Post-operative outcomes associated with posterolateral tibial plateau impaction fractures in the setting of primary ACL tear

Objectives: The primary objective was to assess the effect of impaction fractures of the posterolateral tibial plateau on patient reported post-operative outcomes following primary ACL surgery. Methods: Patients with available MRI images who underwent surgery for primary ACL tears by a single surgeon between April 2010 and September 2017 were identified. A prospectively and consecutively enrolled clinical outcomes database was queried for all patients within this cohort who had 2-year or greater post-operative patient reported outcomes available. Patient reported outcomes included the 12-item Short Form Health Survery (SF-12) Physical Composite Scale (PCS) and Mental Health Composite Scale (MCS), the Western Ontario and McMaster University Osteoarthritis Index (WOMAC), International Knee Documentation Committee Questionnaire (IKDC), Lysholm Knee Questionnaire, Tegner Activity Scale and patient satisfaction. For patients without existing 2-year outcomes, additional inclusion criteria included English-speaking and current age greater than or equal to 18. Patients meeting these criteria were sent electronic surveys to collect patient reported outcomes. MRI images were reviewed for all patients with denotation of displaced posterolateral tibial impaction fractures. Posterolateral tibial impactions were classified based on morphology using the following classification: (Type I) posterior cortical buckle not involving the articular surface, (Type II) posterior impaction fracture involving the articular surface [(with subtype based on (A) tibial plateau depth bone loss <10% and (B) bone loss >10%)], and (III) displaced osteochondral fragment [(with subtypes for (A) shear or (B) depressed fragment)]. All tibial impaction fractures were measured to determine amount of tibial plateau bone loss in the sagittal plane. Pre-operative and 2-year or greater post-operative patient reported outcome scales were compared based on posterolateral tibial impaction fracture classification using Kruskal-Wallis non-parametric ANOVA with Nemenyi post-hoc test. Pearson’s correlations were used to assess for correlations between post-operative patient reported outcomes and amount of tibial plateau sagittal plane bone loss present. Results: There were 638 knees identified with primary ACL tears who underwent surgery between April 2010 and September 2017. Thirty-nine patients met exclusion criteria, leaving 599 total patients. Of these, 2-year outcomes were available for 416 patients for a 69.4% follow-up rate at a mean time of 158 weeks (range: 90-422). There were statistically significant improvements in all PROs from pre-op to 2-year post-op (p < 0.001). Kruskal-Wallis non-parametric ANOVA showed no difference in all PROs based upon posterolateral impaction fracture classification type, except for Tegner Activity Scale which showed difference in outcomes based on impaction fracture type (p < .002) (Table 1). Specifically, diminished post-operative activity level was observed in patients with type 2B, type 3A, and type 3B fractures. Pearson correlation testing showed weak but statistically significant correlations between tibial plateau impaction fracture sagittal bone loss amount and SF-12 PCS (PCC: -0.156, p = 0.023), WOMAC Total Score (PCC: 0.159, p = 0.02), Lysholm (PCC: -0.203, p = .003), and Tegner Activity Scale (PCC: -0.151, p = 0.032). Independent T-testing showed no difference in any patient reported outcome scores at 2-year follow-up when all posterolateral tibial impaction fractures were grouped together compared to those without impaction fracture. Conclusion: Displaced posterolateral tibial plateau impaction fractures occurring in the setting of ACL tear are associated with diminished 2-year post-operative outcomes after ACL reconstruction. When classified based on fracture morphology, posterolateral tibial plateau impaction fracture types 2B, 3A, and 3B are associated with decreased post-operative activity level as assessed by Tegner Activity Scale. When comparing patients with posterolateral impaction fractures, greater amounts sagittal plane tibial plateau bone loss at the posterior rim showed weak but significant correlations with worse scores on SF-12 PCS, WOMAC, Lysholm, and Tegner patient reported outcome measures. [Figure: see text]

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VALIDATION OF A COMPUTER-BASED SYSTEM FOR THE COLLECTION OF PATIENT REPORTED OUTCOME MEASURES IN PEDIATRIC SPORTS MEDICINE

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967119s00037 ◽

2019 ◽

Vol 7 (3_suppl) ◽

pp. 2325967119S0003

Author(s):

Meagan J. Sabatino ◽

Catherine V. Gans ◽

Aaron J. Zynda ◽

Chan-Hee Jo ◽

Jane Chung ◽

...

