scholarly journals A registry based analysis of the patient reported outcome after surgery for trapeziometacarpal joint osteoarthritis

2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Maria Wilcke ◽  
Martin Roginski ◽  
Mikael Åström ◽  
Marianne Arner
Keyword(s):  
Ligament Reconstruction ◽  
Age Groups ◽  
Hand Surgery ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Special Focus ◽  
Trapeziometacarpal Joint ◽  
Patient Reported ◽  
Tendon Interposition ◽  
Joint Arthritis

Abstract Background The aim of the study was to evaluate patient reported outcome measures (PROM) before and after trapeziectomy with or without ligament reconstruction and tendon interposition for trapeziometacarpal joint arthritis with special focus on possible differences due to gender, age and surgical method. Methods Data from the Swedish quality registry for hand surgery (HAKIR) was analyzed preoperatively, 3 months and 1 year postoperatively for 1850 patients (mean age 63 years, 79% women). Results One year postoperatively, mean pain at rest was reduced from 50 to 12 of maximum 100. However, pain on load and weakness had not abated to the same extent (mean 30 and 34 of 100, respectively). The mean improvement in PROM did not differ between age groups or gender. The result was similar after trapeziectomy with ligament reconstruction and tendon interposition (86% of the patients) and simple trapeziectomy but few patients were operated with the latter method. Conclusion Pain on load and weakness remains to some extent 1 year after surgery for trapeziometacarpal joint arthritis. The result is similar after trapeziectomy with or without ligament reconstruction and tendon interposition and the same improvement can be expected after surgery regardless of age and gender.

Preoperative Opioid Use in Patients Undergoing Common Hand Surgeries

Hand ◽  
2021 ◽  
pp. 155894472097412
Author(s):  
Ali Aneizi ◽  
Dominique Gelmann ◽  
Dominic J. Ventimiglia ◽  
Patrick M. J. Sajak ◽  
Vidushan Nadarajah ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Hand Surgery ◽  
Patient Characteristics ◽  
Patient Reported Outcome Measures ◽  
Pain Scale ◽  
Patient Reported Outcome ◽  
Measurement Information ◽  
Opioid Use ◽  
Patient Reported ◽  
Opioid Users

Background: The objectives of this study were to determine the baseline patient characteristics associated with preoperative opioid use and to establish whether preoperative opioid use is associated with baseline patient-reported outcome measures in patients undergoing common hand surgeries. Methods: Patients undergoing common hand surgeries from 2015 to 2018 were retrospectively reviewed from a prospective orthopedic registry at a single academic institution. Medical records were reviewed to determine whether patients were opioid users versus nonusers. On enrollment in the registry, patients completed 6 Patient-Reported Outcomes Measurement Information System (PROMIS) domains (Physical Function, Pain Interference, Fatigue, Social Satisfaction, Anxiety, and Depression), the Brief Michigan Hand Questionnaire (BMHQ), a surgical expectations questionnaire, and Numeric Pain Scale (NPS). Statistical analysis included multivariable regression to determine whether preoperative opioid use was associated with patient characteristics and preoperative scores on patient-reported outcome measures. Results: After controlling for covariates, an analysis of 353 patients (opioid users, n = 122; nonusers, n = 231) showed that preoperative opioid use was associated with higher American Society of Anesthesiologists class (odds ratio [OR], 2.88), current smoking (OR, 1.91), and lower body mass index (OR, 0.95). Preoperative opioid use was also associated with significantly worse baseline PROMIS scores across 6 domains, lower BMHQ scores, and NPS hand scores. Conclusions: Preoperative opioid use is common in hand surgery patients with a rate of 35%. Preoperative opioid use is associated with multiple baseline patient characteristics and is predictive of worse baseline scores on patient-reported outcome measures. Future studies should determine whether such associations persist in the postoperative setting between opioid users and nonusers.

