scholarly journals The Serially-Operated Essex-Lopresti Injury: Long-Term Outcomes in a Retrospective Cohort

2020 ◽  
Vol 12 (01) ◽  
pp. 47-55
Author(s):  
Svenna H. W. L. Verhiel ◽  
Sezai Özkan ◽  
Christopher G. Langhammer ◽  
Neal C. Chen
Keyword(s):  
Upper Extremity ◽  
Radial Head ◽  
Rating Scale ◽  
Case Series ◽  
Outcome Evaluation ◽  
Pain Severity ◽  
Measurement Information ◽  
Radial Head Arthroplasty ◽  
Patient Reported ◽  
Essex Lopresti

Abstract Objective The main aim of this article is to report 10-year outcomes after Essex-Lopresti injury (ELI). Study Design Retrospective case series. Two level I trauma centers and one associated community hospital from 2003 to 2016. Patients Sixteen patients who sustained an ELI and were treated at one of our three regional hospitals. Intervention Initially, 4 patients (25%) were treated nonoperatively by immobilization and 12 patients (75%) were treated operatively. Proximal surgery included radial head open reduction and internal fixation (ORIF), radial head arthroplasty, radial head excision and forearm ORIF, and wound debridement. Ten patients (63%) were acutely identified with longitudinal forearm instability. Of these, four patients had the distal radioulnar joint pinned. In the other six patients, the forearm was immobilized. Overall, 16 patients underwent a total of 32 revision surgeries. Main Outcome Measure Performance of Patient-Reported Outcomes Measurement Information System Upper Extremity (PROMIS UE) Physical score, Numeric Rating Scale (NRS) score for pain-severity, and NRS score for satisfaction of overall outcome. Results Follow-up for outcome evaluation was available for 10 patients, at a median of 10 (interquartile range [IQR]: 8.0–12) years after date of injury. The median PROMIS UE Physical score was 36 (IQR: 33–38). Median NRS score for pain-severity on average was 5 (IQR: 0–6). The median NRS score for satisfaction of overall outcome was 7 (IQR: 5–8). Conclusion Patients who sustain an ELI generally have substantial deficits of upper extremity function as measured by PROMIS UE. Early radial head arthroplasty may be beneficial, but further study in a larger cohort is needed. Outcomes of nonoperative treatment and operative treatment were similar and suggest that current surgical treatments are incomplete.

scholarly journals Establishing a common metric for patient-reported outcomes in cancer patients: linking patient reported outcomes measurement information system (PROMIS), numerical rating scale, and patient-reported outcomes version of the common terminology criteria for adverse events (PRO-CTCAE)

2020 ◽  
Vol 4 (1) ◽  
Author(s):  
Minji K. Lee ◽  
Benjamin D. Schalet ◽  
David Cella ◽  
Kathleen J. Yost ◽  
Amy C. Dueck ◽  
...  
Keyword(s):  
Information System ◽  
Adverse Events ◽  
Patient Reported Outcomes ◽  
Rating Scale ◽  
Measurement Information ◽  
Outcomes Measurement ◽  
T Score ◽  
Patient Reported ◽  
Measurement Information System ◽  
The Common

Abstract Background Researchers and clinicians studying symptoms experienced by people with cancer must choose from various scales. It would be useful to know how the scores on one measure translate to another. Methods Using item response theory (IRT) with the single-group design, in which the same sample answers all measures, we produced crosswalk tables linking five 0–10 numeric rating scale (NRS) and 15 items from Patient-Reported Outcomes version of the Common Terminology Criteria for Adverse Events (PRO-CTCAE, scored on a 1–5 scale) to the T-Score metric of six different scales from the NIH Patient reported Outcomes Measurement Information System (PROMIS®). The constructs, for which we conducted linking, include emotional distress-anxiety, emotional distress-depression, fatigue, sleep disturbance, pain intensity, and pain interference. We tested the IRT linking assumption of construct similarity between measures by comparing item content and testing unidimensionality of item sets comprising each construct. We also investigated the correlation of the measures to be linked and, by inspecting standardized mean differences, whether the linkage is invariant across age and gender subgroups. For measures that satisfied the assumptions, we conducted linking. Results In general, an NRS score of 0 corresponded to about 38.2 on the PROMIS T-Score scale (mean = 50; SD = 10); whereas an NRS score of 10 corresponded to a PROMIS T-Score of approximately 72.7. Similarly, the lowest/best score of 1 on PRO-CTCAE corresponded to 39.8 on T-score scale and the highest/worst score of 5 corresponded to 72.0. Conclusion We produced robust linking between single item symptom measures and PROMIS short forms.

