Assessment of the musculoskeletal system

2020 ◽  
pp. 79-116
Keyword(s):  
Trauma Patient ◽  
Musculoskeletal System ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Evidence Based ◽  
History Taking ◽  
Comprehensive Overview ◽  
Clinical Investigations ◽  
System P ◽  
Patient Reported

This chapter provides a comprehensive overview of the assessment of a patient’s musculoskeletal system. The chapter adopts a systematic approach to holistic patient assessment including history taking, examination, clinical investigations, and use of patient-reported outcome measures. Updated evidence-based information is provided regarding assessment of the trauma patient.

Classification, Categorization, and Algorithms for Articular Cartilage Defects

2020 ◽  
Vol 33 (11) ◽  
pp. 1069-1077
Author(s):  
Emily Leary ◽  
Aaron M. Stoker ◽  
James L. Cook
Keyword(s):  
Articular Cartilage ◽  
Unmet Need ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Cartilage Defects ◽  
Successful Implementation ◽  
Evidence Based ◽  
Clinical Implementation ◽  
Patient Reported ◽  
Multistep Process

AbstractThere is a critical unmet need in the clinical implementation of valid preventative and therapeutic strategies for patients with articular cartilage pathology based on the significant gap in understanding of the relationships between diagnostic data, disease progression, patient-related variables, and symptoms. In this article, the current state of classification and categorization for articular cartilage pathology is discussed with particular focus on machine learning methods and the authors propose a bedside–bench–bedside approach with highly quantitative techniques as a solution to these hurdles. Leveraging computational learning with available data toward articular cartilage pathology patient phenotyping holds promise for clinical research and will likely be an important tool to identify translational solutions into evidence-based clinical applications to benefit patients. Recommendations for successful implementation of these approaches include using standardized definitions of articular cartilage, to include characterization of depth, size, location, and number; using measurements that minimize subjectivity or validated patient-reported outcome measures; considering not just the articular cartilage pathology but the whole joint, and the patient perception and perspective. Application of this approach through a multistep process by a multidisciplinary team of clinicians and scientists holds promise for validating disease mechanism-based phenotypes toward clinically relevant understanding of articular cartilage pathology for evidence-based application to orthopaedic practice.

scholarly journals Questionnaires in otology: a systematic mapping review

2021 ◽  
Vol 10 (1) ◽  
Author(s):  
Koen Viergever ◽  
Jeroen T. Kraak ◽  
Els. M. Bruinewoud ◽  
Johannes C. F. Ket ◽  
Sophia E. Kramer ◽  
...  
Keyword(s):  
Hearing Loss ◽  
English Language ◽  
English Literature ◽  
Adult Population ◽  
Target Population ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Comprehensive Overview ◽  
Ear Diseases ◽  
Patient Reported

Abstract Background Patient-reported outcome measures (PROMs) are valuable tools in assessing the quality of health care from a patient perspective and are increasingly used by otologists. However, selecting the right questionnaire has proven to be a difficult and time-consuming task. To facilitate this process, we will provide a comprehensive overview of existing questionnaires. Methods A systematic literature search has been conducted on August 26, 2019, using the EMBASE and PubMed medical databases. 13,345 unique records were extracted. Questionnaires addressing any otologic complaint (tinnitus, hearing loss, earache, otorrhoea, and ear-related pressure sensation, vertigo, itch, or dysgeusia) were identified. All questionnaires were evaluated for eligibility by two independent researchers. Inclusion criteria were adult population, closed-ended questions, English language of the questionnaire, and the availability of the original article describing the development of the instrument or a validation paper describing the validation process written in English. Objective Create a comprehensive overview of all validated closed-ended otology questionnaires for adults and demonstrate their basic characteristics. Main outcome measure The number of questionnaires in English literature for the adult population, subdivided per symptom and target population. Results A total of 155 unique questionnaires were selected: 33 tinnitus questionnaires, 23 vertigo questionnaires, 84 hearing loss questionnaires, and 15 multiple complaint questionnaires. A protocol for further questionnaire comparison is presented. Discussion Two separate sequential searches were needed to identify unique questionnaires and to identify their development/validation paper. Although many ear diseases create multiple symptoms, the majority of the questionnaires were symptom specific. Conclusion Many questionnaires concerning ear-related symptoms exist and predominantly concern hearing loss, vertigo, or tinnitus. Only a few questionnaires cover the multiple complaints that ear diseases can create. The presented overview is the most comprehensive overview of otology questionnaires in literature to date. It will serve as a basis for questionnaire selection by professionals and could serve as a protocol for questionnaire selection in other fields. Systematic review registration PROSPERO CRD42017058155

scholarly journals Factors in Randomized Controlled Trials Reported to Impact the Implementation of Patient-Reported Outcome Measures Into Routine Care: Protocol for a Systematic Review (Preprint)

