Feasibility of Rapid Development and Deployment of a Telemedicine Program in a Foot and Ankle Orthopedic Practice

2020 ◽  
pp. 107110072096305
Author(s):  
Wesley J. Manz ◽  
Rahul Goel ◽  
Omolola P. Fakunle ◽  
Sameh A. Labib ◽  
Jason T. Bariteau
Keyword(s):  
Rapid Development ◽  
Clinic Visit ◽  
Clinical Approach ◽  
Foot And Ankle ◽  
Office Visits ◽  
Chi Square ◽  
Level Of Evidence ◽  
Phone Survey ◽  
Patient Reported ◽  
The Future

Background: A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared with in-office appointments for all nonemergency visit types. Methods: Telemedicine satisfaction was assessed via phone survey with a modified 1 to 5 Likert scale. Patients who had completed a telemedicine visit between April 13, 2020, and June 19, 2020, were eligible to participate. Patient demographics were recorded, and data were analyzed using paired and independent t tests for parametric continuous data and Fisher’s exact and chi-square tests for noncontinuous data. A total of 216 patients completed the telemedicine questionnaire. Results: The overall mean satisfaction for telemedicine visits (4.7) was significantly lower than that for in-office visits (4.9) ( P < .001). However, the majority (90.3%) of patients reported they would use telemedicine again in the future. When compared, patients seeking fracture care had significantly higher telemedicine satisfaction (4.9, n = 38) than those receiving nonfracture care (4.6, n = 178) ( P = .001), and those greater than 50 miles from the clinic had higher satisfaction (5.0, n = 14) than patients living within 50 miles of the clinic (4.7, n = 202) ( P < .001). Conclusion: Patients were more satisfied with their in-office clinic visit than telemedicine, although the vast majority of patients endorsed a willingness to utilize telemedicine in the future. Patients with trauma and greater barriers to foot and ankle care were more satisfied with their telemedicine visits. Level of Evidence: Level III, retrospective cohort study.

scholarly journals Is Telemedicine Suited for Lower Extremity Pathologies? An Analysis of Non-Urgent Follow-Up in a Foot and Ankle Practice

2020 ◽  
Vol 5 (4) ◽  
pp. 2473011420S0034
Author(s):  
Wesley J. Manz ◽  
Rahul Goel ◽  
Omolola Fakunle ◽  
Sameh A. Labib ◽  
Jason T. Bariteau
Keyword(s):  
Patient Satisfaction ◽  
Clinic Visit ◽  
Continuous Data ◽  
Clinical Approach ◽  
Foot And Ankle ◽  
Office Visits ◽  
Chi Square ◽  
Fracture Care ◽  
Patient Reported ◽  
The Difference

Category: Other; Ankle; Hindfoot; Midfoot/Forefoot Introduction/Purpose: A lack of access to care is predictably associated with negative outcomes in foot and ankle surgery. Despite recent advances in telecommunication technologies, the field of orthopaedics has been slow to adopt these resources in offsetting barriers to care. The COVID-19 pandemic has forced departments to change their clinical approach, lending unprecedented opportunity to better understand how telehealth may bridge this care gap in foot and ankle practices. The purpose of this study was to assess patient-reported outcomes of telemedicine encounters, including comfort and patient satisfaction. Our hypothesis was that patients would be significantly less satisfied with telemedicine when compared to in-office appointments for all non-emergent visit types. Methods: Retrospective analysis of patients seen via telemedicine between April 13, 2020, to June 19, 2020, by one surgeon in the Emory Orthopedics Foot and Ankle department was conducted. Patients were contacted by one of the study authors via telephone to complete a questionnaire; satisfaction and other visit characteristics were assessed with a modified Likert scale from 1 to 5. Patients were designated as either ‘New’ or ‘Established’ based on whether or not they had completed an in-office clinic visit within the last year. Anatomy and pathology of disorder were determined by chief complaint and billing code. Patient demographics were recorded, and data were analyzed using paired and independent t-tests for parametric continuous data, Fisher’s exact and chi-square tests for non-continuous data. Results: 338 eligible patients were contacted via telephone, with 216 (63.9%) completing the telemedicine questionnaire. The patient cohort had an average age of 50.6 (19-84) years old and was 73.6% female (n=159). Overall mean satisfaction for telemedicine visits (4.69) was significantly lower than in-office visits (4.86) (p<0.001). In a subgroup analysis of patient satisfaction, patients seeking fracture care had significantly higher telemedicine satisfaction when compared to those receiving non-fracture care (4.90 vs. 4.64, p=0.001). Telemedicine satisfaction was also significantly greater in patients traveling more than 50 miles from their home to clinic (4.96 vs. 4.67, p<0.001). Patients with median household income less than the Georgia state median ($55,679) were more satisfied with their telemedicine visits than those with greater income, though the difference was non-significant. Conclusion: our data suggest those with significantly hindered mobility such as increased distance from clinic, lower socioeconomic status, and those seeking care for fractures had higher telemedicine satisfaction than their peers. Further study is needed to detail the precise and safe use of telemedicine in practice, but these data illuminate the high ceiling telemedicine offers in expanding patient care. Our hope is that this study aids as a supportive rationale for the continued use of telehealth visits past the period of the pandemic and encourages a more nuanced view of what visit types may be best-suited for telehealthcare