The long-term outcome of simple trapeziectomy

2018 ◽  
Vol 44 (2) ◽  
pp. 146-150 ◽  
Author(s):  
Thomas F. M. Yeoman ◽  
Oliver Stone ◽  
Paul J. Jenkins ◽  
Jane E. McEachan
Keyword(s):  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Level Of Evidence ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Sustained Improvement ◽  
Patient Reported ◽  
The Mean ◽  
Joint Arthritis

The aim of this study was to investigate the long-term outcome of simple trapeziectomy by a single surgeon and to compare this with pre-operative function. Two hundred and five patients completed the shortened disabilities of the arm, shoulder and hand questionnaire (QuickDASH) and the EuroQoL five-dimensional questionnaire (EQ-5D) scores at a mean of 8.2 (range 3.5–17) years after simple trapeziectomy. There were no pre-operative scores available, so case controls were selected from our prospective database to compare pre- and post-operative patient-reported outcome measures. The mean QuickDASH score of the post-operative matched group was 37 (SD 17.0) and the mean EQ-5D was 0.56 (SD 0.31). The mean QuickDASH score of the pre-operative group was 54 (SD 17.0). The mean difference in QuickDASH between the pre- and post-operative groups was 17 (95% CI: 8 to 26, p = 0.0003). This study demonstrated a significant and sustained improvement in patient-reported function after simple trapeziectomy. It supports that simple trapeziectomy is a simple, safe and effective treatment for advanced trapeziometacarpal joint arthritis. Level of evidence: IV

scholarly journals Patient-reported outcome measures as a new application in the Swedish Renal Registry: health-related quality of life through RAND-36

2019 ◽  
Author(s):  
Agneta A Pagels ◽  
Maria Stendahl ◽  
Marie Evans
Keyword(s):  
Age Groups ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Age Group ◽  
Patient Reported ◽  
Related Quality ◽  
Centered Care ◽  
Health Related ◽  
Impaired Health

AbstractBackgroundAlthough patient-reported outcome measures (PROMs) are gaining increased interest in developing health care quality and are a useful tool in person-centered care, their use in routine care is still limited. The aim of this study is to describe the implementation and initial results of PROMs via the Swedish Renal Registry (SRR) on a national level.MethodsAfter testing and piloting the electronic PROM application, nationwide measures were carried out in 2017 for completing the RAND-36 questionnaire online or by paper in a wide range of chronic kidney disease (CKD) patients (Stages 3–5, dialysis and transplantation) through the SRR. Cross-sectional results during the first year were analyzed by descriptive statistics and stratified by treatment modality.ResultsA total of 1378 patients from 26 of 68 renal units (39%) completed the questionnaire. The response rate for all participating hemodialysis units was 38.9%. The CKD patients had an impaired health profile compared with a Swedish general population, especially regarding physical functions and assessed general health (GH). Transplanted patients had the highest scores, whereas patients on dialysis treatment had the lowest scores. The youngest age group assessed their physical function higher and experienced fewer physical limitations and less bodily pain than the other age groups but assessed their GH and vitality (VT) relatively low. The oldest age group demonstrated the lowest health profile but rated their mental health higher than the other age groups. The older the patient, the smaller the difference compared with persons of the same age in the general population.ConclusionsNationwide, routine collection of PROMs is feasible in Sweden. However, greater emphasis is needed on motivating clinical staff to embrace the tool and its possibilities in executing person-centered care. CKD patients demonstrate impaired health-related quality of life, especially regarding limitations related to physical problems, GH and VT/energy/fatigue.

scholarly journals Clinical Outcomes after Isolated Medial Patellofemoral Ligament Reconstruction for Patellar Instability

2017 ◽  
Vol 5 (3_suppl3) ◽  
pp. 2325967117S0012
Author(s):  
Joseph N. Liu ◽  
Jacqueline Munch ◽  
Claire Berdelle Ryan ◽  
Irene L. Kalbian ◽  
Sabrina M. Strickland ◽  
...  
Keyword(s):  
Ligament Reconstruction ◽  
Medial Patellofemoral Ligament ◽  
Trochlear Dysplasia ◽  
Patellofemoral Instability ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Return To Sports ◽  
Medial Patellofemoral Ligament Reconstruction ◽  
Patient Reported