2019 ◽  
Author(s):  
Natasha Anne Roberts ◽  
Kimberly Alexander ◽  
David Wyld ◽  
Monika Janda
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Randomized Controlled Trials ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Implementation Factors

BACKGROUND Patient-reported outcome measures (PROMs) are tools that enable patients to directly report their own assessments of well-being, or symptoms, in a structured and consistent way. Despite the usefulness of PROMs in optimizing health outcomes, their use in clinical practice is not routine. PROMs are complex to integrate into the clinical setting, with many elements potentially impacting on the success of implementation. For this reason, a protocol has been developed to guide a systematic review to collate information on implementation as presented in the randomized controlled trials (RCTs) to date. OBJECTIVE The primary objective of this systematic review is to identify and synthesize factors available from RCT data about the fidelity of PROM interventions in clinical practice. The secondary objective will be an assessment of how implementation factors impact fidelity outcomes. METHODS Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be followed. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature via OvidSP will be accessed using a defined search strategy. Grey literature and ClinicalTrials.gov will be reviewed for unpublished studies. Data extraction will be done to identify fidelity and factors impacting implementation, summarized using a narrative synthesis. An evidence-based implementation science framework will assist in identifying potential elements of importance and their effect on the process and outcomes of implementation. A meta-analysis to assess the impact of implementation factors will be attempted. A Cochrane risk of bias tool will be used. RESULTS This protocol has received funding, and searches of databases will commence at the end of May 2019. It is planned that this systematic review will be finalized for publication in (December) 2019. CONCLUSIONS Applying an implementation science evidence-based framework to the published literature may identify factors present in the data that impact on the implementation of PROMs into routine clinical care. This systematic review aims to improve understanding of how these factors impact the fidelity of this intervention, so that PROMs can be more effectively used in the care of patients. This systematic review can also offer more detailed information about the process and outcomes of successful implementation of PROMs.

scholarly journals Factors in Randomized Controlled Trials Reported to Impact the Implementation of Patient-Reported Outcome Measures Into Routine Care: Protocol for a Systematic Review

10.2196/14579 ◽  
2019 ◽  
Vol 8 (11) ◽  
pp. e14579
Author(s):  
Natasha Anne Roberts ◽  
Kimberly Alexander ◽  
David Wyld ◽  
Monika Janda
Keyword(s):  
Systematic Review ◽  
Clinical Practice ◽  
Randomized Controlled Trials ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Controlled Trials ◽  
Evidence Based ◽  
Randomized Controlled ◽  
Patient Reported ◽  
Implementation Factors

Background Patient-reported outcome measures (PROMs) are tools that enable patients to directly report their own assessments of well-being, or symptoms, in a structured and consistent way. Despite the usefulness of PROMs in optimizing health outcomes, their use in clinical practice is not routine. PROMs are complex to integrate into the clinical setting, with many elements potentially impacting on the success of implementation. For this reason, a protocol has been developed to guide a systematic review to collate information on implementation as presented in the randomized controlled trials (RCTs) to date. Objective The primary objective of this systematic review is to identify and synthesize factors available from RCT data about the fidelity of PROM interventions in clinical practice. The secondary objective will be an assessment of how implementation factors impact fidelity outcomes. Methods Preferred Reporting Items for Systematic Reviews and Meta-Analyses reporting standards will be followed. MEDLINE, EMBASE, and the Cumulative Index to Nursing and Allied Health Literature via OvidSP will be accessed using a defined search strategy. Grey literature and ClinicalTrials.gov will be reviewed for unpublished studies. Data extraction will be done to identify fidelity and factors impacting implementation, summarized using a narrative synthesis. An evidence-based implementation science framework will assist in identifying potential elements of importance and their effect on the process and outcomes of implementation. A meta-analysis to assess the impact of implementation factors will be attempted. A Cochrane risk of bias tool will be used. Results This protocol has received funding, and searches of databases will commence at the end of May 2019. It is planned that this systematic review will be finalized for publication in (December) 2019. Conclusions Applying an implementation science evidence-based framework to the published literature may identify factors present in the data that impact on the implementation of PROMs into routine clinical care. This systematic review aims to improve understanding of how these factors impact the fidelity of this intervention, so that PROMs can be more effectively used in the care of patients. This systematic review can also offer more detailed information about the process and outcomes of successful implementation of PROMs. International Registered Report Identifier (IRRID) PRR1-10.2196/14579

scholarly journals Patient-Reported Outcome Measures of Utilizing Person-Generated Health Data in the Case of Simulated Stroke Rehabilitation: Development Method

