scholarly journals Direct and indirect costs associated with nonoperative treatment for shoulder instability: an observational study in 132 patients

2018 ◽  
Vol 11 (4) ◽  
pp. 265-274 ◽  
Author(s):  
Just A van der Linde ◽  
Judith E Bosmans ◽  
Dirk P ter Meulen ◽  
Derk A van Kampen ◽  
Derek FP van Deurzen ◽  
...  
Keyword(s):  
Observational Study ◽  
Healthcare Utilization ◽  
Shoulder Instability ◽  
Patient Characteristics ◽  
Nonoperative Treatment ◽  
Mean Difference ◽  
Level Of Evidence ◽  
Societal Costs ◽  
Productivity Losses ◽  
Healthcare Expenses

Background Shoulder instability is associated with decreased functioning. The associated costs could be substantial and interesting to clinicians, researchers, and policy makers. This prospective observational study aims to (1) estimate productivity losses and healthcare expenses following the nonoperative treatment of shoulder instability and (2) identify patient characteristics that influence societal costs. Methods One hundred and thirty-two patients completed a questionnaire regarding production losses and healthcare utilization following consecutive episodes of shoulder instability. Productivity losses were calculated using the friction cost approach. Healthcare utilization was evaluated using standard costs. analysis of variance test was used to assess which patient characteristics are related to productivity losses and healthcare expenses. Societal costs were assessed using multilevel analyses. Bootstrapping was used to estimate statistical uncertainty. Results Mean productivity losses are €1469, €881, and €728 and mean healthcare expenses are €3759, €3267, and €2424 per patient per dislocation for the first, second, and third dislocation. Productivity losses decrease significantly after the second (mean difference €−1969, 95%CI= −3680 to −939) and third (mean difference €−2298, 95%CI= −4092 to −1288) compared to the first dislocation. Conclusions Nonoperative treatment of shoulder instability has substantial societal costs. Level of Evidence III, economic analysis.

Risk Factors for Anterior Tibial Tendon Pathology

2020 ◽  
pp. 107110072096307
Author(s):  
Matthew M. Levitsky ◽  
Christina E. Freibott ◽  
Justin K. Greisberg ◽  
J. Turner Vosseller
Keyword(s):  
Risk Factors ◽  
Medical Center ◽  
Academic Medical Center ◽  
Patient Characteristics ◽  
Nonoperative Treatment ◽  
Vital Role ◽  
Single Institution ◽  
Level Of Evidence ◽  
Average Patient ◽  
History Of

Background: Though the tibialis anterior (TA) serves a vital role in ankle dorsiflexion, there is little information regarding risk factors and demographic information that might predispose one to tendinopathy or rupture. This study investigates the features of patients in a single institution who presented with either TA tendinopathy or rupture. The circumstances surrounding rupture were also noted. Methods: ICD-9/10 codes were used to find patients who presented with TA pathology to 2 foot and ankle surgeons at 1 academic medical center from 2011 to 2018. Patient characteristics were noted, including age, sex, body mass index, and the presence of a gastrocnemius equinus contracture. Characteristics of patients with traumatic and atraumatic ruptures were compared. Results: Ninety-four patients presented between 2011 and 2018 (79 cases of tendinopathy and 15 ruptures). The average patient age was 56 years, and the ratio of women to men was 74:20 (3.7:1). With regard to those who experienced rupture, there were 2 ruptures directly related to athletic activity (traumatic), whereas 13 ruptures were found on examination with no overt history of injury (atraumatic). The average age for patients with traumatic ruptures was 39 years compared with 73 years for those with atraumatic rupture ( P < .05). Conclusion: This study investigates the features of patients in a single institution who presented with TA pathology. With regard to tendon ruptures, traumatic ruptures tend to occur in younger patients, whereas older patients are more likely to suffer atraumatic ruptures. Nonoperative treatment often appears to be effective for TA pathology. Level of Evidence: Level III, retrospective comparative series.

scholarly journals Athletes With Anterior Shoulder Instability: A Prospective Study on Player Perceptions of Injury and Treatment

2021 ◽  
Vol 9 (9) ◽  
pp. 232596712110322
Author(s):  
Leslie A. Fink Barnes ◽  
Charles M. Jobin ◽  
Charles A. Popkin ◽  
Christopher S. Ahmad
Keyword(s):  
Physical Therapy ◽  
Shoulder Instability ◽  
Injury Severity ◽  
Treatment Decision ◽  
Cross Sectional Study ◽  
Nonoperative Treatment ◽  
Anterior Shoulder Instability ◽  
Level Of Evidence ◽  
Cross Sectional ◽  
A Prospective Study