Objectives: Medial patellofemoral ligament (MPFL) reconstruction has become an increasingly popular means to regain stability in the setting of recurrent lateral patellar dislocation, with nearly twice the number of medical centers performing reconstruction of the MPFL and outcomes reported on nearly double the number of patients in recent years. While recent studies have demonstrated improved patient reported outcome measures and a high rate of return to sports, limited literature has explored its effectiveness as an isolated intervention in the context of trochlear dysplasia. The purpose of this study was to determine the efficacy of isolated MPFL reconstruction in treating patellar instability in the setting of trochlear dysplasia. Methods: This was a retrospective review of consecutive patients who underwent unilateral or bilateral medial patellofemoral ligament reconstruction for patellofemoral instability. No osteotomies were included. All patients with minimum 2 year follow up were included. Pre- and postoperative assessment included ligamentous laxity, patellar crepitus, tilt, translation, and apprehension, and radiographic features including tibial tubercle-trochlear groove (TT-TG) ratio, Dejour classification, and Caton Deschamps ratio. Final follow up consisted of patient reported outcome measures including the Kujala score, International Knee Documentation Committee (IKDC) score, Lysholm score, and visual analog scale (VAS). Results: 105 MPFL reconstructions were included. Average age at surgery was 23.8 years (SD 9.7, range 12.1 - 57.0) with an average BMI of 23.4 (SD 4.7, range 16.3-43.6) and an average of 4.4 (SD 6.8) dislocation events prior to surgery. Average follow up was 44 months (range 24-111). 76% of patients were female. Average preoperative TT-TG ratio was 13.5 (SD 3.9, range 3.2-22) and Caton Deschamps ratio was 1.2 (SD 0.2, range 0.9-1.6); 74.5% of patients had Dejour C or D trochlear grooves. Kujala score improved from 54.5 (SD 3.8) preoperatively to 87.2 (SD 2.1) at 2 year follow up (p < 0.0001), Lysholm improved from 57.7 (SD 3.6) to 86.4 (SD 2.0) (p < 0.0001), IKDC improved from 52.1 (SD 3.8) to 79.5 (SD 2.6) (p < 0.0001), and VAS pain score improved from 2.9 (SD 0.3) to 1.7 (SD 0.3) (p<0.017). 78.9% of patients were able to return to sports at 1 year, with 69% returning to the same or higher level of play. At minimum 2-year follow up, only 5 patients reported either a postoperative dislocation or subluxation event. Conclusion: This study is the largest single series to report on the effectiveness of isolated MPFL reconstructions in a cohort of patients with a high incidence of trochlear dysplasia. In patients with normal TT-TG ratios, isolated medial patellofemoral ligament reconstruction provides safe and effective treatment for patellofemoral instability, despite the presence of Dejour class C or D trochlear grooves. Most patients are able to return to sports by 1 year postoperatively at the same or higher level of play.

scholarly journals Measuring quality of life and patient satisfaction in hand conditions

2018 ◽  
Vol 1 (2) ◽  
pp. 85-99 ◽  
Author(s):  
Kyra L Sierakowski ◽  
Kathleen A Evans Sanchez ◽  
Rachael A Damarell ◽  
Nicola R Dean ◽  
Philip A Griffin ◽  
...  
Keyword(s):  
International Development ◽  
English Language ◽  
A Priori ◽  
Hand Surgery ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Psychometric Validation ◽  
Surgical Interventions ◽  
Many Instruments ◽  
Patient Reported

Background: Patient reported outcomes (PROs) are important for the assessment of the effectiveness of surgical interventions. If patient reported outcome measures (PROMs) are used to prioritise resources then it is important to ensure that the instruments are scientifically valid. This review aims to assess whether the currently available PROMs in hand surgery adhere to international development guidelines and whether they incorporate the use of item response theory (IRT) or Rasch Analysis (RA). Methods: A systematic review was performed to identify all PROMs that are relevant to the field of hand surgery. An a priori protocol with strict inclusion and exclusion criteria was followed. Only instruments developed in the English language were included. A comprehensive search of nine databases was undertaken. The development methodology of the identified instruments was then analysed, followed by examination of the domain content and initial psychometric validation of each instrument. Results: A total of 3,039 article citations were retrieved, 139 citations went on to a full text review. A total of 24 patient reported outcome instruments were identified. This consisted of 10 regional upper limb, six hand and/or wrist specific and a further eight condition specific instruments. Documentation of the details of PROM development was lacking for many instruments. Conclusion: The field of hand surgery has many instruments available but few fulfil international development guidelines or use IRT or RA psychometric techniques. There are limitations in either the breadth of the domains explored or the developmental methodology used in all currently available instruments.

