Relevance of medical comorbidities for functional mobility in people with limb loss: retrospective explanatory models for a clinical walking measure and a patient-reported functional outcome

OBJECTIVEMedical comorbidities, particularly preoperatively diagnosed anxiety, depression, and obesity, may influence how patients perceive and measure clinical benefit after a surgical intervention. The current study was performed to define and compare the minimum clinically important difference (MCID) thresholds in patients with and without preoperative diagnoses of anxiety or depression and obesity who underwent spinal fusion for grade 1 degenerative spondylolisthesis.METHODSThe Quality Outcomes Database (QOD) was queried for patients who underwent lumbar fusion for grade 1 degenerative spondylolisthesis during the period from January 2014 to August 2017. Collected patient-reported outcomes (PROs) included the Oswestry Disability Index (ODI), health status (EQ-5D), and numeric rating scale (NRS) scores for back pain (NRS-BP) and leg pain (NRS-LP). Both anchor-based and distribution-based methods for MCID calculation were employed.RESULTSOf 462 patients included in the prospective registry who underwent a decompression and fusion procedure, 356 patients (77.1%) had complete baseline and 12-month PRO data and were included in the study. The MCID values for ODI scores did not significantly differ in patients with and those without a preoperative diagnosis of obesity (20.58 and 20.69, respectively). In addition, the MCID values for ODI scores did not differ in patients with and without a preoperative diagnosis of anxiety or depression (24.72 and 22.56, respectively). Similarly, the threshold MCID values for NRS-BP, NRS-LP, and EQ-5D scores were not statistically different between all groups. Based on both anchor-based and distribution-based methods for determination of MCID thresholds, there were no statistically significant differences between all cohorts.CONCLUSIONSMCID thresholds were similar for ODI, EQ-5D, NRS-BP, and NRS-LP in patients with and without preoperative diagnoses of anxiety or depression and obesity undergoing spinal fusion for grade 1 degenerative spondylolisthesis. Preoperative clinical and shared decision-making may be improved by understanding that preoperative medical comorbidities may not affect the way patients experience and assess important clinical changes postoperatively.

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Guideline update for the performance of fusion procedures for degenerative disease of the lumbar spine. Part 2: Assessment of functional outcome following lumbar fusion

Journal of Neurosurgery Spine ◽

10.3171/2014.4.spine14258 ◽

2014 ◽

Vol 21 (1) ◽

pp. 7-13 ◽

Cited By ~ 15

Author(s):

Zoher Ghogawala ◽

Daniel K. Resnick ◽

William C. Watters ◽

Praveen V. Mummaneni ◽

Andrew T. Dailey ◽

...

Keyword(s):

Lumbar Spine ◽

Functional Outcome ◽

Spinal Fusion ◽

Lumbar Fusion ◽

Minimum Clinically Important Difference ◽

Degenerative Disease ◽

Psychological State ◽

Lumbar Spinal Fusion ◽

Patient Reported ◽

Lumbar Spinal

Assessment of functional patient-reported outcome following lumbar spinal fusion continues to be essential for comparing the effectiveness of different treatments for patients presenting with degenerative disease of the lumbar spine. When assessing functional outcome in patients being treated with lumbar spinal fusion, a reliable, valid, and responsive outcomes instrument such as the Oswestry Disability Index should be used. The SF-36 and the SF-12 have emerged as dominant measures of general health-related quality of life. Research has established the minimum clinically important difference for major functional outcomes measures, and this should be considered when assessing clinical outcome. The results of recent studies suggest that a patient's pretreatment psychological state is a major independent variable that affects the ability to detect change in functional outcome.

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Original study: early patient-reported functional outcome of all-inside ACL reconstruction as compared to anteromedial portal technique

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-021-02912-6 ◽

2021 ◽

Author(s):

Vikas Kulshrestha ◽

Munish Sood ◽

Santhosh Kumar ◽

Anurag Kawale

Keyword(s):

Functional Outcome ◽

Acl Reconstruction ◽

Original Study ◽

Anteromedial Portal ◽

Anteromedial Portal Technique ◽

Patient Reported ◽

Portal Technique

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Streamlining the KOOS Activities of Daily Living Subscale Using Machine Learning

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120910447 ◽

2020 ◽

Vol 8 (3) ◽

pp. 232596712091044 ◽

Cited By ~ 1

Author(s):

Ashim Gupta ◽

Ajish S.R. Potty ◽

Deepak Ganta ◽

R. Justin Mistovich ◽

Sreeram Penna ◽

...