scholarly journals Telemedicine Foot and Ankle Visits in the COVID-19 Era

2021 ◽  
Vol 6 (1) ◽  
pp. 247301142199406
Author(s):  
Sameh A. Labib ◽  
Rahul Goel ◽  
Wesley Manz ◽  
Jason Bariteau
Keyword(s):  
Patient Experience ◽  
Expert Opinion ◽  
Foot And Ankle ◽  
Office Visits ◽  
Level Of Evidence ◽  
Excellent Care ◽  
Musculoskeletal Care

Background: The COVID-19 pandemic created a difficult environment to provide musculoskeletal care to patients with foot and ankle pathology given the limitations placed on in-office visits. Telemedicine offered a unique avenue to reach these patients; however, the efficacy of telemedicine visits in patients with foot and ankle pathology is not well studied. We propose a telemedicine protocol that has allowed us to effectively see and treat patients with foot and ankle pathology. Methods: A 12-step standardized telemedicine protocol was created within the Foot and Ankle division that was used for seeing patients through telemedicine. Also included in this is previsit preparation and follow-up recommendations. Press Ganey surveys were retrospectively reviewed to understand patient experience with telemedicine. Results: 85.2% of patients surveyed responded with scores indicating excellent care. When comparing patients who were seen in-office and through telemedicine, 89.2% and 83.4% responded with scores indicating excellent care, respectively ( P = .37). Conclusion: Telemedicine offers an effective and convenient way to provide excellent musculoskeletal care to patients affected with foot and ankle pathology. This is the first study that evaluated a comprehensive protocol for telemedicine encounters and can be used to implement telemedicine by others using this approach. Level of Evidence: Level V, expert opinion.

scholarly journals PROMIS and FAAM Minimal Clinically Important Differences in Foot and Ankle Orthopedics

2018 ◽  
Vol 40 (1) ◽  
pp. 65-73 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Maren W. Voss ◽  
Jerry Bounsanga ◽  
...  
Keyword(s):  
Patient Reported Outcomes ◽  
Minimum Clinically Important Difference ◽  
Measurement Information ◽  
Diagnostic Study ◽  
Foot And Ankle ◽  
Meaningful Change ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Level I

Background: Establishing score points that reflect meaningful change from the patient perspective is important for interpreting patient-reported outcomes. This study estimated the minimum clinically important difference (MCID) values of 2 Patient-Reported Outcomes Measurement Information System (PROMIS) instruments and the Foot and Ankle Ability Measure (FAAM) Sports subscale within a foot and ankle orthopedic population. Methods: Patients seen for foot and ankle conditions at an orthopedic clinic were administered the PROMIS Physical Function (PF) v1.2, the PROMIS Pain Interference (PI) v1.1, and the FAAM Sports at baseline and all follow-up visits. MCID estimation was conducted using anchor-based and distribution-based methods. Results: A total of 3069 patients, mean age of 51 years (range = 18-94), were included. The MCIDs for the PROMIS PF ranged from approximately 3 to 30 points (median = 11.3) depending on the methods being used. The MCIDs ranged from 3 to 25 points (median = 8.9) for the PROMIS PI, and from 9 to 77 points (median = 32.5) for the FAAM Sports. Conclusions: This study established a range of MCIDs in the PROMIS PF, PROMIS PI, and FAAM Sports indicating meaningful change in patient condition. MCID values were consistent across follow-up periods, but were different across methods. Values below the 25th percentile of MCIDs may be useful for low-risk clinical decisions. Midrange values (eg, near the median) should be used for high stakes decisions in clinical practice (ie, surgery referrals). The MCID values within the interquartile range should be utilized for most decision making. Level of Evidence: Level I, diagnostic study, testing of previously developed diagnostic measure on consecutive patients with reference standard applied.