How Should We Use Patient-Reported Outcome Measures at the Point of Care in Hand Surgery?

2021 ◽  
Author(s):  
Lauren M. Shapiro ◽  
David Ring ◽  
Edward Akelman ◽  
David S. Ruch ◽  
Marc J. Richard ◽  
...  
Keyword(s):  
Outcome Measures ◽  
Point Of Care ◽  
Hand Surgery ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Patient Reported

Patient-reported outcome measures following anterior cruciate ligament reconstruction are not related to dynamic knee extension angle

2018 ◽  
Vol 3 (1) ◽  
pp. 33-37 ◽  
Author(s):  
Kanto Nagai ◽  
Elmar Herbst ◽  
Tom Gale ◽  
Yasutaka Tashiro ◽  
James J Irrgang ◽  
...  
Keyword(s):  
Anterior Cruciate Ligament ◽  
Ligament Reconstruction ◽  
Cruciate Ligament ◽  
Patient Reported Outcome Measures ◽  
Knee Extension ◽  
Patient Reported Outcome ◽  
Cruciate Ligament Reconstruction ◽  
Knee Hyperextension ◽  
Patient Reported ◽  
Anterior Cruciate

ObjectivesControversy still exists on whether knee hyperextension affects the outcome following anterior cruciate ligament reconstruction (ACL-R). Therefore, the purpose of the present study was to determine if maximum knee extension angle of ACL-R knees and contralateral uninjured knees during walking is related to the clinical outcome following ACL-R. It was hypothesised that maximum knee extension angle would not be significantly correlated with patient-reported outcome measures (PROMs) following ACL-R.MethodsForty-two patients (age at surgery: 23±9 years, 23 male and 19 female) underwent unilateral ACL-R. Twenty-four months after surgery, subjects performed level walking on a treadmill while biplane radiographs were acquired at 100 Hz. Three-dimensional tibiofemoral motion was determined using a validated model-based tracking process. Tibiofemoral rotations were calculated from foot strike through early stance. The primary kinematic outcome measure was maximum knee extension angle of ACL-R and contralateral uninjured knees during walking, with positive values indicating hyperextension. The side-to-side difference (SSD) in maximum knee extension angle was calculated by subtracting the angle of the contralateral uninjured knee from that of the ACL reconstructed knee. PROMs (International Knee Documentation Committee Subjective Knee Form, Knee Injury and Osteoarthritis Score and Marx Activity Rating Scale) were obtained at 24 months after surgery. Correlations between PROMs and maximum dynamic knee extension angle in ACL-R and contralateral knee were evaluated (P<0.05).ResultsMaximum knee extension angle during walking was 2.3±4.5° in ACL-R knees and 4.3±4.2° in contralateral uninjured knees at 24 months after surgery, indicating hyperextension during walking on average. SSD in maximum knee extension angle was −2.0±3.7°. No significant correlation was observed between maximum knee extension angle and the PROMs.ConclusionMaximum knee extension angle during walking was not significantly correlated with PROMs, suggesting that clinically, physiologic knee hyperextension can be restored after ACL-R and not adversely affect PROMs.Level of evidenceLevel III.

scholarly journals Which patient-reported outcomes shall we use in hand surgery?

2019 ◽  
Vol 45 (1) ◽  
pp. 5-11 ◽  
Author(s):  
Miriam Marks
Keyword(s):  
Patient Reported Outcomes ◽  
Outcome Measurement ◽  
Hand Surgery ◽  
Daily Practice ◽  
Patient Reported Outcome Measures ◽  
Patient Reported Outcome ◽  
Measurement Instruments ◽  
Patient Reported ◽  
General Quality

Nowadays, the use of patient-reported outcome measures to monitor a treatment effect in daily practice or to quantify study outcomes is indispensable. In hand surgery, there is a wide variety available. This article provides an overview about the most common hand-specific, upper-extremity specific and general quality of life patient-reported outcome measurement instruments with adequate psychometric properties. A checklist and a decision tree are provided for choosing the appropriate instrument when evaluating patients with hand conditions.

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