Background: Many in-season athletes choose to delay or avoid surgery in order to continue playing and avoid downtime such as missed games or seasons. Purpose: To learn about the attitudes toward the injury and treatment of in-season shoulder instability in competitive athletes who have suffered a shoulder dislocation. Study Design: Cross-sectional study; Level of evidence, 3. Methods: A study-specific questionnaire about athletes’ perceptions of injury and treatment was administered to injured players. Secondary outcomes included the American Shoulder and Elbow Surgeons (ASES) score and the Western Ontario Shoulder Instability Index (WOSI). Mean scores and standard deviations were calculated, and between-group analyses with t tests were performed to compare the ASES and WOSI scores. The Mann-Whitney U test was used for analyses performed on the following groups: early operative versus nonoperative management; age <18 versus ≥18 years; first-time dislocators versus recurrent dislocators; self-reducing subluxations versus dislocations requiring assistance; and dominant arm affected versus nondominant arm. Results: There were 45 patients included in this study (33 male, 12 female) with a mean age of 18 ± 2.8 years. Several sports were represented, with the most common being football, baseball, soccer, and rugby. In this study of in-season athletes with shoulder instability, 13 (28.9%) chose early surgery, 4 (8.9%) chose surgery at season’s end, while 28 (62.2%) chose physical therapy followed by a wait-and-see approach, with 13 (46.4%) of these patients ultimately requiring surgery. Athletes who chose nonoperative treatment were statistically more likely to believe that their shoulder would heal on its own ( P < .001) or with physical therapy ( P < .025); they were also more likely to agree that they would rather stop sports than undergo surgery ( P < .04). Athletes with worse ASES and WOSI scores at injury were more likely to choose surgery ( P < .03 and P < .05, respectively). Athletes with >1 dislocation were less likely to believe that the shoulder would heal without surgery ( P < .025). Most athletes agreed that seasonal timing and recruitment prospects were an important factor in their decision in favor of surgery ( P < .038), and most agreed that their doctor influenced their ultimate treatment decision ( P < .006). Most athletes also agreed that a repeat dislocation would cause further injury to the shoulder. Conclusion: Treatment decisions were most strongly related to the athletes’ perceptions of injury severity and the influence of the treating surgeon.

scholarly journals Does Functional Bracing of the Unstable Shoulder Improve Return to Play in Scholastic Athletes? Returning the Unstable Shoulder to Play

2020 ◽  
Vol 13 (1) ◽  
pp. 45-48 ◽  
Author(s):  
Adam Kwapisz ◽  
Ellen Shanley ◽  
Amit M. Momaya ◽  
Chris Young ◽  
Michael J. Kissenberth ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Nonoperative Treatment ◽  
Return To Play ◽  
Successful Outcome ◽  
Anterior Shoulder Instability ◽  
Success Rates ◽  
Shoulder Injury ◽  
Adolescent Athletes ◽  
Level Of Evidence ◽  
Current Season

Background: Functional bracing is often used as an adjunct to nonoperative treatment of anterior shoulder instability, but no study has evaluated the effectiveness of in-season bracing. The purpose of this study was to examine successful return to play in a nonoperative cohort of adolescent athletes with in-season shoulder instability and compare those athletes treated with bracing to those who were not. Hypothesis: The use of functional bracing will improve success rates in a cohort of athletes treated nonoperatively for in-season shoulder instability. Study Design: Cohort study. Level of Evidence: Level 3. Methods: A total of 97 athletes with anterior shoulder instability were followed for a minimum of 1 year. The mean age was 15.8 ± 1.4 years (range, 12.0-18.0 years). All athletes were treated with initial nonoperative management. Twenty athletes (21%) were also treated with bracing while 77 (79%) were not. The athlete completing the current season and 1 subsequent season without surgery or time lost from shoulder injury was defined as a successful outcome. Results: There was no statistical difference in nonoperative success rates between the braced and nonbraced athletes ( P = 0.33). Braced athletes (n = 20) returned to play 80% of the time, while nonbraced athletes (n = 77) returned at a rate of 88%. Of the braced athletes, 85% were football players (n = 17). A football-only comparison demonstrated no difference between braced failures (26%) and nonbraced failures (16%) ( P = 0.47). Conclusion: This is the first study to evaluate the utility of functional bracing in returning an athlete to sport and completing a full subsequent season without surgery or time loss due to injury of the shoulder. In adolescent athletes with shoulder instability treated nonoperatively, functional bracing did not result in increased success rates when compared with no bracing. Clinical Relevance: The data from this study indicate that functional bracing may not improve success rates for athletes with shoulder instability.