scholarly journals The Influence of Psychological Factors on the Michigan Hand Questionnaire

Hand ◽  
2016 ◽  
Vol 12 (2) ◽  
pp. 197-201 ◽  
Author(s):  
Yekyoo Oh ◽  
Tessa Drijkoningen ◽  
Mariano E. Menendez ◽  
Femke M. A. P. Claessen ◽  
David Ring
Keyword(s):  
Upper Extremity ◽  
Emotional Health ◽  
Pain Catastrophizing ◽  
Pain Interference ◽  
Measurement Information ◽  
Web Based ◽  
Psychological Measures ◽  
Symptoms Of Depression ◽  
Patient Reported ◽  
Multivariable Regression

Background: Psychosocial factors help account for the gap between impairment and disability. This study examines the relationship between the Michigan Hand Questionnaire (MHQ) and commonly used psychological measures in patients with upper extremity illness. Methods: A cohort of 135 new or follow-up patients presenting to an urban academic hospital–based hand surgeon were invited to complete a web-based version of the MHQ, Abbreviated Pain Catastrophizing Scale (PCS), and two Patient-Reported Outcomes Measurement Information System (PROMIS)-based questionnaires: Pain Interference and Depression. Bivariate and multivariable analyses measured the correlation of these psychological measures with MHQ. Results: Accounting for potential confounding factors in multivariable regression, upper extremity disability as rated by the MHQ was independently associated with PROMIS Depression, PROMIS Pain Interference, visit type, and working status. The model accounted for 37% of the variability in MHQ scores, with PROMIS Pain Interference having the most influence. Conclusion: Among the non-pathophysiological factors that contribute to patient-to-patient variation in MHQ scores, the measure of less effective coping strategies and symptoms of depression were most influential. Our data add to the evidence of the pivotal role of emotional health in upper extremity symptoms and limitations and the importance of psychosocial considerations in the care of hand illness.

scholarly journals Identification of Functioning Domains in the Presurgical Period and Their Relationships with Opioid Use and Pain Catastrophizing

Pain Medicine ◽  
2018 ◽  
Vol 20 (9) ◽  
pp. 1717-1727 ◽  
Author(s):  
Letitia E Travaglini ◽  
Krista B Highland ◽  
Winifred Rojas ◽  
Chester C Buckenmaier ◽  
Michael Kent
Keyword(s):  
Factor Analysis ◽  
Structural Equation ◽  
Rating Scale ◽  
Pain Catastrophizing ◽  
Medical Center ◽  
Measurement Information ◽  
Opioid Use ◽  
Latent Factors ◽  
Targeted Interventions ◽  
Patient Reported

AbstractObjectivesThe National Institutes of Health Patient-Reported Outcomes Measurement Information System (PROMIS) is a multidimensional screening system evaluating biopsychosocial factors affecting pain and functioning. Using a military sample, the current study 1) examined the structure and domains of the PROMIS, the Defense and Veterans Pain Rating Scale 2.0 (DVPRS), and the Pain Catastrophizing Scale (PCS) within a presurgical setting and 2) examined the relationship of these variables to pre- and postsurgical opioid use.MethodsThis cross-sectional study included 279 adult patients scheduled for surgery at the Walter Reed National Military Medical Center and a validation sample of 79 additional patients from the Naval Medical Center, San Diego. PROMIS, DVPRS, PCS, and opioid use data were collected before surgery. Exploratory factor analysis and confirmatory factor analysis identified the latent structure for the measures. A structural equation model (SEM) examined their relationship to pre- and postsurgical opioid use.ResultsTwo latent factors represented Psychosocial Functioning (PROMIS Depression, PROMIS Anxiety, and PROMIS Social Isolation) and Pain Impact (DVPRS, PROMIS Pain Interference, PROMIS Physical Functioning). The remaining PROMIS scales did not load onto a single factor. In the SEM, the two latent factors and PCS were significantly related to pre- and postsurgical opioid use.ConclusionsThis study highlights the utility and relative ease of using a convenient multidimensional assessment in presurgical settings. Using such an assessment can help provide targeted interventions for individuals who may be at greatest risk for negative postsurgical outcomes.