scholarly journals Responsiveness of the PROMIS and FAAM Instruments in Foot and Ankle Orthopedic Population

2018 ◽  
Vol 40 (1) ◽  
pp. 56-64 ◽  
Author(s):  
Man Hung ◽  
Judith F. Baumhauer ◽  
Frank W. Licari ◽  
Jerry Bounsanga ◽  
Maren W. Voss ◽  
...  
Keyword(s):  
T Test ◽  
Measurement Information ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Paired Samples ◽  
Level Ii ◽  
Patient Reported ◽  
Prospective Comparative Study ◽  
Ability Measure

Background: Investigating the responsiveness of an instrument is important in order to provide meaningful interpretation of clinical outcomes. This study examined the responsiveness of the Patient-Reported Outcomes Measurement Information System (PROMIS) Physical Function (PF), the PROMIS Pain Interference (PI), and the Foot and Ankle Ability Measure (FAAM) Sports subscale in an orthopedic sample with foot and ankle ailments. Methods: Patients presenting to an orthopedic foot and ankle clinic during the years 2014–2017 responded to the PROMIS and FAAM instruments prior to their clinical appointments. The responsiveness of the PROMIS PF v1.2, PROMIS PI v1.1, and FAAM Sports were assessed using paired samples t test, effect size (ES), and standardized response mean (SRM) at 4 different follow-up points. A total of 785 patients with an average age of 52 years (SD = 17) were included. Results: The PROMIS PF had ESs of 0.95 to 1.22 across the 4 time points (3, >3, 6, and <6 months) and SRMs of 1.04 to 1.43. The PROMIS PI had ESs of 1.04 to 1.63 and SRMs of 1.17 to 1.23. For the FAAM Sports, the ESs were 1.25 to 1.31 and SRMs were 1.07 to 1.20. The ability to detect changes via paired samples t test provided mixed results. But in general, the patients with improvement had statistically significant improved scores, and the worsening patients had statistically significant worse scores. Conclusion: The PROMIS PF, PROMIS PI, and FAAM Sports were sensitive and responsive to changes in patient-reported health. Level of Evidence: Level II, prospective comparative study.

scholarly journals Comparison of Patient Satisfaction Between Virtual Visits During the COVID-19 Pandemic and In-person Visits Pre-pandemic

2020 ◽  
pp. 000348942097776
Author(s):  
Kyohei Itamura ◽  
Dennis M. Tang ◽  
Thomas S. Higgins ◽  
Franklin L. Rimell ◽  
Elisa A. Illing ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Interpersonal Communication ◽  
Healthcare Providers ◽  
The United States ◽  
Clinic Visit ◽  
Chi Square ◽  
Level Of Evidence ◽  
Virtual Visits ◽  
Chi Square Test ◽  
Student’S T

Objective: To compare the patient experience of a virtual otolaryngology clinic visit to an in-person visit, especially with its significantly increased implementation during the COVID-19 pandemic. Methods: Patient satisfaction (PS) metrics from the Clinician and Group Consumer Assessment of Healthcare Providers and Systems survey were queried from March 1, 2020 to May 1, 2020 for telehealth visits and January 1, 2020 to March 1, 2020 for in-person visits. Overlapping and comparable questions were analyzed using Mann-Whitney U test, Chi-square test for independence, and Student’s t-test. Results: There were 1284 partial or complete PS surveys from in-person visits and 221 partial or complete virtual PS surveys. There were statistically significantly worse virtual visit evaluations of provider listening, conveyance of information, likelihood to recommend, and overall provider ratings compared to in-person visits. Conclusion: Telehealth has become the new norm for most healthcare providers in the United States. This study demonstrates some of the initial shortcomings of telehealth in an otolaryngology practice and identifies challenges with interpersonal communication that may need to be addressed as telehealth becomes increasingly prevalent. Level of Evidence: Three.