Keyword(s):

Outcome Measures ◽

Sports Medicine ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Electronic Format ◽

Pediatric Sports Medicine ◽

Patient Reported ◽

Computer Based ◽

Activity Scale ◽

Tegner Activity Scale

Background: In orthopedics, patient reported outcome measures (PROMs) have become popularized due to an increase in patient-centered research and pay for performance reimbursement models. Most pediatric PROMs have been utilized and validated in paper format. However, the use of a computer-based system may improve patient and physician efficiency, decrease cost, ensure completion, provide instantaneous information, and minimize inconvenience. The purpose of the study is to validate the use, evaluate patient satisfaction, and review differences of electronic compared to paper PROMs in a pediatric sports medicine practice. Methods: New patients between 12 – 19 years of age with a knee-related primary complaint were identified prior to their appointment. Patients were then randomized into two groups to complete standard clinical PROMs; including the Pedi-IKDC, HSS Pedi-FABS, Tegner Activity Scale, Visual Analogue Scale (VAS) and PedsQL-Teen. Group 1 completed paper forms followed by electronic, while Group 2 received the electronic format followed by paper, with a 10-minute break between formats in each group. Following the completion of PROMs, subjects completed a satisfaction survey. A Pearson’s correlation was used to calculate the association between the measures and a paired t-test to compare means between electronic and paper forms. Reliability analysis was conducted using an ICC calculation. Results: 87 subjects were enrolled with one excluded due to incomplete PROMs, for a total of 86. 54 subjects were female and 32 were male with an average age of 14.3 years (range 12-18). A high degree of reliability was found when comparing the paper and electronic versions of the Pedi-IKDC, HSS Pedi-FABS, PedsQL 13-18 and the Tegner activity scale (Figure 1). Differences were noted between the VAS scores, with paper scores being significantly higher than electronic (5.3 vs 4.6, p<0.001). Excluding the 10-minute break, it took subjects an average of 21.3 minutes to complete the PROMs. Although not significant, electronic PROMs took less time than paper on average (10.0 min vs 11.2 min, p=0.096). All subjects endorsed that PROMs captured on paper were the same as electronic with 69.8% of subjects preferring the electronic PROMs. 67.4% of subjects reported they felt the electronic format was faster, with only 5.8% of patients reporting the electronic forms were hard or confusing. 93.0% stated they would complete forms at home prior to appointments if it were an option and 91.8% were not concerned about the safety/privacy of electronic forms. Conclusion/Significance: PROMs captured electronically were reliable and valid when compared to paper, with differences noted only on the VAS. Electronic PROMs may be quicker, will not require manual scoring, and are preferred by patients. Electronic PROMs will improve the clinician’s ability to collect complete and validated data while reducing the burden on the clinical staff and patients. [Figure: see text]

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Patient-Reported Allergies Do Not Predict Poorer PROMIS Function, Pain, and Depression Scores Following Foot and Ankle Surgery

Foot & Ankle International ◽

10.1177/1071100718769667 ◽

2018 ◽

Vol 39 (8) ◽

pp. 949-953 ◽

Cited By ~ 7

Author(s):

Devon C. Nixon ◽

Brian M. Cusworth ◽

Jeremy J. McCormick ◽

Jeffrey E. Johnson ◽

Sandra E. Klein

Keyword(s):