scholarly journals Performance of Pediatric PROMIS CATs in Children With Upper Extremity Fractures

Hand ◽  
2018 ◽  
Vol 15 (2) ◽  
pp. 194-200 ◽  
Author(s):  
William D. Gerull ◽  
Ugochi C. Okoroafor ◽  
Jason Guattery ◽  
Charles A. Goldfarb ◽  
Lindley B. Wall ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Peer Relationships ◽  
Outcome Measurement ◽  
Pain Interference ◽  
Measurement Information ◽  
Strong Positive Correlation ◽  
Lower Extremity Function ◽  
Positive Correlation ◽  
Patient Reported ◽  
Parent Proxy

Background: This study was designed to quantify the performance of the pediatric Patient-Reported Outcome Measurement Information System (PROMIS) when delivered as part of routine care to children with upper extremity (UE) fractures. Methods: This cross-sectional study analyzed 964 new pediatric patients presenting with an UE fracture. All patients completed PROMIS computer adaptive tests for pain interference, peer relationships, UE function, and mobility domains at clinic registration. PROMIS was completed by parent-proxy (n = 418) for 5- to 7-year-olds and self-reported by 8- to 10-year-olds (n = 546). PROMIS score distributions were defined, and Pearson correlations assessed the interrelation between PROMIS domains. Student’s t tests compared mean PROMIS scores between parent-proxy and self-completion groups. Results: UE scores indicated the greatest average impairment of all PROMIS domains. However, 13% of patients reached the UE score ceiling indicating maximal UE function. UE scores and mobility scores had a strong positive correlation while UE scores had a moderate negative correlation with pain interference. In all patients, peer relationships were, at most, very weakly correlated with any other PROMIS domain. After grouping by fracture type, parent-proxy completion estimated worse UE function, more pain interference, and worse peer relationship. Conclusions: Pediatric PROMIS UE function scores capture impairment from UE fractures but do have a strong positive correlation with pediatric PROMIS Mobility, which assesses lower extremity function. Among children with UE fractures, parent-proxy completion of pediatric PROMIS appears associated with worse scores on most PROMIS domains.

scholarly journals Achilles Tendon Rupture Repairs: A Case Series Reporting Clinical Outcomes of a Novel Technique

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0049
Author(s):  
Caroline Williams ◽  
Christopher P. Miller ◽  
John Y. Kwon
Keyword(s):  
Achilles Tendon ◽  
Clinical Outcomes ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Case Series ◽  
Patient Positioning ◽  
Measurement Information ◽  
Repair Technique ◽  
Patient Reported ◽  
Mini Open