scholarly journals Latarjet procedure enables 73% to return to play within 8 months depending on preoperative SIRSI and Rowe scores

2021 ◽  
Author(s):  
Yoann Bohu ◽  
◽  
Pierre Abadie ◽  
Floris van Rooij ◽  
Luca Nover ◽  
...  
Keyword(s):  
Shoulder Instability ◽  
Multivariable Analysis ◽  
Return To Sport ◽  
Patient Characteristics ◽  
Return To Play ◽  
Anterior Shoulder Instability ◽  
Latarjet Procedure ◽  
Level Of Evidence ◽  
Injury Index ◽  
Sport Type

Abstract Purpose Systematic reviews report return to play (RTP) within 5.8 months (range, 3–8) following the Latarjet procedure, but the factors that influence RTP remain unknown. The present study aimed to report the rate and time of return to play (RTP) during the first 8 months following the Latarjet procedure, and to determine the influence of sport type or patient characteristics. Methods The authors retrospectively collected the records of patients that underwent Latarjet procedures for anterior shoulder instability between 2015 and 2017. Patients were excluded if they had any concomitant rotator cuff tendon lesions, or previous ipsilateral shoulder surgery. The authors retrieved patient demographics, time from injury to surgery, type of sport practiced (overhead/non-overhead, contact/non-contact), as well as pre- and postoperative Western Ontario Shoulder Instability index (WOSI), Shoulder Instability-Return to Sport After Injury index (SIRSI), and Rowe score. Results A total of 217 patients (217 shoulders) were eligible for inclusion, comprising 184 males and 33 females, aged 26.8 ± 7.3 years at index surgery. The main sport practiced prior to surgery involved overhead (n = 173, 80%) and/or contact (n = 152, 70%) activities. By 8 month follow-up, 158 patients (73%) resumed their main sport, at a mean of 5.1 ± 1.5 months. Multivariable analysis revealed that RTP was more likely in patients with higher preoperative Rowe score (OR, 1.02; p = 0.024) and SIRSI score (OR, 1.02; p = 0.008). Conclusions By 8 months following the Latarjet procedure, 73% of patients had resumed their main sport. The likelihood of RTP was significantly associated with preoperative Rowe and SIRSI scores, but not with sport type. Level of evidence IV.

scholarly journals Parkinson’s Patients’ Tolerance for Risk and Willingness to Wait for Potential Benefits of Novel Neurostimulation Devices: A Patient-Centered Threshold Technique Study

2021 ◽  
Vol 6 (1) ◽  
pp. 238146832097840
Author(s):  
Brett Hauber ◽  
Brennan Mange ◽  
Mo Zhou ◽  
Shomesh Chaudhuri ◽  
Heather L. Benz ◽  
...  
Keyword(s):  
Trial Design ◽  
Patient Characteristics ◽  
Risk Tolerance ◽  
Level Of Evidence ◽  
Treatment Benefit ◽  
Study Results ◽  
Potential Benefits ◽  
Risk Thresholds ◽  
Time Motor ◽  
Threshold Technique

Background. Parkinson’s disease (PD) is neurodegenerative, causing motor, cognitive, psychological, somatic, and autonomic symptoms. Understanding PD patients’ preferences for novel neurostimulation devices may help ensure that devices are delivered in a timely manner with the appropriate level of evidence. Our objective was to elicit preferences and willingness-to-wait for novel neurostimulation devices among PD patients to inform a model of optimal trial design. Methods. We developed and administered a survey to PD patients to quantify the maximum levels of risks that patients would accept to achieve potential benefits of a neurostimulation device. Threshold technique was used to quantify patients’ risk thresholds for new or worsening depression or anxiety, brain bleed, or death in exchange for improvements in “on-time,” motor symptoms, pain, cognition, and pill burden. The survey elicited patients’ willingness to wait to receive treatment benefit. Patients were recruited through Fox Insight, an online PD observational study. Results. A total of 2740 patients were included and a majority were White (94.6%) and had a 4-year college degree (69.8%). Risk thresholds increased as benefits increased. Threshold for depression or anxiety was substantially higher than threshold for brain bleed or death. Patient age, ambulation, and prior neurostimulation experience influenced risk tolerance. Patients were willing to wait an average of 4 to 13 years for devices that provide different levels of benefit. Conclusions. PD patients are willing to accept substantial risks to improve symptoms. Preferences are heterogeneous and depend on treatment benefit and patient characteristics. The results of this study may be useful in informing review of device applications and other regulatory decisions and will be input into a model of optimal trial design for neurostimulation devices.