Physical Function ◽

Shoulder Arthroplasty ◽

Patient Reported Outcomes ◽

Patient Reported Outcome ◽

Pain Interference ◽

Foot And Ankle ◽

Operative Outcomes ◽

Ankle Surgery ◽

Patient Reported ◽

Outcome Scores

Background: Identifying preoperative risk factors that may portend poorer operative outcomes remains a topic of current interest. In hip and knee arthroplasty patients, the presence of patient-reported allergies (PRAs) has been associated with worse pain and function after joint replacement. However, these results have not been replicated across studies, including in shoulder arthroplasty cases. The impact of PRAs on foot and ankle outcomes has yet to be studied. The purpose of our study was to evaluate whether PRAs influence patient-reported outcome in foot and ankle surgery. Methods: To determine if PRAs are linked to poorer operative outcomes, we retrospectively identified 159 patients who underwent elective foot and ankle surgery. PRA data were obtained via chart review, and patient-reported outcomes were assessed preoperatively and postoperatively via multiple domains, including Patient Reported Outcome Measurement Information System (PROMIS) physical function, pain interference, and depression measures. Consistent with prior methodology, we compared outcome measures (preoperative, postoperative, and the change in outcome scores) between patients without self-reported allergies to patients with at least 1 PRA. Results: There were 159 patients studied; 79 patients had no allergies listed, and 80 patients had at least 1 PRA. Of the 80 patients with at least 1 PRA, there were a total of 170 possible allergies. There were no differences in preoperative, postoperative, or the change in outcome scores for all PROMIS measures (physical function, pain interference, and depression; P > .05) between patients with at least 1 PRA and those patients without any listed PRAs. Conclusions: We were unable to prove our hypothesis that PRAs were linked to poorer patient-reported outcomes following foot and ankle surgery. Closer review of the published reports linking PRAs to worse total joint arthroplasty outcomes revealed data that, while statistically significant, are likely not clinically relevant. Our negative findings, then, may in fact parallel prior studies on hip, knee, and shoulder arthroplasty patients. The presence of PRAs does not appear to be a risk factor for suboptimal outcomes in foot and ankle surgery. Level of Evidence: Level III, comparative series.

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A high tibial slope, allograft use, and poor patient-reported outcome scores are associated with multiple ACL graft failures

Knee Surgery Sports Traumatology Arthroscopy ◽

10.1007/s00167-021-06460-8 ◽

2021 ◽

Author(s):

Philipp W. Winkler ◽

Nyaluma N. Wagala ◽

Jonathan D. Hughes ◽

Bryson P. Lesniak ◽

Volker Musahl

Keyword(s):

Acl Reconstruction ◽

Graft Failure ◽

Tibial Slope ◽

Patient Reported Outcome ◽

Acl Graft ◽

Revision Acl Reconstruction ◽

Patient Reported ◽

Outcome Scores ◽

Activity Scale ◽

Tegner Activity Scale

Abstract Purpose To compare clinical outcomes, radiographic characteristics, and surgical factors between patients with single and multiple anterior cruciate ligament (ACL) graft failures. It was hypothesized that patients experiencing multiple ACL graft failures exhibit lower patient-reported outcome scores (PROs) and a higher (steeper) posterior tibial slope (PTS) than patients with single ACL graft failure. Methods Patients undergoing revision ACL reconstruction with a minimum follow-up of 12 months were included in this retrospective cohort study. Based on the number of ACL graft failures, patients were assigned either to the group “single ACL graft failure “or” multiple ACL graft failures “. The PTS was measured on strict lateral radiographs. Validated PROs including the International Knee Documentation Committee (IKDC) subjective knee form, Knee Injury and Osteoarthritis Outcome Score, Lysholm Score, Tegner Activity Scale, ACL-Return to Sport after Injury Scale, and Visual Analogue Scale for pain were collected. Results Overall, 102 patients were included with 58 patients assigned to the single ACL graft failure group and 44 patients to the multiple ACL graft failures group. Quadriceps tendon autograft was used significantly more often (55% vs. 11%, p < 0.001) and allografts were used significantly less often (31% vs. 66%, p < 0.001) as the graft for first revision ACL reconstruction in patients with single versus multiple ACL graft failures. Patients with multiple ACL graft failures were associated with statistically significantly worse PROs (IKDC: 61.7 ± 19.3 vs. 77.4 ± 16.8, p < 0.05; Tegner Activity Scale: 4 (range, 0–7) vs. 6 (range 2–10), p < 0.05), higher PTS (12 ± 3° vs. 9 ± 3°, p < 0.001), and higher rates of subsequent surgery (73% vs. 14%, p < 0.001) and complications (45% vs. 17%, p < 0.05) than patients with single ACL graft failure. Conclusion Compared to single ACL graft failure in this study multiple ACL graft failures were associated with worse PROs, higher PTS, and allograft use. During the first revision ACL reconstruction, it is recommended to avoid the use of allografts and to consider slope-reducing osteotomies to avoid multiple ACL graft failures and improve PROs. Level of evidence Level 3.

