Gait Alterations in Adults after Ankle Fracture: A Systematic Review

(1) Background: Ankle fracture results in pain, swelling, stiffness and strength reduction, leading to an altered biomechanical behavior of the joint during the gait cycle. Nevertheless, a common pattern of kinematic alterations has still not been defined. To this end, we analyzed the literature on instrumental gait assessment after ankle fracture, and its correlation with evaluator-based and patient-reported outcome measures. (2) Methods: We conducted a systematic search, according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, of articles published from January 2000 to June 2021 in PubMed, Embase and PEDro on instrumental gait assessment after ankle fracture. (3) Results: Several changes in gait occur after ankle fracture, including a reduction in step length, swing time, single support time, stride length, cadence, speed and an earlier foot-off time in the affected side. Additionally, trunk movement symmetry (especially vertical) is significantly reduced after ankle fracture. The instrumental assessments correlate with different clinical outcome measures. (4) Conclusions: Instrumental gait assessment can provide an objective characterization of the gait alterations after ankle fracture. Such assessment is important not only in clinical practice to assess patients’ performance but also in clinical research as a reference point to evaluate existing or new rehabilitative interventions.

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A systematic review of the measurement properties of patient reported outcome measures used for adults with an ankle fracture

Journal of Patient-Reported Outcomes ◽

10.1186/s41687-019-0159-5 ◽

2019 ◽

Vol 3 (1) ◽

Cited By ~ 1

Author(s):

Rebecca McKeown ◽

David R. Ellard ◽

Abdul-Rasheed Rabiu ◽

Eleni Karasouli ◽

Rebecca S. Kearney

Keyword(s):

Systematic Review ◽

Construct Validity ◽

Outcome Measures ◽

Ankle Fracture ◽

Methodological Quality ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Measurement Properties ◽

Health Measurement ◽

Patient Reported

Abstract Background Ankle fractures are painful and debilitating injuries that pose a significant burden to society and healthcare systems. Patient reported outcome measures (PROMs) are commonly used outcome measures in clinical trials of interventions for ankle fracture but there is little evidence on their validity and reliability. This systematic review aims to identify and appraise evidence for the measurement properties of ankle specific PROMs used in adults with an ankle fracture using Consensus Based Standards for the Selection of Health Measurement Instrument (COSMIN) methodology. Methods We searched MEDLINE, Embase and CINAHL online databases for evidence of measurement properties of ankle specific PROMs. Articles were included if they assessed or described the development of the PROM in adults with ankle fracture. Articles were ineligible if they used the PROM to assess the measurement properties of another instrument. Abstracts without full articles and conference proceedings were ineligible, as were articles that adapted the PROM under evaluation without any formal justification of the changes as part of a cross-cultural validation or translation process. Two reviewers completed the screening. To assess methodological quality we used COSMIN risk of bias checklist and summarised evidence using COSMIN quality criteria and a modified Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Two reviewers assessed the methodological quality and extracted the data for a sample of articles. Results The searches returned a total of 377 articles. From these, six articles were included after application of eligibility criteria. These articles evaluated three PROMs: A-FORM, OMAS and AAOS. The A-FORM had evidence of a robust development process within the patient population, however lacks post-formulation testing. The OMAS showed sufficient levels of reliability, internal consistency and construct validity. The AAOS showed low quality evidence of sufficient construct validity. Conclusions There is insufficient evidence to support the recommendation of a particular PROM for use in adult ankle fracture research based on COSMIN methodology. Further validation of these outcome measures is required in order to ensure PROMs used in this area are sufficiently valid and reliable to assess treatment effects. This would enable high quality, evidenced-based management of adults with ankle fracture.

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Mid-term Prospective Follow-up of Ankle Fracture Fixation Using Patient Reported Outcome Measures

Foot & Ankle Orthopaedics ◽

10.1177/2473011418s00393 ◽

2018 ◽

Vol 3 (3) ◽

pp. 2473011418S0039

Author(s):

Paul Rai ◽

Jitendra Mangwani

Keyword(s):

Outcome Measures ◽

Ankle Fracture ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Ankle Fractures ◽