scholarly journals Benchmarking European Home Care Models for Older Persons on Societal Costs: The IBenC Study

2021 ◽  
Vol 14 ◽  
pp. 117863292110224
Author(s):  
Lisanne I van Lier ◽  
Henriëtte G van der Roest ◽  
Vjenka Garms-Homolová ◽  
Graziano Onder ◽  
Pálmi V Jónsson ◽  
...  
Keyword(s):  
Home Care ◽  
Patient Centered Care ◽  
Mean Difference ◽  
Care Model ◽  
Patient Centered ◽  
Societal Costs ◽  
Centered Care ◽  
Care Models ◽  
Prospective Longitudinal ◽  
Care Performance

This study aims to benchmark mean societal costs per client in different home care models and to describe characteristics of home care models with the lowest societal costs. In this prospective longitudinal study in 6 European countries, 6-month societal costs of resource utilization of 2060 older home care clients were estimated. Three care models were identified and compared based on level of patient-centered care (PCC), availability of specialized professionals (ASP) and level of monitoring of care performance (MCP). Differences in costs between care models were analyzed using linear regression while adjusting for case mix differences. Societal costs incurred in care model 2 (low ASP; high PCC & MCP) were significantly higher than in care model 1 (high ASP, PCC & MCP, mean difference €2230 (10%)) and in care model 3 (low ASP & PCC; high MCP, mean difference €2552 (12%)). Organizations within both models with the lowest societal costs, systematically monitor their care performance. However, organizations within one model arranged their care with a low focus on patient-centered care, and employed mainly generalist care professionals, while organizations in the other model arranged their care delivery with a strong focus on patient-centered care combined with a high availability of specialized care professionals.

Composite Breast Remodeling After Implant Removal by Tissue Recruitment and Loops Fixation With Power-Assisted Liposuction and Lipofilling (PALLL)

2021 ◽  
Author(s):  
Marwan H Abboud ◽  
Ayush K Kapila ◽  
Svetlana Bogaert ◽  
Nicolas M Abboud
Keyword(s):  
Breast Implant ◽  
Capsular Contracture ◽  
Patient Characteristics ◽  
Fat Grafting ◽  
Implant Removal ◽  
Level Of Evidence ◽  
Patient Reported ◽  
Aesthetic Results ◽  
And Migration ◽  
The Aesthetic

Abstract Background An increasing number of women wish breast implant removal whilst maintaining an acceptable projection and form were possible. Objectives The authors propose a technique to remodel the breast after implant removal utilizing internal suture loops to project the breast, recruit abdominal and axillary tissue cranially and medially, and provide a matrix for lipofilling. Methods A prospective analysis was performed of consecutive patients undergoing implant extraction followed by power-assisted liposuction loops and lipofilling. Patient characteristics were measured. The aesthetic results were evaluated by 2 independent raters. Patient-reported satisfaction was measured by standardized questionnaires. Results Implants in 52 patients with an average age of 55 and body mass index of 23.7 were extracted followed by breast remodeling. A total of 73% of patients had implants for aesthetic reasons, 41% were smokers, and 43% of the reconstruction cases received radiotherapy. A total of 28% had implant extraction for rupture, 58% for capsular contracture, and 14% due to pain and migration. The average volume of the implants removed was 292 cc, followed by an average lipofilling of 223 cc, yielding a ratio of 0.76 to 1. The average tissue recruited by loops was 82.5 cc. Independent raters measured 79% of results as good, 13% as acceptable, and 8% as requiring improvement; 80% of patients were satisfied to very satisfied. Conclusions The authors propose implant extraction followed by power-assisted liposuction loops and lipofilling can provide footprint definition, sustained projection, and high patient satisfaction. Moreover, the recruitment of a vascularized adipo-cutaneous flap by loops allows a reduced ratio of fat grafting to implant volume. Level of Evidence: 4

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