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What Are the Predictors of Poor Patient-Reported Outcomes After Shoulder Instability Surgery?

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120966343 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096634

Author(s):

◽

Ahmad F. Bayomy ◽

Mark S. Schickendantz ◽

Isaac N. Briskin ◽

Lutul D. Farrow ◽

...

Keyword(s):

Articular Cartilage ◽

Bone Loss ◽

Shoulder Instability ◽

Patient Reported Outcomes ◽

Patient Reported Outcome ◽

Early Revision ◽

Labral Tears ◽

Patient Reported ◽

Cartilage Injuries ◽

Articular Cartilage Injuries

Background: Prospectively collected responses to Patient Acceptable Symptom State (PASS) questions after shoulder instability surgery are limited. Responses to these outcome measures are imperative to understanding their clinical utility. Purpose/Hypothesis: The purpose of this study was to evaluate which factors predict unfavorable patient-reported outcomes after shoulder instability surgery, including “no” to the PASS question. We hypothesized that poor outcomes would be associated with male adolescents, bone loss, combined labral tears, and articular cartilage injuries. Study Design: Cohort study; Level of evidence, 2. Methods: Patients aged ≥13 years undergoing shoulder instability surgery were included in point-of-care data collection at a single institution across 12 surgeons between 2015 and 2017. Patients with anterior-inferior labral tears were included, and those with previous ipsilateral shoulder surgery were excluded. Demographics, American Shoulder and Elbow Surgeons (ASES) and Single Assessment Numeric Evaluation (SANE) scores, and surgical findings were obtained at baseline. ASES and SANE scores, PASS responses, and early revision surgery rates were obtained at a minimum of 1 year after the surgical intervention. Regression analyses were performed. Results: A total of 234 patients met inclusion criteria, of which 176 completed follow-up responses (75.2%). Nonresponders had a younger age, greater frequency of glenoid bone loss, fewer combined tears, and more articular cartilage injuries ( P < .05). Responders’ mean age was 25.1 years, and 22.2% were female. Early revision surgery occurred in 3.4% of these patients, and 76.1% responded yes to the PASS question. A yes response correlated with a mean 25-point improvement in the ASES score and a 40-point improvement in the SANE score. On multivariate analysis, combined labral tears (anterior-inferior plus superior or posterior tears) were associated with greater odds of responding no to the PASS question, while both combined tears and injured capsules were associated with lower ASES and SANE scores ( P < .05). Sex, bone loss, and grade 3 to 4 articular cartilage injuries were not associated with variations on any patient-reported outcome measure. Conclusion: Patients largely approved of their symptom state at ≥1 year after shoulder instability surgery. A response of yes to the PASS question was given by 76.1% of patients and was correlated with clinically and statistically significant improvements in ASES and SANE scores. Combined labral tears and injured capsules were negative prognosticators across patient-reported outcome measures, whereas sex, bone loss, and cartilage injuries were not.

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High Tibial Osteotomy with a Modern Polyetheretherketone (PEEK) System: Mid-Term Results at a Mean of 6 Years Follow-Up

The Journal of Knee Surgery ◽

10.1055/s-0040-1721090 ◽

2020 ◽

Author(s):

Lucas K. Keyt ◽

Mario Hevesi ◽

Bruce A. Levy ◽

Aaron J. Krych ◽

Christopher L. Camp ◽

...

