melanie Cozad
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - John M Brooks
- Center for Effectiveness Research in Orthopaedics, Columbia, SC
- Department of Health Services Policy and Management, University of South Carolina, Columbia, SC
| | - Paul Siffri
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC
| | - Brian Burnikel
- Steadman Hawkins Clinic of the Carolinas, Prisma Health-Upstate, Greenville, SC
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Floyd SB, Oostdyk A, Cozad M, Brooks JM, Siffri P, Burnikel B. Assessing the Patient-Perceived Monetary Value of Patient-Reported Outcome Improvement for Patients With Chronic Knee Conditions. J Patient Cent Res Rev 2021. [DOI: 10.17294/2330-0698.1803] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
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Longstaffe R, Adams K, Thigpen C, Pill S, Rush L, Alexander R, Hall TM, Siffri P, Kwapisz A, Hawkins R, Tokish JM, Kissenberth M, Tolan S. Is residual tendon a predictor of outcome following arthroscopic rotator cuff repair? A preliminary outlook at short-term follow-up. J Shoulder Elbow Surg 2020; 29:S53-S58. [PMID: 32284306 DOI: 10.1016/j.jse.2020.01.083] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 01/14/2020] [Accepted: 01/21/2020] [Indexed: 02/01/2023]
Abstract
BACKGROUND Multiple factors including muscle atrophy, fatty infiltration, smoking, advanced patient age, and increasing tear size have been identified as risk factors for retear after rotator cuff repair. However, little is known about what effect the length of the residual rotator cuff tendon has on the success of repair and patient outcomes. METHODS This study included 64 patients. Patients were stratified based on a residual tendon length of greater than 15 mm (group 1, residual tendon) or 15 mm or less (group 2, no residual tendon). Rotator cuff tendon integrity was then evaluated using ultrasound imaging at 6 months. Outcome measures included the Single Assessment Numeric Evaluation score, visual analog scale score, EQ5D Index score, Global Rating of Change score, and Penn Shoulder Score. RESULTS No differences were found between groups regarding demographic data or repair configuration. Assessment of tendon healing demonstrated an increased rate of tendons that had "not healed" in group 2 (19.3% [n = 5] vs. 13.2% [n = 5]), but this difference was not statistically significant (P = .55). Functional outcome scores improved significantly from preoperatively to final follow-up in both groups and displayed no differences at 6-month follow-up. CONCLUSION A smaller residual tendon length was not a negative predictor of clinical outcomes following arthroscopic rotator cuff repair in patients with short-term follow-up. Although there was a trend toward a decreased rate of healing in patients with smaller residual tendons, this was not significant.
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Affiliation(s)
- Robert Longstaffe
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; Pan Am Clinic, Winnipeg, MB, Canada.
| | - Kyle Adams
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Charles Thigpen
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; ATI Physical Therapy, Greenville, SC, USA
| | - Stephan Pill
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Lane Rush
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; Lane Rush Medical Group, Meridian, MS, USA
| | - Ryan Alexander
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Taylor M Hall
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Paul Siffri
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Adam Kwapisz
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA; Clinic of Orthopaedics and Pediatric Orthopaedics, Medical University of Lodz, Lodz, Poland
| | - Richard Hawkins
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | | | - Michael Kissenberth
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
| | - Stefan Tolan
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, SC, USA
