scholarly journals Reply: Identifying Factors Most Important to Lower Extremity Trauma Patients: Key Concepts from the Development of a Patient-Reported Outcome Instrument for Lower Extremity Trauma, The LIMB-Q

2021 ◽  
Vol Publish Ahead of Print ◽  
Author(s):  
Lily R. Mundy ◽  
Anne Klassen ◽  
Andrea L. Pusic ◽  
Scott T. Hollenbeck ◽  
Mark J. Gage
Keyword(s):  
Lower Extremity ◽  
Patient Reported Outcome ◽  
Trauma Patients ◽  
Lower Extremity Trauma ◽  
Outcome Instrument ◽  
Extremity Trauma ◽  
Patient Reported ◽  
Key Concepts

Content Validity of the LIMB-Q: A Patient-Reported Outcome Instrument for Lower Extremity Trauma Patients

2020 ◽  
Vol 36 (09) ◽  
pp. 625-633
Author(s):  
Lily R. Mundy ◽  
Anne Klassen ◽  
Amanda R. Sergesketter ◽  
Andrew Jordan Grier ◽  
Matthew J. Carty ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Expert Opinion ◽  
Content Validity ◽  
Clinical Care ◽  
Trauma Patients ◽  
Response Options ◽  
Lower Extremity Trauma ◽  
Outcome Instrument ◽  
Extremity Trauma ◽  
Patient Reported

Abstract Background Limb-threatening lower extremity traumatic injuries can be devastating events with a multifaceted impact on patients. Therefore, evaluating patient-reported outcomes (PROs) in addition to traditional surgical outcomes is important. However, currently available instruments are limited as they were not developed specific to lower extremity trauma patients and lack content validity. The LIMB-Q is being developed as a novel PRO instrument to meet this need, with the goal to measure all relevant concepts and issues impacting amputation and limb-salvage patients after limb-threatening lower extremity trauma. Methods This is a qualitative interview-based study evaluating content validity for the LIMB-Q. Patients aged 18 years and older who underwent amputation, reconstruction, or amputation after failed reconstruction were recruited using purposeful sampling to maximize variability of participant experiences. Expert opinion was solicited from a variety of clinical providers and qualitative researchers internationally. Preliminary items and scales were modified, added, or removed based on participant and expert feedback after each round of participant interviews and expert opinion. Results Twelve patients and 43 experts provided feedback in a total of three rounds, with changes to the preliminary instrument made between each round. One scale was dropped after round one, one scale was added after round two, and only minor changes were needed after round three. Modifications, additions and removal of items, instructions, and response options were made after each round using feedback gathered. Conclusion The LIMB-Q was refined and modified to reflect feedback from patients and experts in the field. Content validity for the LIMB-Q was established. Following a large-scale field test, the LIMB-Q will be ready for use in research and clinical care.

scholarly journals Development of a Patient-Reported Outcome Instrument for Patients With Severe Lower Extremity Trauma (LIMB-Q): Protocol for a Multiphase Mixed Methods Study

10.2196/14397 ◽  
2019 ◽  
Vol 8 (10) ◽  
pp. e14397
Author(s):  
Lily R Mundy ◽  
Anne Klassen ◽  
Jordan Grier ◽  
Matthew J Carty ◽  
Andrea L Pusic ◽  
...  
Keyword(s):  
Mixed Methods ◽  
Lower Extremity ◽  
Phase I ◽  
Patient Reported Outcome ◽  
Phase Iii ◽  
Trauma Patients ◽  
Traumatic Injuries ◽  
Lower Extremity Trauma ◽  
Extremity Trauma ◽  
Patient Reported

Background A current limitation in the care of patients with severe lower extremity traumatic injuries is the lack of a rigorously developed patient-reported outcome (PRO) instrument specific to lower extremity trauma patients. Objective This mixed methods protocol aims to describe phases I and II of the development of a PRO instrument for lower extremity trauma patients, following international PRO development guidelines. Methods The phase I study follows an interpretive description approach. Development of the PRO instrument begins with identifying the concepts that are important to patients, after which a preliminary conceptual framework is devised from a systematic literature review and used to generate an interview guide. Patients aged 18 years or above with limb-threatening lower extremity traumatic injuries resulting in reconstruction, amputation, or amputation after failed reconstruction will be recruited. The subjects will participate in semistructured, in-depth qualitative interviews to identify all important concepts of interest. The qualitative interview data will be coded with top-level domains, themes, and subthemes. The codes will then be utilized to refine the conceptual framework and generate preliminary items and a set of scales. The preliminary scales will be further refined via a process of conducting cognitive debriefing interviews with lower extremity trauma patients and soliciting expert opinions. Phase III will include a large-scale field test, using Rasch measurement theory to analyze the psychometric properties of the instrument; shortening and finalizing the scales; and determining the reliability, validity, and responsiveness of the instrument. Results Phases I and II of this study have been funded. Phase I of this study has been completed, and phase II began in January 2019 and is expected to be completed in November 2019. Phase III will begin following the completion of phase II. Conclusions This protocol describes the initial phases of development of a novel PRO instrument for use in lower extremity trauma patients. International Registered Report Identifier (IRRID) DERR1-10.2196/14397

