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Daza JF, Cuthbertson BH, Myles PS, Shulman MA, Wijeysundera DN, Wijeysundera DN, Pearse RM, Myles PS, Abbott TEF, Shulman MA, Torres E, Ambosta A, Melo M, Mamdani M, Thorpe KE, Wallace S, Farrington C, Croal BL, Granton JT, Oh P, Thompson B, Hillis G, Beattie WS, Wijeysundera HC, Ellis M, Borg B, Kerridge RK, Douglas J, Brannan J, Pretto J, Godsall MG, Beauchamp N, Allen S, Kennedy A, Wright E, Malherbe J, Ismail H, Riedel B, Melville A, Sivakumar H, Murmane A, Kenchington K, Kirabiyik Y, Gurunathan U, Stonell C, Brunello K, Steele K, Tronstad O, Masel P, Dent A, Smith E, Bodger A, Abolfathi M, Sivalingam P, Hall A, Painter TW, Macklin S, Elliott A, Carrera AM, Terblanche NCS, Pitt S, Samuels J, Wilde C, Leslie K, MacCormick A, Bramley D, Southcott AM, Grant J, Taylor H, Bates S, Towns M, Tippett A, Marshall F, McCartney CJL, Choi S, Somascanthan P, Flores K, Karkouti K, Clarke HA, Jerath A, McCluskey SA, Wasowicz M, Day L, Pazmino-Canizares J, Belliard R, Lee L, Dobson K, Stanbrook M, Hagen K, Campbell D, Short T, Van Der Westhuizen J, Higgie K, Lindsay H, Jang R, Wong C, McAllister D, Ali M, Kumar J, Waymouth E, Kim C, Dimech J, Lorimer M, Tai J, Miller R, Sara R, Collingwood A, Olliff S, Gabriel S, Houston H, Dalley P, Hurford S, Hunt A, Andrews L, Navarra L, Jason-Smith A, Thompson H, McMillan N, Back G. Measurement properties of the WHO Disability Assessment Schedule 2.0 for evaluating functional status after inpatient surgery. Br J Surg 2022; 109:968-976. [PMID: 35929065 DOI: 10.1093/bjs/znac263] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2022] [Revised: 05/17/2022] [Accepted: 07/08/2022] [Indexed: 11/12/2022]
Abstract
BACKGROUND Expert recommendations propose the WHO Disability Assessment Schedule (WHODAS) 2.0 as a core outcome measure in surgical studies, yet data on its long-term measurement properties remain limited. These were evaluated in a secondary analysis of the Measurement of Exercise Tolerance before Surgery (METS) prospective cohort. METHODS Participants were adults (40 years of age or older) who underwent inpatient non-cardiac surgery. The 12-item WHODAS and EQ-5DTM-3L questionnaires were administered preoperatively (in person) and 1 year postoperatively (by telephone). Responsiveness was characterized using standardized response means (SRMs) and correlation coefficients between change scores. Construct validity was evaluated using correlation coefficients between 1-year scores and comparisons of WHODAS scores across clinically relevant subgroups. RESULTS The analysis included 546 patients. There was moderate correlation between changes in WHODAS and various EQ-5DTM subscales. The strongest correlation was between changes in WHODAS and changes in the functional domains of the EQ-5D-3L-for example, mobility (Spearman's rho 0.40, 95 per cent confidence interval [c.i.] 0.32 to 0.48) and usual activities (rho 0.45, 95 per cent c.i. 0.30 to 0.52). When compared across quartiles of EQ-5D index change, median WHODAS scores followed expected patterns of change. In subgroups with expected functional status changes, the WHODAS SRMs ranged from 'small' to 'large' in the expected directions of change. At 1 year, the WHODAS demonstrated convergence with the EQ-5D-3L functional domains, and good discrimination between patients with expected differences in functional status. CONCLUSION The WHODAS questionnaire has construct validity and responsiveness as a measure of functional status at 1 year after major surgery.
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Affiliation(s)
- Julian F Daza
- Division of General Surgery, Department of Surgery, University of Toronto, Toronto, Ontario, Canada.,Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada
| | - Brian H Cuthbertson
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Critical Care Medicine, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
| | - Paul S Myles
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Mark A Shulman
- Department of Anaesthesiology and Perioperative Medicine, Alfred Hospital and Monash University, Melbourne, Victoria, Australia
| | - Duminda N Wijeysundera
- Institute of Health Policy, Management, and Evaluation, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesiology and Pain Medicine, University of Toronto, Toronto, Ontario, Canada.,Department of Anesthesia, St. Michael's Hospital, Toronto, Ontario, Canada
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Painter TW, Daly DJ, Kluger R, Rutherford A, Ditoro A, Grant C, Howell S. Intravenous tranexamic acid and lower limb arthroplasty-a randomised controlled feasibility study. Anaesth Intensive Care 2018; 46:386-395. [PMID: 29966112 DOI: 10.1177/0310057x1804600407] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Tranexamic acid (TA) is widely reported to reduce bleeding and the risk of blood transfusion in patients undergoing lower limb arthroplasty. No study in this setting has had adequate power to examine for the effect of TA on either uncommon, but clinically important, adverse events or patient-centric endpoints. A large randomised controlled trial (RCT) is required to address these questions. As a preliminary feasibility study, we conducted an investigator-initiated, prospective, randomised, double blind placebo-controlled trial in 140 patients, aged 45 years or older, undergoing elective primary or revision hip or knee joint replacement. Subjects were randomised to receive intravenous (IV) TA or a placebo. The primary endpoints were the proportion of patients receiving allogenic blood transfusion and the feasibility of extending our trial methodology to a large trial of TA in this population. Secondary endpoints included a range of adverse clinical and surgical events as well as several patient-centric questionnaires. Red blood cell transfusion occurred in 15% of all patients prior to discharge from hospital. Transfusion rates were significantly different between the TA and placebo groups (8.5% versus 21.7%, <i>P</i>=0.03). Three out of four feasibility endpoints were met, with recruitment being slower than expected. No significant differences were seen between groups in the secondary endpoints. Despite a lower rate of transfusion than that widely reported, IV TA reduced transfusion in patients undergoing lower limb arthroplasty. Our trial methodology would be feasible in the setting of a large multicentre study to investigate whether TA is safe and reduces bleeding in lower limb arthroplasty.
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Affiliation(s)
- T W Painter
- Clinical Senior Lecturer, Discipline of Acute Care Medicine, Adelaide Medical School, University of Adelaide; Adelaide, South Australia
| | - D J Daly
- Staff Anaesthetist, Department of Anaesthesia and Perioperative Medicine, Alfred Hospital; Clinical Senior Lecturer, Monash University; Melbourne, Victoria
| | - R Kluger
- Senior Staff Anaesthetist, Department of Anaesthesia and Acute Pain Medicine, St. Vincent's Hospital, Melbourne, Victoria
| | - A Rutherford
- Research nurse, Pain and Anaesthesia Research Centre, Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - A Ditoro
- Research Nurse, Department of Anaesthesia and Perioperative Medicine, Alfred Hospital, Alfred Hospital, Victoria
| | - C Grant
- Research Associate, Discipline of Acute Care Medicine, Adelaide Medical School, The University of Adelaide, Adelaide, South Australia
| | - S Howell
- Senior Statistician, Data Design and Statistics Service, Adelaide Health Technology Assessment, School of Public Health, The University of Adelaide, Adelaide, South Australia
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