Application of Computerized Adaptive Testing to the Foot and Ankle Ability Measure

2020 ◽  
pp. 107110072097266
Author(s):  
Joseph T. O’Neil ◽  
Otho R. Plummer ◽  
Steven M. Raikin
Keyword(s):  
Computerized Adaptive Testing ◽  
Case Series ◽  
Adaptive Testing ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Patient Reported ◽  
The Mean ◽  
Ability Measure ◽  
The Impact

Background: Patient-reported outcome measures are an increasingly important tool for assessing the impact of treatments orthopedic surgeons render. Despite their importance, they can present a burden. We examined the validity and utility of a computerized adaptive testing (CAT) method to reduce the number of questions on the Foot and Ankle Ability Measure (FAAM), a validated anatomy-specific outcome measure. Methods: A previously developed FAAM CAT system was applied to the responses of patients undergoing foot and ankle evaluation and treatment over a 3-year period (2017-2019). A total of 15 902 responses for the Activities of Daily Living (ADL) subscale and a total of 14 344 responses for the Sports subscale were analyzed. The accuracy of the CAT to replicate the full-form score was assessed. Results: The CAT system required 11 questions to be answered for the ADL subscale in 85.1% of cases (range, 11-12). The number of questions answered on the Sports subscale was 6 (range, 5-6) in 66.4% of cases. The mean difference between the full FAAM ADL subscale and CAT was 0.63 of a point. The mean difference between the FAAM Sports subscale and CAT was 0.65 of a point. Conclusion: The FAAM CAT was able to reduce the number of responses a patient would need to answer by nearly 50%, while still providing a valid outcome score. This measure can therefore be directly correlated with previously obtained full FAAM scores in addition to providing a foot/ankle-specific measure, which previously reported CAT systems are not able to do. Level of Evidence: Level IV, case series.

scholarly journals Determining Success or Failure After Foot and Ankle Surgery Using Patient Acceptable Symptom State (PASS) and Patient Reported Outcome Information System (PROMIS)

2018 ◽  
Vol 39 (8) ◽  
pp. 894-902 ◽  
Author(s):  
Michael R. Anderson ◽  
Judith F. Baumhauer ◽  
Benedict F. DiGiovanni ◽  
Sam Flemister ◽  
John P. Ketz ◽  
...  
Keyword(s):  
Patient Outcome ◽  
Patient Outcomes ◽  
Roc Analysis ◽  
Patient Reported Outcome ◽  
Foot And Ankle ◽  
Chi Square ◽  
Ankle Surgery ◽  
Patient Reported ◽  
Patient Acceptable Symptom State ◽  
Chi Square Analysis

Background: As the role of generic patient-reported outcomes (PROs) expands, important questions remain about their interpretation. In particular, how the Patient Reported Outcome Measurement Instrumentation System (PROMIS) t score values correlate with the patients’ perception of success or failure (S/F) of their surgery is unknown. The purposes of this study were to characterize the association of PROMIS t scores, the patients’ perception of their symptoms (patient acceptable symptom state [PASS]), and determination of S/F after surgery. Methods: This retrospective cohort study contacted patients after the 4 most common foot and ankle surgeries at a tertiary academic medical center (n = 88). Patient outcome as determined by phone interviews included PASS and patients’ judgment of whether their surgery was a S/F. Assessment also included PROMIS physical function (PF), pain interference (PI), and depression (D) scales. The association between S/F and PASS outcomes was evaluated by chi-square analysis. A 2-way analysis of variance (ANOVA) evaluated the ability of PROMIS to discriminate PASS and/or S/F outcomes. Receiver operator curve (ROC) analysis was used to evaluate the ability of pre- (n = 63) and postoperative (n = 88) PROMIS scores to predict patient outcomes (S/F and PASS). Finally, the proportion of individuals classified by the identified thresholds were evaluated using chi-square analysis. Results: There was a strong association between PASS and S/F after surgery (chi-square <0.01). Two-way ANOVA demonstrated that PROMIS t scores discriminate whether patients experienced positive or negative outcome for PASS ( P < .001) and S/F ( P < .001). The ROC analysis showed significant accuracy (area under the curve > 0.7) for postoperative but not preoperative PROMIS t scores in determining patient outcome for both PASS and S/F. The proportion of patients classified by applying the ROC analysis thresholds using PROMIS varied from 43.0% to 58.8 % for PASS and S/F. Conclusions: Patients who found their symptoms and activity at a satisfactory level (ie, PASS yes) also considered their surgery a success. However, patients who did not consider their symptoms and activity at a satisfactory level did not consistently consider their surgery a failure. PROMIS t scores for physical function and pain demonstrated the ability to discriminate and accurately predict patient outcome after foot and ankle surgery for 43.0% to 58.8% of participants. These data improve the clinical utility of PROMIS scales by suggesting thresholds for positive and negative patient outcomes independent of other factors. Level of Evidence: II, prospective comparative series.