Category: Trauma; Ankle; Sports Introduction/Purpose: Achilles tendon rupture repair has undergone several changes in the last ten years, aiming to minimize complications while maximizing clinical and functional outcomes. Selecting a less invasive approach instead of traditional open incision has shown through various studies to generate excellent results and significantly reduce post-operative infections. Choice of patient positioning during operative repair has also shown to be of great impact, with prone positioning being associated with elevated surgical times and anesthetic requirements, thus secondary affecting clinical outcomes. Other complications associated with prone positioning include neuropraxia and increased risk of iatrogenic ophthalmologic insults as compared to the supine position. This case report evaluates clinical outcomes of patients following treatment of Achilles rupture with a novel Medial Mini- Open Supine Achilles Repair Technique. Methods: Patients were selected for case series inclusion after undergoing novel Medial Mini-Open Supine Achilles Repair Technique for acute achilles rupture. Retrospective medical record review for demographic, perioperative and functional data was completed for each patient, with means, range and standard deviations calculated when appropriate. Patients were then followed postoperatively to monitor recovery. At a final follow up visit scheduled no sooner than six months post operatively, outcomes were assessed with three separate Patient-Reported Outcomes Measurement Information System (PROMIS) surveys; Physical Function, Pain Interference and Depression. Two separate Foot and Ankle Ability Measure (FAAM) assessments, ADLs and Sport, were also completed. Patients were also assessed for physical pain/discomfort using the Visual Analog Scale (VAS). Results: Eighteen patients were included in this study; fifteen male, three female. Mean age was 37.5 years (+-12, range= 20-68). Mean duration of surgery was 31.0 minutes (+- 7.0). Follow up duration averaged 11.8 months (range 6.0-13.5). All patients completed three Patient-Reported Outcomes Measurement Information System (PROMIS) studies and two Foot and Ankle Ability Measure (FAAM) surveys. Mean score for the PROMIS Physical Function survey was 52.3 (+-11.5), for Pain Interference, mean= 50.0 (+-7.30), and for Depression, mean=39.5 (+- 6.96). FAAM Sport survey showed a mean=71.3 (+-29.4), with ADLs form responses showing a mean of 90.7 (+-12.7). All patients reported 0/10 pain on Visual Analog Scale (VAS), and overall satisfaction with their outcomes. Conclusion: In reviewing data collected thus far, the Medial Mini-Open Supine Achilles Repair technique shows promise to serve as a viable option for achilles tendon rupture repair; ease of patient positioning preoperatively translates to decreased set up, operative, and sedation time, directly benefiting patients. No complications have been reported at this time; patients have demonstrated excellent outcomes in physical exam in postoperative clinic visits. All patients have expressed satisfaction with their results at final visit.

scholarly journals Operative Management of Unstable Radial Head Fractures in a Young Active Population

Hand ◽  
2017 ◽  
Vol 13 (4) ◽  
pp. 473-480 ◽  
Author(s):  
Nicholas Kusnezov ◽  
Emmanuel Eisenstein ◽  
John C. Dunn ◽  
Austin Fares ◽  
Justin Mitchell ◽  
...  
Keyword(s):  
Upper Extremity ◽  
Radial Head ◽  
Operative Management ◽  
Elbow Fracture ◽  
Complication Rates ◽  
Radial Head Fractures ◽  
Radial Head Arthroplasty ◽  
Increased Risk ◽  
Ligamentous Repair

Background: Radial head and neck fractures are the most common elbow fracture in the general adult population; however, the optimal treatment for radial head fractures remains a topic of ongoing clinical controversy. The purpose of this study was to determine the rate of return to function, complications, and reoperation following operative management of unstable radial head fractures in a young, active patient population with intense upper extremity demands. Methods: A military health care database was queried for all US military servicemembers undergoing open reduction with internal fixation (ORIF; Current Procedural Terminology [CPT] code: 24665) and radial head arthroplasty (RHA; CPT code: 24666) between 2010 and 2015. All patients with minimum 2-year follow-up were included. Univariate and chi-square analyses were performed to evaluate the association between potential risk factors and the primary outcome measures. Results: A total of 67 ORIF (n = 69 elbows) and 10 RHA patients were included. The average age was 31 ± 8.0 years. At mean follow-up of 3.5 ± 1.1 years, 90% of patients overall were able to return to active military service, 96% of which with unrestricted upper extremity function. Nearly one-third (31.2%) of patients developed at least 1 postoperative complication. RHA has higher overall complication rates (70% vs 48%) when compared with ORIF, but this finding did not reach statistical significance ( P = .073). However, RHA had significantly higher rates of implant failure (20% vs 2.9%, P = .0498). Seventeen (21%) individuals required reoperation, 5 of which (6.3%) were revision procedures. Dislocation, coronoid fracture, and concomitant ligamentous repair portended a significantly increased risk of sustaining 1 or more complications ( P < .05), while dislocation and requirement for ligamentous repair independently predicted revision surgery ( P < .05). Conclusions: Arthroplasty and ORIF are both viable options for treating unstable radial head fractures in a young, athletic population, offering comparable return to function despite increased complications with RHA.

scholarly journals #MadelungDeformity: Insights Into a Rare Congenital Difference Using Social Media