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Momaya AM, Beicker C, Siffri P, Kissenberth MJ, Backes J, Bailey L, Rulewicz GJ, Mercuri JM, Shealy EC, Tokish JM, Thigpen CA. Preoperative Ultrasonography Is Unreliable in Predicting Hamstring Tendon Graft Diameter for ACL Reconstruction. Orthop J Sports Med 2018; 6:2325967117746146. [PMID: 29318179 PMCID: PMC5755799 DOI: 10.1177/2325967117746146] [Citation(s) in RCA: 10] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Hamstring autograft size <8 mm has been shown to be a predictor for failure after anterior cruciate ligament (ACL) reconstruction. The ability to predict graft size preoperatively is helpful in counseling patients about the possible need for graft augmentation. Purpose: To determine whether preoperative ultrasound (US) measurements of hamstring tendons can predict intraoperative graft diameter during ACL reconstruction. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Twenty patients undergoing unilateral isolated ACL reconstruction were prospectively enrolled in the study (10 males, 10 females; mean ± SD age, 22.8 ± 6.6 years; height, 175.1 ± 7.1 cm; weight, 81.4 ± 14.2 kg; body mass index, 26.5 ± 4.1 kg/m2). Hamstrings were assessed by US, and double-looped semitendinosus-gracilis hamstring size was independently calculated with a freehand selection method on a nonmagnified US image by 2 orthopaedic surgeons. Intraoperative autograft size was determined with a standard graft-sizing tool. Intra- and interrater reliability was measured with intraclass correlation coefficients (ICCs) and standard error of the measure (SEM). A receiver operating characteristic curve was calculated to assess the ability of the US measurement to predict intraoperative measurements. Results: The mean autograft diameter by US was 8.9 ± 0.98 mm, while the mean intraoperative hamstring graft size was 8.1 ± 0.89 mm. There was excellent intrarater (ICC2,1 = 0.95, SEM = 0.32 mm) and interrater (ICC2,1 = 0.88, SEM = 0.55 mm) reliability for US measurements. Receiver operating characteristic analysis showed that US did not consistently quantify graft size. Graft size did not significantly correlate with height, weight, or body mass index in our sample (P > .05). Conclusion: These results suggest that preoperative US imaging of the hamstring tendons is unreliable in predicting intraoperative graft diameter.
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Affiliation(s)
- Amit M Momaya
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
| | - Clint Beicker
- Texas Hill Country Orthopaedics and Sports Medicine, Fredericksburg, Texas, USA
| | - Paul Siffri
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
| | - Michael J Kissenberth
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, Greenville, South Carolina, USA
| | | | - Lane Bailey
- Memorial Hermann Ironman Sports Medicine Institute, Houston, Texas, USA
| | - Gabriel J Rulewicz
- North Mississippi Sports Medicine Orthopaedic Clinic, Tupelo, Mississippi, USA
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Phillips JC, Cook C, Beaty S, Kissenberth MJ, Siffri P, Hawkins RJ. Validity of noncontrast magnetic resonance imaging in diagnosing superior labrum anterior-posterior tears. J Shoulder Elbow Surg 2013; 22:3-8. [PMID: 22938789 DOI: 10.1016/j.jse.2012.03.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [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] [Received: 09/21/2011] [Revised: 03/05/2012] [Accepted: 03/12/2012] [Indexed: 02/01/2023]
Abstract
BACKGROUND The biceps labral complex has received much interest in recent years as a source of shoulder pain. Magnetic resonance imaging (MRI) is the imaging modality of choice for those patients with a suspected superior labrum anterior-posterior (SLAP) tear. The goal of this study was to look at the accuracy of MRI without arthrography to correctly identify SLAP tears. METHODS The study had a prospective, case-based, case-control design. Participants were consecutive patients seen at an orthopaedic outpatient clinic who received an MRI scan as part of their diagnostic cycle. All patients were aged at least 18 years, with various shoulder dysfunctions (impingement, rotator cuff tear, and so on) that were evaluated during a routine clinical evaluation. Arthroscopic surgery was performed as the reference standard for a SLAP lesion. RESULTS Seventy-seven patients were evaluated during arthroscopic surgery. The pretest probability of a SLAP lesion-only diagnosis was 18.2%, and for a SLAP lesion with or without a concomitant diagnosis, the pretest probability was 66.2%. In both cases, use of MRI led to post-test probability values that were worse when a positive finding was identified on the MRI scan. DISCUSSION The results of this study suggest that SLAP tears are often incorrectly diagnosed based on MRI evaluation, with MRI providing a high level of sensitivity and low level of specificity. On the basis of the results of this study, conventional MRI is not a suitable test to accurately evaluate the biceps labral complex for the presence of a SLAP tear.