scholarly journals Comparison of Visual Analog Pain Score Reported to Physician vs Nurse in Nonoperatively Treated Foot and Ankle Patients

2018 ◽  
Vol 39 (12) ◽  
pp. 1444-1448 ◽  
Author(s):  
Kevin D. Martin ◽  
Trevor McBride ◽  
Jeffrey Wake ◽  
Jeffrey Preston Van Buren ◽  
Cuyler Dewar
Keyword(s):  
Pain Score ◽  
Operative Procedure ◽  
Patient Reported Outcome Measures ◽  
Mean Difference ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Vas Score ◽  
Pain Scores ◽  
Patient Reported ◽  
The Mean

Background: Patient-reported outcome measures (PROMs) are taking a more prominent role in orthopedics as health care seeks to define treatment outcomes. The visual analog scale (VAS) is considered a reliable measure of acute pain. A previous study found that operative candidates’ VAS pain score was significantly higher when reported to the surgeon compared to the nurse. This study’s aim is to examine whether this phenomenon occurs in patients that do not undergo an operative procedure. We hypothesized that patients’ VAS pain scores reported to the surgeon vs the nurse would be the same. Methods: This study is a retrospective cohort of 201 consecutive nonoperative foot and ankle patients treated by a single surgeon. Patients were asked to rate pain intensity by a nurse followed by the surgeon using a horizontal VAS, 0 “no pain” to 10 “worst pain.” Differences in reported pain levels were compared with data from the previous cohort of 201 consecutive operative foot and ankle patients. Results: The mean VAS score reported to the nurse was 3.2 whereas the mean VAS score reported to the surgeon was 4.2 ( P < .001). The mean difference in VAS scores reported for operative patients was 2.9, whereas the mean difference for nonoperative patients was 1.0 ( P < .001). Conclusion: This study found statistically significant differences between VAS pain scores reported to the surgeon vs the nurse in nonoperative patients. These results support the trend found in our previous study, where operative patients reported significantly higher pain scores to the surgeon vs the nurse. The mean difference between reported pain scores was significantly higher for operative patients compared to nonoperative patients. Level of Evidence: Level III, comparative study.

scholarly journals Surgical excision of complex lipoma from the foot: a case report 

2020 ◽  
Author(s):  
Akram Uddin ◽  
George Flanagan ◽  
Ian Reilly
Keyword(s):  
Soft Tissue ◽  
Diagnostic Imaging ◽  
Histopathological Examination ◽  
Histopathological Analysis ◽  
Soft Tissue Tumour ◽  
Foot And Ankle ◽  
Level Of Evidence ◽  
Plantar Aspect ◽  
Tissue Tumour ◽  
Patient Reported

