scholarly journals Development and field testing of a patient decision aid for management of acute Achilles tendon rupture: a study protocol

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Brad Meulenkamp ◽  
Julia Brillinger ◽  
Dean Fergusson ◽  
Dawn Stacey ◽  
Ian D. Graham
Keyword(s):  
Achilles Tendon ◽  
Study Protocol ◽  
Decision Aid ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Field Testing ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Patient Decision ◽  
Tendon Ruptures

Abstract Background Achilles tendon ruptures are common injuries in an otherwise healthy, active population. Several treatment options exist, with both surgical and non-surgical options. Each treatment option has a unique set of risks and harms, which may present patients with decisional conflict. The aim of the proposed study is to develop, alpha test and field test a patient decision aid for patients presenting with acute Achilles tendon ruptures. Methods This is a three-stage study protocol. First, we will assemble a multi-disciplinary steering group including patients, clinicians, educators, and researchers to develop the patient decision aid prototype using the Ottawa Decision Support Framework. Second, we will perform a mixed-methods alpha test of the decision aid prototype with patients and clinicians experienced in acute Achilles tendon ruptures. Outcomes measured will include acceptability and usability of the patient decision aid measured using validated outcome scales and semi-structured interviews. A minimum of three rounds of feedback will be obtained. Results will be analyzed using descriptive statistics, reviewed by the steering group, to guide revisions to decision aid prototype at each round. The third stage will be field testing the revised decision aid prototype in usual clinical care. A pre-/post-study will be performed with patients with acute Achilles tendon ruptures. Patients will be recruited from the emergency department and complete the pre-consultation decision aid prior to a one-week follow up with their surgeon. The primary outcome of field testing will be feasibility of implementing the decision aid in the clinical setting and will be measured with recruitment and completion metrics. Secondary outcomes include acceptability of the decision aid, knowledge, preparedness for decision making, and decisional conflict, measured using validated outcome measures. Statistical analysis will be performed using descriptive analysis for primary outcomes and a student t-test and Wilcoxon Rank-Sum test for secondary outcomes. Discussion This comprehensive study protocol outlines the development, alpha testing, and field testing of a patient decision aid for patients with acute Achilles tendon rupture. Systematic and transparent development and testing of patient decision aids is critical to improve decision aid quality. Trial registration Not Applicable.

scholarly journals The Influence of Diabetes on Acute Achilles Tendon Rupture Repair

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0028
Author(s):  
Jonathan Kaplan ◽  
Jeffery Hillam ◽  
Amiethab Aiyer ◽  
Niall Smyth
Keyword(s):  
Diabetes Mellitus ◽  
Postoperative Complications ◽  
Achilles Tendon ◽  
Power Analysis ◽  
Tendon Rupture ◽  
Surgical Repair ◽  
Achilles Tendon Rupture ◽  
The United States ◽  
Foot And Ankle ◽  
Tendon Ruptures

Category: Sports Introduction/Purpose: Diabetes Mellitus (DM) is an epidemic affecting millions of individuals in the United States. Multiple studies have demonstrated an increase in complications in foot and ankle surgery in patients with DM, including wound healing complications, surgical site infections (SSI), or surgical failure. The goal of this study was to retrospectively review outcomes data from the National Surgical Quality Improvement Program (NSQIP) to determine the impact of DM on operative treatment of achilles tendon ruptures. Methods: Using the NSQIP from 2006-2015, patients were identified using common procedure terminology (CPT) for Achilles tendon ruptures. Diabetic and non-diabetic cohorts were evaluated to compare demographics, comorbidities, perioperative details and 30-day outcomes. Statistical evaluation included a power analysis for the primary outcome measure of wound disruption as well as univariate analysis was performed using chi-squared or Fisher’s exact and Wilcoxon signed-rank tests. Results: A total of 2,014 patients were identified having sustained an Achilles tendon rupture. There were 1,981 patients without DM and 33 patients with DM. There were no significant differences in postoperative complications, including SSI, medical complications, and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures. The power analysis for wound disruption showed a P=0.9 with an alpha of 0.05, sample size of n=2014, and Pearson correlation coefficient of r=0.0721 Conclusion: While DM has been shown to have an increase in complications in various foot and ankle procedures, this study demonstrates that there is no significant difference in postoperative complications and 30-day outcomes between patients with DM and non-DM patients undergoing surgical repair of acute Achilles tendon ruptures using the NSQIP database from 2006-2015. Based on this data, patients with diabetes mellitus can be considered adequate surgical candidates for acute Achilles tendon rupture repair.

scholarly journals Assessing Preference Shift and Effects on Patient Knowledge and Decisional Conflict: Cross-Sectional Study of an Interactive Prostate-Specific Antigen Test Patient Decision Aid (Preprint)