Keyword(s):

Machine Learning ◽

Activities Of Daily Living ◽

Functional Outcome ◽

Acl Reconstruction ◽

Daily Living ◽

High Accuracy ◽

Quality Data ◽

Specific Patient ◽

Patient Reported ◽

Essential Questions

Background: Functional outcome scores provide valuable data, yet they can be burdensome to patients and require significant resources to administer. The Knee injury and Osteoarthritis Outcome Score (KOOS) is a knee-specific patient-reported outcome measure (PROM) and is validated for anterior cruciate ligament (ACL) reconstruction outcomes. The KOOS requires 42 questions in 5 subscales. We utilized a machine learning (ML) algorithm to determine whether the number of questions and the resultant burden to complete the survey can be lowered in a subset (activities of daily living; ADL) of KOOS, yet still provide identical data. Hypothesis: Fewer questions than the 17 currently provided are actually needed to predict KOOS ADL subscale scores with high accuracy. Study Design: Cohort study (diagnosis); Level of evidence, 2. Methods: Pre- and postoperative patient-reported KOOS ADL scores were obtained from the Surgical Outcome System (SOS) data registry for patients who had ACL reconstruction. Categorical Boosting (CatBoost) ML models were built to analyze each question and its value in predicting the patient’s actual functional outcome (ie, KOOS ADL score). A streamlined set of minimal essential questions were then identified. Results: The SOS registry contained 6185 patients who underwent ACL reconstruction. A total of 2525 patients between the age of 16 and 50 years had completed KOOS ADL scores presurgically and 3 months postoperatively. The data set consisted of 51.84% male patients and 48.16% female patients, with a mean age of 29 years. The CatBoost model predicted KOOS ADL scores with high accuracy when only 6 questions were asked ( R2 = 0.95), similar to when all 17 questions of the subscale were asked ( R2 = 0.99). Conclusion: ML algorithms successfully identified the essential questions in the KOOS ADL questionnaire. Only 35% (6/17) of KOOS ADL questions (descending stairs, ascending stairs, standing, walking on flat surface, putting on socks/stockings, and getting on/off toilet) are needed to predict KOOS ADL scores with high accuracy after ACL reconstruction. ML can be utilized successfully to streamline the burden of patient data collection. This, in turn, can potentially lead to improved patient reporting, increased compliance, and increased utilization of PROMs while still providing quality data.

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Surgical treatment of Neer type II and type V lateral clavicular fractures: comparison of hook plate versus superior plate with lateral extension: a retrospective cohort study

European Journal of Orthopaedic Surgery & Traumatology ◽

10.1007/s00590-019-02411-9 ◽

2019 ◽

Vol 29 (5) ◽

pp. 989-997 ◽

Cited By ~ 4

Author(s):

Yassine Ochen ◽

Herman Frima ◽

R. Marijn Houwert ◽

Marilyn Heng ◽

Mark van Heijl ◽

...

Keyword(s):

Functional Outcome ◽

Retrospective Cohort ◽

Removal Rate ◽

Implant Removal ◽

Type Ii ◽

Lateral Extension ◽

Significant Difference ◽

Patient Reported ◽

Outcome Scores ◽

Type V

Abstract Purpose Different fixation methods are used for treatment of unstable lateral clavicle fractures (LCF). Definitive consensus and guidelines for the surgical fixation of LCF have not been established. The aim of this study was to compare patient-reported functional outcome after open reduction and internal fixation with the clavicle hook plate (CHP) and the superior clavicle plate with lateral extension (SCPLE). Methods A dual-center retrospective cohort study was performed. All patients operatively treated for unstable Neer type II and type V LCF between 2011 and 2016, with the CHP (n = 23) or SCPLE (n = 53), were eligible for inclusion. The primary outcome was the QuickDASH score. Secondary outcomes were the numerical rating scale (NRS) pain score, complications, and implant removal. Results A total of 67 patients (88%) were available for the final follow-up. There was a significant difference in bicortical lateral fragment size, 15 mm (± 4, range 6–21) in the CPH group compared to 20 mm (± 8, range 8–43) in the SCPLE group (p ≤ 0.001). There was no significant difference in median QuickDASH score (CHP; 0.00 [IQR 0.0–0.0], SCPLE; 0.00 [IQR 0.0–4.5]; p = 0.073) or other functional outcome scores (NRS at rest; p = 0.373, NRS during activity; p = 0.559). There was no significant difference in median QuickDASH score or other functional outcome scores between Neer type II and type V fractures. There was no significant difference in complication rate, CHP 11% and SCPLE 8% (relative risk 1.26; [95% CI 0.25–6.33; p = 0.777]). The implant removal rate was 100% in the CHP group compared to 42% in the SCPLE group (relative risk 2.40; [95% CI 1.72–3.35; p ≤ 0.001]). Conclusion Both the CHP and SCPLE are effective fixation methods for the treatment of unstable LCF, resulting in excellent patient-reported functional outcome and similar complication rates. SCPLE fixation is an effective fixation method for the treatment of both Neer type II and type V LCF. The SCPLE has a lower implant removal rate. Therefore, if technically feasible, we recommend SCPLE fixation for the treatment of unstable LCF.

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