Keyword(s):

Postoperative Complications ◽

High Tibial Osteotomy ◽

Patient Reported Outcomes ◽

Hardware Removal ◽

Tibial Osteotomy ◽

Sf 36 ◽

Patient Reported ◽

Activity Scale ◽

Tegner Activity Scale

AbstractThe purpose of this study was to determine patient-reported outcomes, hardware removal rates, as well as conversion to arthroplasty at mid-term follow-up following high tibial osteotomy (HTO) with a modern polyetheretherketone (PEEK) system. All PEEK system-based HTOs performed at a single institution between January 2010 and January 2016 with a minimum of 2 years follow-up were reviewed. Rates of postoperative complications, hardware removal and conversion to arthroplasty were calculated. Patient-reported outcomes including visual analog pain scale (VAS), Tegner activity scale, Lysholm, Knee Injury and Osteoarthritis Outcome Score (KOOS), and 36-Item Short Form Survey (SF-36) were obtained. Forty-seven HTOs in 43 patients (mean age: 37.6 ± 10.8 years; 30 M, 13 F) were followed for a mean of 6.0 ± 1.5 years. A total of four postoperative complications occurred in three patients, resulting in an overall complication rate of 6.4%. Hardware removal occurred in three patients at a mean of 0.73 ± 0.53 years after surgery, with overall survival free of hardware removal of 96% (95% confidence interval [CI]: 85–99) at 1 year, 94% (95% CI: 82–98) at 2 years, and 94% (95% CI: 82–98) at 8 years. Conversion to arthroplasty occurred in three patients at a mean of 3.2 ± 1.0 years after surgery, with mean survival of 100% (95% CI: 94–100) at 1 year, 100% (95% CI: 94–100) at 2 years, and 93% (95% CI: 81–98) at 8 years. VAS at rest improved, from 3.1 ± 2.5 preoperatively to 1.1 ± 1.6 postoperatively (p < 0.001). Patients remained active, with a mean Tegner activity scale of 4.4 ± 1.4 at final follow-up and satisfactory Lysholm, KOOS, and SF-36 scores. At mid-term follow-up, medial opening-wedge HTO using a modern PEEK-based system was found to be safe, efficacious, and durable, with satisfactory outcome scores and a low rate of conversion to arthroplasty. PEEK-based implants were found to have low hardware removal rates of 6% at 5 years, which compares favorably to historic metal fixation. This is a Level III study.

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What is the optimal outcome after endoscopic sinus surgery in the treatment of chronic rhinosinusitis? A consultation of Canadian experts

Journal of Otolaryngology - Head and Neck Surgery ◽

10.1186/s40463-021-00519-9 ◽

2021 ◽

Vol 50 (1) ◽

Author(s):

Nadim Saydy ◽

Sami P. Moubayed ◽

Marie Bussières ◽

Arif Janjua ◽

Shaun Kilty ◽

...

Keyword(s):

Chronic Rhinosinusitis ◽

Endoscopic Sinus Surgery ◽

Patient Reported Outcome ◽

Sinus Surgery ◽

Structured Interviews ◽

Subjective Data ◽

Operative Outcomes ◽

Patient Reported ◽

Definition Of Success ◽

Reported Data

Abstract Objectives Many experts feel that in the absence of well-defined goals for success, they have an easier time identifying failure. As success ought to not be defined only by absence of failure, we aimed to define optimal outcomes for endoscopic sinus surgery (ESS) in chronic rhinosinusitis (CRS) by obtaining expert surgeon perspectives. Methods A total of 12 surgeons participated in this targeted consultation. Face to face semi-structured interviews were performed with expert surgeons in the field of CRS and ESS. General impressions and personal definitions of acceptable operative success and optimal operative outcomes were compiled and summarized. Results According to an expert survey, patients’ main objectives are an improvement in their chief complain, a general improvement in quality of life (QoL), and a better overall symptomatic control. The most important aspects of endoscopy for defining a successful intervention were an adequate mucus circulation, a healthy mucosa, minimal edema, and patency of all explored cavities or ostia. In the assessment of surgical outcomes, it was determined that both objective and patient reported data must be carefully examined, with more attention given to subjective outcomes. Conclusions According to data gathered from a Canadian expert consultation, a definition of success must be based on both subjective data and nasal endoscopy. We propose to define an acceptable outcome as either a subjective improvement of at least the minimal clinically improvement difference of a validated patient reported outcome questionnaire, along with a satisfactory endoscopic result (1) or a complete subjective resolution with a sub-optimal endoscopy (2). Graphical abstract

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Scope and heterogeneity of outcomes reported in randomized trials in patients receiving peritoneal dialysis

Clinical Kidney Journal ◽

10.1093/ckj/sfaa224 ◽

2020 ◽

Author(s):

Karine E Manera ◽

David W Johnson ◽

Yeoungjee Cho ◽

Benedicte Sautenet ◽

Jenny Shen ◽

...