2018 ◽  
Author(s):  
Peter Scalia ◽  
Glyn Elwyn ◽  
Jan Kremer ◽  
Marjan Faber ◽  
Marie-Anne Durand
Keyword(s):  
Prostate Specific Antigen ◽  
Decision Aid ◽  
Specific Antigen ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Web Based ◽  
Psa Test ◽  
Psa Testing ◽  
Patient Decision ◽  
The Web

BACKGROUND Randomized trials of Web-based decision aids for prostate-specific antigen (PSA) testing indicate that these interventions improve knowledge and reduce decisional conflict. However, we do not know about these tools’ impact on people who spontaneously use a PSA testing patient decision aid on the internet. OBJECTIVE The objectives of this study were to (1) determine the impact of the Web-based PSA Option Grid patient decision aid on preference shift, knowledge, and decisional conflict; (2) identify which frequently asked questions (FAQs) are associated with preference shift; and (3) explore the possible relationships between these outcomes. METHODS Data were collected between January 1, 2016, and December 30, 2017. Users who accessed the Web-based, interactive PSA Option Grid were provided with 3 options: have a PSA test, no PSA test, or unsure. Users first declared their initial preference and then completed 5 knowledge questions and a 4-item (yes or no) validated decisional conflict scale (Sure of myself, Understand information, Risk-benefit ratio, Encouragement; SURE). Next, users were presented with 10 FAQs and asked to identify their preference for each question based on the information provided. At the end, users declared their final preference and completed the same knowledge and decisional conflict questions. Paired sample t tests were employed to compare before and after knowledge and decisional conflict scores. A multinomial regression analysis was performed to determine which FAQs were associated with a shift in screening preference. RESULTS Of all the people who accessed the PSA Option Grid, 39.8% (186/467) completed the interactive journey and associated surveys. After excluding 22 female users, we analyzed 164 responses. At completion, users shifted their preference to “not having the PSA test” (43/164, 26.2%, vs 117/164, 71.3%; P<.001), had higher levels of knowledge (112/164, 68.3%, vs 146/164, 89.0%; P<.001), and lower decisional conflict (94/164, 57.3%, vs 18/164, 11.0%; P<.001). There were 3 FAQs associated with preference shift: “What does the test involve?” “If my PSA level is high, what are the chances that I have prostate cancer?” and “What are the risks?” We did not find any relationship between knowledge, decisional conflict, and preference shift. CONCLUSIONS Unprompted use of the interactive PSA Option Grid leads to preference shift, increased knowledge, and reduced decisional conflict, which confirms the ability of these tools to influence decision making, even when used outside clinical encounters.

scholarly journals Management of Missed Traumatic Achilles Tendon Rupture in a Pediatric Patient: A Case Report

2021 ◽  
Vol 9 (4) ◽  
pp. 465-470
Author(s):  
Saad Andaloussi
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Tendon Repair ◽  
Skin Wound ◽  
Plantaris Tendon ◽  
First Case ◽  
Tendon Ruptures ◽  
Post Traumatic

BACKGROUND: Missed traumatic Achilles tendon ruptures in children are rarely reported in the literature. Various techniques have been described to reconstruct delayed Achilles tendon ruptures for adults, but the long-term consequences in the growing child are unknown. CLINICAL CASE: The article presents a clinical observation of a 8-year-old girl with missed rupture of the Achilles tendon operated 7 weeks after the trauma by end-to-end Kessler-type sutures augmented with the plantaris tendon. At 2-year follow-up, the patient was completely asymptomatic. DISCUSSION: A review of the literature shows that this is the third neglected pediatric case of post-traumatic Achilles tendon rupture. The first case concerns a 10-year-old boy treated successfully six weeks after the traumat by open surgical repair using the Bunnell sutures technique. The second patient was a 7-year-old girl, she was operated 8 weeks after the trauma with a termino-terminal tenorrhaphy using the Bunnell technique augmented with the plantaris tendon. CONCLUSIONS: Using the plantaris tendon to reinforce the Achilles tendon repair offers satisfactory results with minimal morbidity. Prognosis depends on the extent of tendon defect which determines the long-term functional outcome. Any skin wound that sits on the back of the leg requires a systematic and careful physical examination to check the integrity of the Achilles tendon.

scholarly journals Ultrasonographic Classification of Achilles Tendon Ruptures as a Rationale for Individual Treatment Selection

2011 ◽  
Vol 2011 ◽  
pp. 1-10 ◽  
Author(s):  
Michael H. Amlang ◽  
Hans Zwipp ◽  
Adina Friedrich ◽  
Adam Peaden ◽  
Alfred Bunk ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Achilles Tendon Rupture ◽  
Individual Treatment ◽  
Reliable Instrument ◽  
Tendon Ruptures ◽  
Selection For ◽  
Sonographic Classification