Anatomical Reduction ◽

Clear Space ◽

Significant Difference ◽

Patient Reported

Category: Trauma Introduction/Purpose: Open reduction and internal fixation (ORIF) is a common procedure to stabilise unstable ankle fractures. Anatomical reduction and stable fixation is desirable to achieve good clinical and radiological outcome after this injury. This prospective study examines the correlation between mid-term patient reported outcome measures (PROMs) and quality of fracture reduction of adult patients with ankle fractures treated with ORIF. Methods: A total of 100 patients with unstable ankle fracture who underwent ORIF were prospectively entered into the study between Nov 2013 to Oct 2014. Exclusion criteria were: age <18 years, pathological or open fractures and patients with cognitive impairment. Two independent observers assessed fracture patterns and quality of reduction. Fixations were analysed using Pettrone’s criteria including assessment of fracture displacement, medial clear space and tibiofibular overlap. Patients were followed up at two years post-operatively with postal questionnaires. Validated PROMs, Olerud-Molander Score (OMAS) and the Lower Extremity Functional Scale (LEFS) were used. For both scores a higher number indicated a better result. Co-morbidities and infection data were collated from Hospital records. Results: At 2 years post-op there were 5 deceased patients,17 did not have accessible radiographs and there was a 65% response rate to questionnaires. 46 patients were included in the final study group with a mean age of 45 (16-90). There was 1 Weber A fracture, 26 Weber B, 16 Weber C and 3 Medial malleolus fractures. 7% had Diabetes Mellitus, 22% were smokers. The mean OMAS score was 71.4(SD26.9) and LEFS score 56.7(SD25.9). There was no significant difference in PROM scores when fracture fragment reduction was optimised. There was a significant improvement in PROMs with low medial clear space and high tibiofibular overlap. Conclusion: This study reports a good correlation between quality of reduction and favourable PROMs at 2 years post ORIF ankle fracture. Reduced medial clear space and increased tibiofibular overlap were most associated with good outcome scores. Anatomical reduction of fracture fragments did not appear to affect PROMs on its own. There was very little infection in this cohort to confound the results. We would advise careful consideration of medial clear space and tibiofibular overlap in particular at time of fixation of unstable ankle fractures.

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Correlation of Functional Measures of Mobility with Patient-Reported Outcomes after Total Ankle Arthroplasty

Foot & Ankle Orthopaedics ◽

10.1177/2473011417s000004 ◽

2017 ◽

Vol 2 (2) ◽

pp. 2473011416S0000

Author(s):

Justin Kane ◽

James Brodsky ◽

Yahya Daoud

Keyword(s):

Gait Analysis ◽

Outcome Measures ◽

Walking Speed ◽

Step Length ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Sf 36 ◽

Patient Reported ◽

Spatial Parameters ◽

Moderate Positive Correlation

Category: Ankle Introduction/Purpose: Patients undergoing total ankle arthroplasty (TAA) have a proven track record of clinical improvements in subjective patient-reported outcome measures (PROMs) and objective measures with three dimensional gait analysis. Each represents a valid, but different kind of information, and both are important. What is unknown is whether and how objective improvements as measured by gait analysis correlate with the improvements measured by PROMs. The goal of this study was to investigate the correlation between objective function and PROMs in patients undergoing TAA. Methods: Seventy-six patients (28m/48f) aged 61 (37-79) with a mean BMI of 29.60 (19.63-46.64) and greater than 1-year follow-up underwent preoperative and postoperative gait analysis. Temporal-spatial, kinematic, and kinetic parameters of gait were recorded. Patients also completed AOFAS Ankle/Hindfoot scores, visual analog score for pain (VAS), and the MOS 36-Item Short-Form Health Survey (SF-36) questionnaires within two weeks of their preoperative gait analysis and at the one-year postoperative gait analysis. A t-test for dependent means was used to compare preoperative and postoperative outcomes. Additionally, a Pearson correlation coefficient was utilized to measure the strength of association between parameters of gait and PROMs. A p-value of < 0.05 was considered to be statistically significant. Results: Gait Analysis: Patients had a statistically significant improvement in all temporal-spatial parameters of gait, in total range of motion, mean maximum plantarflexion, and ankle power. Patient-reported outcome measures: A statistically significant and clinically meaningful significant improvement was detected for AOFAS score, VAS score, and SF-36-Physical score. Changes in the SF-36-Mental score were not detected to be statistically significant or clinically significant. Correlation: The AOFAS score had a moderate positive correlation with preoperative walking-speed, step-length and ankle-power, postoperative walking-speed, step-length and ankle-power, and improvement in walking-speed, cadence, and ankle-power. The SF-36-Physical score had a weak to moderate positive correlation with preoperative walking speed, step length, and ankle power and postoperative walking speed, step length and ankle power. No correlation between VAS or SF-36-Mental score and function could be detected. Conclusion: There is a moderate correlation with AOFAS and SF-36-Physical scores between walking speed (temporal-spatial parameters), and ankle push-off power (kinetic parameters). PROMs did not correlate with improvements in ROM (kinematic parameters). This may challenge the assumption that preservation of motion is the most important role of TAA. The data may be interpreted to mean cadence, walking-speed, step-length and ankle power are the most important aspects of gait with respect to patients’ perceived outcomes. However, perhaps ROM is important to patient satisfaction – but the outcome measures we use are not sufficiently sensitive/specific to measure the effect of improved or maintained motion.

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(119) Characterization of chemotherapy-induced neuropathy using patient reported outcome measures

Journal of Pain ◽

10.1016/j.jpain.2015.01.033 ◽

2015 ◽

Vol 16 (4) ◽

pp. S5

Author(s):

M. Mazor ◽

B. Cooper ◽

S. Paul ◽

J. Mastick ◽

L. Chen ◽

...

Keyword(s):

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Patient Reported

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Combining scores from different patient reported outcome measures in meta-analyses: when is it justified?