10.2196/16827 ◽  
2020 ◽  
Vol 9 (5) ◽  
pp. e16827 ◽  
Author(s):  
Gerardo Luis Dimaguila ◽  
Kathleen Gray ◽  
Mark Merolli
Keyword(s):  
Health Care ◽  
Outcome Measures ◽  
Clinical Work ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Health Data ◽  
Health Conditions ◽  
Evidence Based ◽  
Development Method ◽  
Patient Reported

Background Person-generated health data (PGHD) are health data that people generate, record, and analyze for themselves. Although the health benefits of PGHD use have been reported, there is no systematic way for patients to measure and report the health effects they experience from using their PGHD. Patient-reported outcome measures (PROMs) allow patients to systematically self-report their outcomes of a health care service. They generate first-hand evidence of the impact of health care services and are able to reflect the real-world diversity of actual patients and management approaches. Therefore, this paper argues that a PROM of utilizing PGHD, or PROM-PGHD, is necessary to help build evidence-based practice in clinical work with PGHD. Objective This paper aims to describe a method for developing PROMs for people who are using PGHD in conjunction with their clinical care—PROM-PGHD, and the method is illustrated through a case study. Methods The five-step qualitative item review (QIR) method was augmented to guide the development of a PROM-PGHD. However, using QIR as a guide to develop a PROM-PGHD requires additional socio-technical consideration of the PGHD and the health technologies from which they are produced. Therefore, the QIR method is augmented for developing a PROM-PGHD, resulting in the PROM-PGHD development method. Results A worked example was used to illustrate how the PROM-PGHD development method may be used systematically to develop PROMs applicable across a range of PGHD technology types used in relation to various health conditions. Conclusions This paper describes and illustrates a method for developing a PROM-PGHD, which may be applied to many different cases of health conditions and technology categories. When applied to other cases of health conditions and technology categories, the method could have broad relevance for evidence-based practice in clinical work with PGHD.

Proceedings from the Consensus Conference on Trauma Patient-Reported Outcome Measures

2020 ◽  
Vol 230 (5) ◽  
pp. 819-835 ◽  
Author(s):  
Joseph V. Sakran ◽  
Hiba Ezzeddine ◽  
C. William Schwab ◽  
Stephanie Bonne ◽  
Karen J. Brasel ◽  
...  
Keyword(s):  
Trauma Patient ◽  
Outcome Measures ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Consensus Conference ◽  
Patient Reported

scholarly journals Decision thresholds and minimal important difference estimates for evidence-based practice and policy (Part 2)

2021 ◽  
Vol 47 (1) ◽  
Author(s):  
Beth McDougall ◽  
Mike Reid ◽  
Souvik Mitra ◽  
Bradley Johnston
Keyword(s):  
Decision Making ◽  
Clinical Practice ◽  
Minimal Important Difference ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
P Value ◽  
Evidence Based ◽  
Patient Reported ◽  
Core Concepts ◽  
Evidence Based Decision Making

Understanding core concepts in epidemiology and biostatistics is crucial for evidence-based clinical practice and policy. In this second installment of our two-part series on threshold concepts, we transition from understanding the ubiquitous p-value to tools and measures for decision making among clinicians-in-training, highlighting the growing importance of utilizing explicit and evidence-based approaches to make appropriate and efficient decisions. We review two related decision-making concepts: (1) Minimal Important Difference (MID) estimates and (2) Decision Thresholds, focusing specifically on patient-reported outcome measures (PROMs). These terms and many other related expressions are used regularly, and often interchangeably, but what are they? Why are they valuable? And how can they be used to support evidence-based decision-making in clinical contexts and develop strong clinical practice guidelines? We conclude our brief review on the utility of these measures with a spotlight on a local example of how the theory underlying MID estimates and decision thresholds is currently being embedded in electronic platforms in primary care contexts targeting depression in Nova Scotia.

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