Abstract Background: Soft tissue malignant tumours of the foot and ankle are rare. Diagnostic imaging and interventional biopsy are vital to establish the nature and grading of a suspicious tumour prior to surgical intervention. The purpose of the study is to provide an account on how a symptomatic mass to the plantar aspect of the foot warranted a referral to a sarcoma centre, highlighting the importance of having urgent access to diagnostic imaging and a pathway to refer suspected cases to specialist centres. Method: A single patient with a symptomatic soft tissue tumour of the plantar foot was referred from our service to the regional sarcoma centre. It was considered to be benign and therefore open surgical resection was performed under local anaesthesia by our team, and the lesion sent for histopathological examination. Results: Histopathological analysis identified the excised mass as a lipoma to show no atypia or necrosis and mature adipose tissue with fibrous bands. At 2 years postoperatively there was no recurrence and the patient presented an asymptomatic foot. Favourable patient reported outcomes measures were observed. Conclusion: United Kingdom (UK) Guidelines suggest that all soft tissue masses of suspicious nature, greater than 50mm, deep seated irrespective of size, or fast growing should be referred to a sarcoma unit prior to surgical management. European guidance identifies a threshold of 15mm for a mass in the foot. Patients presenting with red flag symptoms irrespective of size of mass should be referred to a sarcoma centre. Advanced imaging and multidisciplinary input to enable appropriate surgical planning is recommended for these soft tissue tumours that present to the foot and ankle surgeon.Level of evidence: V case study.

Comparison of Standard and Right/Left International Knee Documentation Committee Subjective Knee Form Scores

2019 ◽  
Vol 47 (5) ◽  
pp. 1203-1208 ◽  
Author(s):  
Justin A. Magnuson ◽  
Greg Strnad ◽  
Clair Smith ◽  
Morgan H. Jones ◽  
Paul Saluan ◽  
...  
Keyword(s):  
Study Design ◽  
A Priori ◽  
International Knee Documentation Committee ◽  
Patient Reported Outcome ◽  
Minimal Detectable Change ◽  
Chi Square ◽  
Level Of Evidence ◽  
Relevant Difference ◽  
Patient Reported ◽  
Injured Knee

Background: The International Knee Documentation Committee Subjective Knee Form (IKDC-SKF) is a validated patient-reported outcome used in clinical research. No studies exist directly comparing the standard unilateral adult version (IKDC-SKF) with the bilateral adult version (R/L IKDC-SKF). Hypotheses: The first hypothesis is that no clinically relevant difference would be observed between standard IKDC-SKF scores and involved R/L scores. The second hypothesis is that a relevant difference would be observed between involved and uninvolved scores on the R/L IKDC-SKF. Study Design: Cohort study (Diagnosis); Level of evidence, 2. Methods: One hundred patients were enrolled via a crossover study design. Participants were split into 2 groups per simple randomization. One group completed the standard IKDC-SKF first and the R/L IKDC-SKF second. The other group completed forms in the reverse order. A 10-minute washout period was administered between questionnaires. Participants reported their preferred form in a postquestionnaire survey. A 5-point threshold for clinical relevance was set a priori, which is less than multiple published minimal detectable change and minimal clinically important difference metrics of the standard IKDC-SKF, ranging from 6.3 to 20.5. Data were analyzed with Bland-Altman plots, paired t tests, correlations, and chi-square tests. Results: Paired t tests between the standard IKDC-SKF and the involved R/L IKDC-SKF scores demonstrated a statistically significant mean difference of 1.4 ( P = .008; 95% CI, 0.4-2.4). However, the 95% CI falls under the clinically relevant threshold of 5. Standard and involved knee scores from the R/L IKDC-SKF were highly correlated, with a rho of 0.95. Patients consistently distinguished the injured knee from the uninjured knee across a range of scores via the R/L IKDC-SKF ( P < .001). The postquestionnaire survey showed that 55 patients preferred the R/L IKDC-SKF, 30 preferred the standard IKDC-SKF, and 15 had no preference. Post hoc analysis showed a significant preference for “R/L vs standard IKDC-SKF” ( P = .014) and “R/L IKDC-SKF vs no preference” ( P < .003). Conclusion: No clinically relevant difference was observed between the standard IKDC-SKF and the involved knee score of the R/L IKDC-SKF. Therefore, for symptomatic unilateral knee diagnosis, either form can be used. The R/L IKDC-SKF showed a consistent and clinically relevant difference between involved and uninvolved knees. Patients in this study preferred the R/L IKDC-SKF.

Sign in / Sign up

Export Citation Format

Share Document