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Cook C, Beaty S, Kissenberth MJ, Siffri P, Pill SG, Hawkins RJ. Diagnostic accuracy of five orthopedic clinical tests for diagnosis of superior labrum anterior posterior (SLAP) lesions. J Shoulder Elbow Surg 2012; 21:13-22. [PMID: 22036538 DOI: 10.1016/j.jse.2011.07.012] [Citation(s) in RCA: 79] [Impact Index Per Article: 6.6] [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] [Received: 03/22/2011] [Revised: 07/04/2011] [Accepted: 07/10/2011] [Indexed: 02/01/2023]
Abstract
BACKGROUND The clinical diagnosis of a superior labral anterior posterior (SLAP) tear is extremely challenging. Most studies that advocate selected tests have errors in study design or significant bias, or both. The purpose of this study was to identify the diagnostic utility of the Active Compression/O'Brien's test, Biceps Load II test, Dynamic Labral Shear test (O'Driscoll's test), Speed's test, and the Labral Tension test when diagnosing isolated SLAP lesions (SLAP-only) and a SLAP lesion with concomitant disorders (eg, rotator cuff tear), as stand-alone and clustered tests, with diagnostic confirmation by arthroscopic surgery. MATERIALS AND METHODS This diagnostic accuracy study was a case-based, case-control design that included 87 individuals with variable shoulder pathology. RESULTS Of the 5 tests, only the Biceps Load II test demonstrated utility in identifying patients with a SLAP-only lesion, with a positive predictive value of 26 (95% confidence limits [CL], 18, 31), negative predictive value of 93 (95% CL, 84, 97), positive likelihood ratio of 1.7 (95% CL, 1.1, 2.6), and negative likelihood ratio of 0.39 (95% CL, 0.14, 0.91). No tests demonstrated diagnostic utility when diagnosing any SLAP lesion, including those with concomitant diagnoses. No clusters demonstrated better diagnostic accuracy than stand-alone findings. CONCLUSION There are a number of potential reasons for the poor utility in the 5 test findings. The heterogeneous sample included patients with a variety of shoulder disorders. The study was organized using very strict methodologic controls that should reduce the risk of bias, which normally overinflates the accuracy of a specific tool. The findings may truly reflect the stand-alone, diagnostic utility of the 5 tests, suggesting when used alone provides little usefulness toward decision making of the diagnostic clinician.
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Affiliation(s)
- Chad Cook
- Division of Physical Therapy, Walsh University, North Canton, OH, USA.
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Allen CS, Deyle GD, Wilken JM, Gill NW, Baker SM, Rot JA, Cook CE, Beaty S, Kissenberth M, Siffri P, Hawkins R, Cook CE, Hegedus EJ, Ross MD, Cook CE, Beaty S, Kissenberth M, Siffri P, Pill S, Hawkins R, Erhardt JW, Harris KD, Deyle GD, Gill NW, Howes RR, Koch WK, Kramer CD, Kumar SP, Adhikari P, Jeganathan PS, D’Souza SC, Misri ZK, Manning DM, Dedrick GS, Sizer PS, Brismée JM, Matthijs OC, Dedrick GS, Brismée JM, McGalliard MK, James CR, Sizer PS, Ross MD, Childs JD, Middel C, Kujawa J, Brown D, Corrigan M, Parsons N, Schmidt SG, Grant R, Spryopolous P, Dansie D, Taylor J, Wang H, Silvernail JL, Gill NW, Teyhen DS, Allison SC, Sueki DG, Almaria SM, Bender MA, Kamara M, Magpali A, Mancilla A, McConnell BJ, Montoya RC, Murphy AW, Romero ML, Viti JA, Rot JA, Augustsson H, Werstine RJ, Birmingham T, Jenkyn T, Yung EY, Tonley JC. AAOMPT platform presentations selection. J Man Manip Ther 2011; 19:239-46. [DOI: 10.1179/106698111x12998437860712] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
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