Purpose. This work introduces a distinct sonographic classification of Achilles tendon ruptures which has proven itself to be a reliable instrument for an individualized and differentiated therapy selection for patients who have suffered an Achilles tendon rupture. Materials and Methods. From January 1, 2000 to December 31, 2005, 273 patients who suffered from a complete subcutaneous rupture of the Achilles tendon (ASR) were clinically and sonographically evaluated. The sonographic classification was organized according to the location of the rupture, the contact of the tendon ends, and the structure of the interposition between the tendon ends. Results. In 266 of 273 (97.4%) patients the sonographic classification of the rupture of the Achilles tendon was recorded. Type 1 was detected in 54 patients (19.8%), type 2a in 68 (24.9%), type 2b in 33 (12.1%), type 3a in 20 (7.3%), type 3b in 61 (22.3%), type 4 in 20 (7.3%), and type 5 in 10 (3.7%). Of the patients with type 1 and fresh ASR, 96% () were treated nonoperative-functionally, and 4% () were treated by percutaneous suture with the Dresden instrument (pDI suture). Of the patients classified as type 2a with fresh ASR, 31 patients (48%) were treated nonoperatively-functionally and 33 patients (52%) with percutaneous suture with the Dresden instrument (pDI suture). Of the patients with type 3b and fresh ASR, 94% () were treated by pDI suture and 6% () by open suture according to Kirchmayr and Kessler. Conclusion. Unlike the clinical classification of the Achilles tendon rupture, the sonographic classification is a guide for deriving a graded and differentiated therapy from a broad spectrum of treatments.

scholarly journals Effect of a patient decision aid (PDA) for type 2 diabetes on knowledge, decisional self-efficacy, and decisional conflict

2015 ◽  
Vol 16 (1) ◽  
Author(s):  
Robert. A. Bailey ◽  
Michael Pfeifer ◽  
Alicia C. Shillington ◽  
Qing Harshaw ◽  
Martha M. Funnell ◽  
...  
Keyword(s):  
Type 2 Diabetes ◽  
Self Efficacy ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Patient Decision

scholarly journals Seasonal Variation of Achilles Tendon Injury

2018 ◽  
Vol 3 (3) ◽  
pp. 2473011418S0017
Author(s):  
Jon-Michael Caldwell ◽  
Harry Lightsey ◽  
Hasani Swindell ◽  
Justin Greisberg ◽  
J. Turner Vosseller
Keyword(s):  
Seasonal Variation ◽  
Achilles Tendon ◽  
Tendon Rupture ◽  
Seasonal Pattern ◽  
Achilles Tendon Rupture ◽  
Tendon Injury ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Significant Difference ◽  
Tendon Ruptures

Category: Sports Introduction/Purpose: Achilles tendon ruptures are increasingly common injuries. There are several known risk factors for Achilles tendon rupture, although little is reported on the seasonal variation of the incidence of these injuries. Of the few studies in the literature touching on this question, the results have been varied. We sought to determine if there is any seasonal pattern of Achilles tendon ruptures. Knowledge of such a seasonal pattern could be advantageous for patient education, risk assessment, and ultimately prevention of these injuries. Methods: We queried billing records for CPT codes 27650, 27652, and 27654 as well as ICD diagnosis codes 727.67, 845.09, and S86.01x pertaining to Achilles tendon injury, repair, and reconstruction. Charts were screened and included if the patient suffered an acute Achilles tendon rupture on a known date. Charts were excluded if the patient had a chronic Achilles tear or underwent reconstruction or debridement for tendonitis, Haglunds deformity, tendon laceration, or any other indication aside from acute rupture. Data was analyzed using a chi-squared test for categorical variables, binomial tests for dichotomous variables and Mann-Whitney-U or Welch t-test for continuous variables. Significance was set at p < 0.05. Results: Our search yielded 499 cases with 245 meeting inclusion criteria. Sixty-six percent (66%) of injuries were identified as sports-related while 34% were non-sports related. When stratified by month, significant peaks occurred in April and July (p = .036, .011 respectively) with significantly fewer injuries occurring in October through December (p = 0.049). The highest rate of injury was seen in Spring (p = .015) and the lowest was seen in Fall (p < .001). There was no significant difference between seasons when only the non-sports related injuries were considered. Basketball was the most common sport involved (n=78) accounting for 51% of injuries (p < .001), followed by soccer and tennis. There was no significant variation between seasons in any particular sport. Conclusion: There was significant seasonal variation in the incidence of Achilles tendon ruptures. Both sports and non-sports-related injuries followed a similar pattern, with most injuries occurring during the Spring and Summer and fewer during Fall and Winter. This increase corresponds to the increase in activity in the recreational athlete population in the region which is often preceded by a time of relative inactivity. Our study confirms that the deconditioned athlete is at particularly elevated risk for Achilles tendon rupture during the Spring season when abrupt increases in sporting activity are common. Targeted education and prevention efforts could help mitigate this risk.