Hand ◽  
2021 ◽  
pp. 155894472110541
Author(s):  
Abbas Peymani ◽  
Max M. Lokhorst ◽  
Austin D. Chen ◽  
Chantal M.A.M. van der Horst ◽  
Bernard T. Lee ◽  
...  
Keyword(s):  
Social Media ◽  
Pain Intensity ◽  
Upper Extremity ◽  
Peer Relationships ◽  
Well Being ◽  
Global Perspective ◽  
Pain Interference ◽  
Measurement Information ◽  
Madelung Deformity ◽  
Patient Reported

Background Madelung deformity is a rare congenital hand difference with little known regarding the patient perspective. In this cross-sectional survey study, we harnessed the global reach of social media to understand the clinical spectrum of Madelung deformity and its impact on physical, mental, and social health. Methods A survey was developed based on a previously published protocol and multiple Patient-Reported Outcomes Measurement Information System (PROMIS) short forms. The survey was distributed on several Madelung deformity communities on Facebook and Instagram. T-scores were calculated, interpreted, and compared between patients who underwent surgery and those who did not. Correlations between scores were calculated using the Spearman rank correlation coefficient. Results Mean PROMIS scores for adults were as follows: pain intensity, 4.9 ± 2.8; pain interference, 57.6 ± 10.0; upper extremity, 35.2 ± 8.1; depression, 53.8 ± 11.1; anxiety, 55.4 ± 11.4; and ability to participate in social roles and activities, 42.5 ± 7.7. Mean scores for children were as follows: pain intensity, 5.0 ± 2.8; pain interference, 55.7 ± 11.3; upper extremity function, 24.6 ± 10.4; depressive symptoms, 57.7 ± 11.3; anxiety, 57.3 ± 11.9; and peer relationships, 42.2 ± 10.3. Conclusions Madelung deformity has significant effects on patients’ physical, mental, and social well-being, even after surgical treatment. Using social media, we were able to compensate for Madelung deformity’s rarity by engaging an international audience, demonstrating the feasibility to conduct research through it, and providing a global perspective of the disease entity.

Predictors of PROMIS Physical Function at 2 Years following Knee Surgery

2020 ◽  
Author(s):  
Darius Hunt ◽  
Tina Zhang ◽  
Scott Koenig ◽  
Ali Aneizi ◽  
Gregory Perraut ◽  
...  
Keyword(s):  
Physical Function ◽  
Rating Scale ◽  
Multivariable Analysis ◽  
Knee Surgery ◽  
Activity Level ◽  
Measurement Information ◽  
Opioid Use ◽  
Body Pain ◽  
Patient Reported ◽  
Preoperative Factors

AbstractThe purpose of this study was to evaluate Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) 2 years following knee surgery, and identify preoperative factors associated with postoperative PROMIS PF. Three hundred and sixty-five patients, age 17 years and older, undergoing knee surgery at one institution were studied. Patients completed multiple questionnaires prior to surgery and again 2 years postoperatively including PROMIS PF, International Knee Documentation Committee (IKDC), joint and body numeric pain scales (NPS), Tegner's activity scale (TAS), and Marx's activity rating scale (MARS). Mean PROMIS PF improved from 41.4 to 50.9 at 2 years postoperatively (p < 0.001) and was strongly correlated with 2-year IKDC scores. Older age, female gender, non-Hispanic ethnicity, unemployment, lower income, government insurance, smoking, preoperative opioid use, having a legal claim, comorbidities, previous surgeries, higher body mass index (BMI), and knee arthroplasty were associated with worse 2-year PROMIS PF. Multivariable analysis confirmed that lower BMI, less NPS body pain, and higher MARS were independent predictors of greater 2-year PROMIS PF and better improvement in PROMIS PF. In this large, broad cohort of knee surgery patients, multiple preoperative factors were associated with PROMIS PF 2 years postoperatively. PROMIS PF scores improved significantly, but worse 2 year PROMIS PF scores and less improvement from baseline were independently predicted by higher BMI, greater NPS body pain, and lower MARS activity level. PROMIS PF can be implemented as an efficient means to assess outcomes after knee surgery.

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