Keyword(s):

Peritoneal Dialysis ◽

Patient Reported Outcomes ◽

Randomized Trials ◽

Primary Outcome ◽

Median Number ◽

Patient Reported Outcome ◽

Patient Reported ◽

Inform Decision Making ◽

Solute Clearance

Abstract Background Randomized trials can provide evidence to inform decision-making but this may be limited if the outcomes of importance to patients and clinicians are omitted or reported inconsistently. We aimed to assess the scope and heterogeneity of outcomes reported in trials in peritoneal dialysis (PD). Methods We searched the Cochrane Kidney and Transplant Specialized Register for randomized trials in PD. We extracted all reported outcome domains and measurements and analyzed their frequency and characteristics. Results From 128 reports of 120 included trials, 80 different outcome domains were reported. Overall, 39 (49%) domains were surrogate, 23 (29%) patient-reported and 18 (22%) clinical. The five most commonly reported domains were PD-related infection [59 (49%) trials], dialysis solute clearance [51 (42%)], kidney function [45 (38%)], protein metabolism [44 (37%)] and inflammatory markers/oxidative stress [42 (35%)]. Quality of life was reported infrequently (4% of trials). Only 14 (12%) trials included a patient-reported outcome as a primary outcome. The median number of outcome measures (defined as a different measurement, aggregation and metric) was 22 (interquartile range 13–37) per trial. PD-related infection was the most frequently reported clinical outcome as well as the most frequently stated primary outcome. A total of 383 different measures for infection were used, with 66 used more than once. Conclusions Trials in PD include important clinical outcomes such as infection, but these are measured and reported inconsistently. Patient-reported outcomes are infrequently reported and nearly half of the domains were surrogate. Standardized outcomes for PD trials are required to improve efficiency and relevance.

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Strain Elastography and Tendon Response to an Exercise Program in Patients With Supraspinatus Tendinopathy: An Exploratory Study

Orthopaedic Journal of Sports Medicine ◽

10.1177/2325967120965185 ◽

2020 ◽

Vol 8 (12) ◽

pp. 232596712096518

Author(s):

Karen Brage ◽

Birgit Juul-Kristensen ◽

John Hjarbaek ◽

Eleanor Boyle ◽

Per Kjaer ◽

...

Keyword(s):

Patient Reported Outcomes ◽

Structural Changes ◽

Supraspinatus Tendon ◽

Patient Reported Outcome ◽

Minimal Detectable Change ◽

Detectable Change ◽

Tendon Stiffness ◽

Patient Reported ◽

Tendon Thickness

Background: Shoulder pain is common, with a lifetime prevalence of up to 67%. Evidence is conflicting in relation to imaging findings and pain in the shoulder. Sonoelastography can be used to estimate tissue stiffness and may be a clinically relevant technique for diagnosing and monitoring tendon healing. Purpose: To evaluate changes in supraspinatus tendon stiffness using strain elastography (SEL) and associations with changes in patient-reported outcomes, supraspinatus tendon thickness, and grade of tendinopathy after 12 weeks of unilateral shoulder exercises in patients with supraspinatus tendinopathy. Study Design: Controlled laboratory study. Methods: A total of 23 patients with unilateral clinical supraspinatus tendinopathy performed 12 weeks of “standard care” exercises. At baseline and follow-up, supraspinatus tendon stiffness was measured bilaterally using SEL and compared with tendinopathy grading on magnetic resonance imaging scans and tendon thickness measured using conventional ultrasound. Patient-reported outcome measures included physical function and symptoms from the Disabilities of the Arm, Shoulder and Hand questionnaire and pain rating (visual analog scale). Results: No significant changes in SEL within or between groups (asymptomatic vs symptomatic tendon) were seen. All patient-reported outcomes showed significant improvement from baseline to follow-up, but with no change in tendinopathy grading and tendon thickness. No significant differences in the proportion of patients changing above the minimal detectable change in SEL and PROM were seen, except for discomfort while sleeping. Conclusion: Despite no significant within-group or between-group changes in SEL, significant improvements were found in patient-reported outcomes. An acceptable agreement between patients changing above the minimal detectable change in SEL and patient-reported outcome measure was seen. Further studies should explore the use of SEL to detect changes after tendon repair and long-term training potentially in subgroups of different tendinopathy phases. Clinical Relevance: In the short term, structural changes in supraspinatus tendons could not be visualized using SEL, indicating that a longer time span should be expected in order to observe structural changes, which should be considered before return to sports. Subgrouping based on stage of tendinopathy may also be important in order to evaluate changes over time with SEL among patients with supraspinatus tendinopathy. Registration: NCT03425357 ( ClinicalTrials.gov identifier).