scholarly journals A patient decision aid for antidepressant use in pregnancy: study protocol for a randomized controlled trial

Trials ◽  
2016 ◽  
Vol 17 (1) ◽  
Author(s):  
Simone Vigod ◽  
Neesha Hussain-Shamsy ◽  
Sophie Grigoriadis ◽  
Louise M. Howard ◽  
Kelly Metcalfe ◽  
...  
Keyword(s):  
Randomized Controlled Trial ◽  
Study Protocol ◽  
Decision Aid ◽  
Controlled Trial ◽  
Patient Decision Aid ◽  
Randomized Controlled ◽  
Patient Decision ◽  
Antidepressant Use ◽  
In Pregnancy

Prospective evaluation of a new patient decision aid to enhance prostate cancer screening decision-making.

2019 ◽  
Vol 37 (7_suppl) ◽  
pp. 87-87
Author(s):  
Michael Austin Brooks ◽  
Anita Misra-Hebert ◽  
Alexander Zajichek ◽  
Sigrid V. Carlsson ◽  
Jonas Hugosson ◽  
...  
Keyword(s):  
Prostate Cancer ◽  
Decision Making ◽  
Health Literacy ◽  
Decision Aid ◽  
Decisional Conflict ◽  
Patient Decision Aid ◽  
Psa Screening ◽  
Psa Testing ◽  
Patient Decision ◽  
The Impact

87 Background: We previously developed screening nomograms to predict 15-year risk of all-cause mortality, prostate cancer diagnosis, and prostate cancer mortality, and incorporated them into a graphical patient decision aid (PtDA). Our objective was to prospectively recruit primary care patients interested in shared-decision making regarding prostate specific antigen (PSA) screening and assess the impact of individualized counseling using our new PtDA. Methods: 50 patients from one internal medicine practice were enrolled in a single-arm sequential trial design, with face-to-face clinician counseling and questionnaires. Eligibility criteria included men age 50-69 years old and life expectancy > 10 years. Patients were excluded for a personal history of prostate cancer or PSA screening within the prior year. Participants completed baseline questionnaires regarding prior PSA testing, demographic information, health literacy, and the Control Preferences Scale (CPS). They then received standardized counseling (based on large trial and epidemiologic data) regarding PSA screening, followed by individualized counseling using our new PtDA. Participants then made a screening decision, and completed a post decision questionnaire including a Decisional Conflict Scale. Results: The median age was 60 (IQR 54; 65). 41 (82%) had a prior PSA test, while 9 (18%) had not. 42 (84%) of participants received some education beyond high school, 41 (82%) demonstrated high health literacy, and 45 (90%) desired to have an active role in decision-making based on the CPS. After undergoing counseling, 34 (68%) participants chose to undergo initial or repeat PSA screening, 8 (16%) chose against future screening, and 8 (16%) remained uncertain. 45 (90%) participants found individualized counseling using the PtDA more useful than standardized counseling. Finally, patients reported reduced decisional conflict compared to historical controls (P < 0.001). Conclusions: Our process of standardized counseling followed by individualized counseling using our new PtDA was effective in reducing decisional conflict. The majority of participants found the PtDA more useful for decision making than standardized counseling. Clinical trial information: NCT03387527.

scholarly journals Subcutaneous Achilles tendon rupture in an eighty-year-old female with an absence of risk factors

2010 ◽  
Vol 2 (1) ◽  
pp. 11
Author(s):  
Motoki Sonohata ◽  
Tsutomu Okamoto ◽  
Kazuyoshi Uchihashi ◽  
Tsutomu Motooka ◽  
Hirofumi Tanaka ◽  
...  
Keyword(s):  
Achilles Tendon ◽  
Tendon Rupture ◽  
Case Reports ◽  
Achilles Tendon Rupture ◽  
Treatment Protocol ◽  
The Elderly ◽  
Clinical Results ◽  
Level Of Activity ◽  
Healthy Female ◽  
Tendon Ruptures

Achilles tendon ruptures rarely occur in patients over 80 years of age. However, it is unclear what treatment, surgical or conservative, is suitable for such an Achilles tendon rupture in the elderly. In addition, the clinical results of an Achilles tendon rupture in the elderly are disappointing. We report here the case of a subcutaneous Achilles tendon rupture in an eighty-year-old, healthy female, who returned to her previous level of activity following surgical treatment. Additional case reports of other instances of successful treatment are needed to help establish the optimal treatment protocol for an Achilles tendon rupture in the elderly.

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