scholarly journals Patient-reported Outcome Instruments in Lower Extremity Trauma

2019 ◽  
Vol 7 (5) ◽  
pp. e2218 ◽  
Author(s):  
Lily R. Mundy ◽  
A. Jordan Grier ◽  
E. Hope Weissler ◽  
Matthew J. Carty ◽  
Andrea L. Pusic ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Patient Reported Outcome ◽  
Lower Extremity Trauma ◽  
Extremity Trauma ◽  
Patient Reported

Identifying Factors Most Important to Lower Extremity Trauma Patients

2020 ◽  
Vol 145 (5) ◽  
pp. 1292-1301
Author(s):  
Lily R. Mundy ◽  
Anne Klassen ◽  
A. Jordan Grier ◽  
Christopher Gibbons ◽  
Whitney Lane ◽  
...  
Keyword(s):  
Lower Extremity ◽  
Trauma Patients ◽  
Lower Extremity Trauma ◽  
Extremity Trauma

Longitudinal relationships between anxiety, depression, and pain: Results from a two-year cohort study of lower extremity trauma patients

Pain ◽  
2013 ◽  
Vol 154 (12) ◽  
pp. 2860-2866 ◽  
Author(s):  
Renan C. Castillo ◽  
Stephen T. Wegener ◽  
Sara E. Heins ◽  
Jennifer A. Haythornthwaite ◽  
Ellen J. MacKenzie ◽  
...  
Keyword(s):  
Cohort Study ◽  
Lower Extremity ◽  
Trauma Patients ◽  
Lower Extremity Trauma ◽  
Extremity Trauma ◽  
Anxiety Depression ◽  
Longitudinal Relationships

scholarly journals Patient Reported Outcomes after Local Flap Coverage for Lower Extremity Trauma

2020 ◽  
Vol 3 ◽  
Author(s):  
Neel Bhagat ◽  
Scott Loewenstein ◽  
Kevin Knox ◽  
Joshua Adkinson ◽  
Aladdin Hassanein ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Lower Extremity ◽  
Local Flaps ◽  
Fasciocutaneous Flaps ◽  
Muscle Flaps ◽  
Lower Extremity Trauma ◽  
Sf 36 ◽  
Extremity Trauma ◽  
Patient Reported

Background:  Complex lower extremity trauma can result in devastating outcomes including amputation and poor quality of life. Limb salvage can be achieved with the use of local flaps like muscle flaps such as the gastrocnemius or soleus flaps, which detach muscles in order to use them for local coverage.  Fasciocutaneous flaps such as reverse sural and propeller flaps are other examples of local flaps which utilize overlying soft tissue for local rearrangement.  Patient-reported outcome (PRO) studies have not been reported for local flaps. Additionally, the potential for functional deficits as a result of muscle flaps in comparison to fasciocutaneous flaps has not been investigated.    Methods:  Local flap coverage for lower extremity traumas between 2014-2019 were reviewed. 248 local flaps were performed for lower extremity salvage following trauma. PROs were recorded utilizing both the Lower Extremity Functional scale (LEFS) and the 36-Item Short-Form Health Survey (SF-36).     Results:  Surveys were completed by 37 patients (response rate 18.3%, mean follow-up time 3.16 years, average age 49.72 years old). The average LEFS score was 42.09 ± 14.18, and the average physical functioning score was 43.03 ± 21.54. LEFS score and SF-36 physical functioning scores were significantly lower in patients who underwent muscle flaps compared to fasciocutaneous flaps (p=0.021 and p=0.022 respectively).    Conclusions and Impact:  Patients undergoing local flaps for lower extremity reconstruction have low quality of life scores. Patients who underwent fasciocutaneous flaps had significantly higher quality of life scores compared to muscle flap patients suggesting that fasciocutaneous flaps may cause less functional deficit in salvage operations. 

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