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Acceptability of no-test medical abortion provided via telemedicine: analysis of patient-reported outcomes

BMJ Sexual & Reproductive Health ◽

10.1136/bmjsrh-2020-200954 ◽

2021 ◽

pp. bmjsrh-2020-200954

Author(s):

Chelsey Porter Erlank ◽

Jonathan Lord ◽

Kathryn Church

Keyword(s):

Patient Reported Outcomes ◽

Medical Abortion ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Post Procedure ◽

High Satisfaction ◽

First Choice ◽

Patient Reported ◽

At Home

IntroductionThe English government approved both stages of early medical abortion (EMA), using mifepristone and misoprostol under 10 weeks’ gestation, for at-home use on 30 March 2020. MSI Reproductive Choices UK (MSUK), one of the largest providers of abortion services in England, launched a no-test telemedicine EMA pathway on 6 April 2020. The objectives of this study were to report key patient-reported outcome measures and to assess whether our sample was representative of the whole population receiving no-test telemedicine EMA.MethodsA sample of all MSUK’s telemedicine EMA patients between April and August 2020 were invited to opt in to a follow-up call to answer clinical and satisfaction questions. A total of 1243 (13.7% of all telemedicine EMAs) were successfully followed-up, on average within 5 days post-procedure.ResultsPatients reported high confidence in telemedicine EMA and high satisfaction with the convenience, privacy and ease of managing their abortion at home. The sample responding were broadly equivalent to the whole population receiving telemedicine. No patient reported that they were unable to consult privately. The majority (1035, 83%) of patients reported preferring the telemedicine pathway, with 824 (66%) indicating that they would choose telemedicine again if COVID-19 were no longer an issue.ConclusionsTelemedicine EMA is a valued, private, convenient and more accessible option that is highly acceptable for patients seeking an abortion, especially those for whom in-clinic visits are logistically or emotionally challenging. Evidence that this pathway would be a first choice again in future for most patients supports the case to make telemedicine EMA permanent.

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PROsetta: An R Package for Linking Patient-Reported Outcome Measures

Applied Psychological Measurement ◽

10.1177/01466216211013106 ◽

2021 ◽

pp. 014662162110131

Author(s):

S. W. Choi ◽

S. Lim ◽

B. D. Schalet ◽

A. J. Kaat ◽

D. Cella

Keyword(s):

Patient Reported Outcomes ◽

R Package ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Measurement Information ◽

Short History ◽

Rosetta Stone ◽

Patient Reported ◽

R Packages ◽

Measurement Information System

A common problem when using a variety of patient-reported outcomes (PROs) for diverse populations and subgroups is establishing a harmonized scale for the incommensurate outcomes. The lack of comparability in metrics (e.g., raw summed scores vs. scaled scores) among different PROs poses practical challenges in studies comparing effects across studies and samples. Linking has long been used for practical benefit in educational testing. Applying various linking techniques to PRO data has a relatively short history; however, in recent years, there has been a surge of published studies on linking PROs and other health outcomes, owing in part to concerted efforts such as the Patient-Reported Outcomes Measurement Information System (PROMIS®) project and the PRO Rosetta Stone (PROsetta Stone®) project ( www.prosettastone.org ). Many R packages have been developed for linking in educational settings; however, they are not tailored for linking PROs where harmonization of data across clinical studies or settings serves as the main objective. We created the PROsetta package to fill this gap and disseminate a protocol that has been established as a standard practice for linking PROs.

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