Health and Quality of Life Outcomes ◽

10.1186/1477-7525-4-94 ◽

2006 ◽

Vol 4 (1) ◽

Cited By ~ 53

Author(s):

Milo A Puhan ◽

Irene Soesilo ◽

Gordon H Guyatt ◽

Holger J Schünemann

Keyword(s):

Outcome Measures ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Patient Reported ◽

Meta Analyses

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A comparison of patient-reported outcome measures (PROMs) between short and conventional stem hip replacements: a systematic review and meta-analysis

Hip International ◽

10.1177/1120700019888210 ◽

2019 ◽

Vol 30 (5) ◽

pp. 513-522

Author(s):

Satish Babu ◽

Prashant Singh ◽

Anatole Wiik ◽

Oliver Shastri ◽

Khalid Malik ◽

...

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Meta Analysis ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Total Hip Replacements ◽

Significant Difference ◽

Patient Reported ◽

Hip Replacements ◽

Meta Analyses

Introduction: Short stem hip replacements may allow preservation of proximal bone stock and minimise soft tissue disruption, easing future revision surgery. However patient satisfaction with these implants must be determined before widespread use. We aimed to compare patient reported outcome measures (PROMs) between short and conventional stem hip replacements. Methods: A systematic review was conducted according to PRISMA guidelines for studies comparing short and conventional stem hip replacements with validated PROMs. Meta-analyses were performed for studies reporting Harris Hip and WOMAC scores. Study bias was assessed with the Cochrane Risk of Bias tool and Newcastle-Ottawa Scale. Results: 24 studies, incorporating 2593 total hip replacements were included for qualitative analysis. 17 studies were included in the meta-analyses. Of the 7 excluded, 1 study reported the Japanese Orthopaedic Association score and 2 others reported the Oxford Hip score. All three showed no difference between the stems. A meta-analysis of 17 studies reporting Harris hip scores showed no statistically significant difference between short and conventional stems (standard mean difference (SMD) −0.06, 95% CI −0.20—0.07, p = 0.35). 6 studies reported WOMAC scores with higher scores indicating worse outcome. No difference was seen between the two groups (SMD 0.21, 95%CI, −0.01—0.42, p = 0.06). 4 studies reported higher WOMAC scores as better. Once again, a meta-analysis showed no statistically significant difference between the stems (SMD 0.28, 95% CI −0.07—0.63, p = 0.12). Conclusions: Our systematic review showed no difference in PROMs between short and conventional stem total hip replacements. This is in keeping with previous evidence but is a more comprehensive analysis. Short stems may have an important role in younger individuals as they allow preservation of proximal femoral bone, minimal access surgery and are amenable to abnormal anatomy. The current literature is hindered by non-uniform methodologies and outcome assessments across studies. Further, standardised, high quality evidence is required before widespread changes in practice.

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How Is Scaphoid Malunion Defined: A Systematic Review

Hand ◽

10.1177/15589447211038678 ◽

2021 ◽

pp. 155894472110386

Author(s):

Michelle Xiao ◽

Jessica M. Welch ◽

Samuel A. Cohen ◽

Robin N. Kamal ◽

Lauren M. Shapiro

Keyword(s):

Systematic Review ◽

Outcome Measures ◽

Patient Outcomes ◽

English Language ◽

Patient Reported Outcome Measures ◽

Patient Reported Outcome ◽

Future Studies ◽

Scaphoid Fractures ◽

Patient Reported ◽

Meta Analyses

Background: Abnormal scaphoid alignment after fracture is used as an indication for fixation. Acceptable alignment after reduction and fixation of scaphoid fractures is not well defined. We systematically reviewed the literature to identify how scaphoid malunion is currently defined and by what parameters. Methods: A systematic review was performed using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines. Multiple databases were searched for studies published in the English language that reported on outcomes after scaphoid malunion and included measurements to define malunions. Radiographic scaphoid measurement parameters were collected. Clinical outcome measures recorded included grip strength, wrist range of motion, and patient-reported outcome measures. Study quality was analyzed using the Methodological Index for Non-Randomized Studies (MINORS) criteria. Descriptive summaries of the studies are presented. Results: The initial search yielded 1600 articles. Ten articles (161 participants, 93% males, mean age = 28.3 + 6.3 years, mean MINORS score = 10.2 + 1.6) were included and analyzed. Scaphoid malunion was defined if the lateral intrascaphoid angle (LISA) was >45° (3 articles), LISA >35° (1 article), and height to length ratio >0.6 (3 articles). Four out of 5 studies found no significant associations between patient outcomes and degree of scaphoid malunion measured on imaging. Conclusions: There is a lack of consensus for defining scaphoid malunion on imaging and absence of correlation between findings on imaging and patient outcomes. Future studies defining scaphoid malunion should be appropriately powered, incorporate measures of intrarater and interrater reliabilities for all reported imaging measurements, and utilize validated patient-reported outcome measures to reflect that malunion is associated with inferior outcomes meaningful to patients.

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