scholarly journals Research priorities for lower limb amputation in patients with vascular disease

2021 ◽  
Vol 1 (1) ◽  
pp. 11-16
Author(s):  
DC Bosanquet ◽  
S Nandhra ◽  
KHF Wong ◽  
J Long ◽  
I Chetter ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Lower Limb ◽  
Healthcare Professionals ◽  
Research Priorities ◽  
Consensus Meeting ◽  
Lower Limb Amputation ◽  
Nominal Group ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Specific Research

Introduction: Major lower limb amputation (MLLA) is a life-changing event often associated with high mortality and morbidity rates. Research into MLLA surgery is limited. The Vascular Society of Great Britain and Ireland (VSGBI) in partnership with the James Lind Alliance (JLA) aimed to identify and develop key research priorities for MLLA. Methods: A modified JLA Priority Setting Partnership was undertaken, encompassing all vascular practice. Two separate Delphi processes to identify research priorities were undertaken with healthcare professionals, patients and carers, led by the VSGBI. The priorities were then scored by the same participants and amalgamated to produce a list for final ranking. The final consensus meeting was attended by patients, carers and healthcare professionals from a variety of backgrounds involved in the care of people with MLLA. Using a nominal group technique, a ranked list of the top ten research priorities were identified. Results: A total of 481 clinicians submitted 1,231 research priorities relating to vascular surgery in general. Sixty-three MLLA-specific research priorities were combined into five final priorities. Three hundred and seventy-three patients or carers submitted 582 research priorities related to vascular surgery in general. Nine MLLA-specific research priorities were identified after combining similar priorities. The final consensus meeting produced a ranked top 10 list of research priorities relating to: MLLA prevention, supporting rehabilitation, improving clinical outcomes following MLLA (preventing/treating pain including phantom limb pain and improving wound healing) and research into information provision for patients undergoing MLLA. Conclusions: The top 10 MLLA research priorities provide guidance for researchers, clinicians and funders on the direction of future research questions that are important to both healthcare professionals and patients.

scholarly journals Research priorities for lower limb amputation in patients with vascular disease

2021 ◽  
Author(s):  
David Bosanquet ◽  
Sandip Nandhra ◽  
Kitty Wong ◽  
Judith Long ◽  
Ian Chetter ◽  
...  
Keyword(s):  
Vascular Surgery ◽  
Lower Limb ◽  
Healthcare Professionals ◽  
Research Priorities ◽  
Lower Limb Amputation ◽  
Nominal Group ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Specific Research ◽  
Research Questions

Introduction Lower limb amputation is a life-changing event for patients and can be associated with high mortality and morbidity rates. Research into this critical part of vascular surgery is limited. The Vascular Society of Great Britain and Ireland (VSGBI) in partnership with the James Lind Alliance (JLA) process, aimed to identify and develop key research priorities for amputation. Methods A modified JLA Priority Setting Partnership was undertaken, encompassing all vascular practice. Two separate Delphi processes to identify research topics were undertaken with healthcare professionals, patients and carers, led by the VSGBI. The priorities were then ranked by the same participants and amalgamated to produce a list for final prioritisation. The final consensus meeting was attended by patients, carers and healthcare professionals from a variety of backgrounds involved in the care of people with amputation. Using a nominal group technique, the top ten research priorities were identified. Results A total of 481 clinicians submitted 1231 research questions relating to vascular surgery in general. 63 amputation-specific research questions were combined into 5 final clinical questions. 373 patients or carers submitted 582 research questions related to vascular surgery in general. Nine amputation-specific research questions were identified after combining similar questions. Amalgamating both the clinician and patient questions, 12 questions were discussed at the final prioritisation meeting and the top 10 identified. These related to amputation prevention, supporting rehabilitation, improving clinical outcomes following amputation (preventing/treating pain including phantom limb pain and improving wound healing) and research into information provision for patients undergoing amputation. Conclusion The top 10 research priority areas in vascular amputation provide guidance for researchers, clinicians, and funders on the direction of future research questions that are important to both healthcare professionals and patients.

scholarly journals P90 PERCEIVE: PrEdiction of Risk and Communication of outcome following major lower limb amputation - a collaboratIVE study

BJS Open ◽  
2021 ◽  
Vol 5 (Supplement_1) ◽  
Author(s):  
B Gwilym ◽  
C Waldron ◽  
E Thomas-Jones ◽  
P Pallmann ◽  
R Preece ◽  
...  
Keyword(s):  
Risk Prediction ◽  
Lower Limb ◽  
Health Care Professionals ◽  
Healthcare Professionals ◽  
Demographic Data ◽  
Collaborative Study ◽  
Lower Limb Amputation ◽  
Research Network ◽  
Limb Amputation ◽  
Prediction Tools

Abstract Introduction Major Lower Limb Amputation (MLLA) is a life changing event with significant morbidity and mortality. Inaccurate risk prediction can lead to poor decision making, resulting in delay to definitive surgery, or undertaking amputation when not in the patient’s best interest. We aim to answer: In adult patients undergoing MLLA for chronic limb threatening ischaemia or diabetes, how accurately do health care professionals prospectively predict outcomes after MLLA, and how does this compare to existing prediction tools? Methods A multicentre prospective observational cohort study is being delivered through the Vascular and Endovascular Research Network. Dissemination was via an existing network of contacts and social media. Consecutive data will be collected for seven months from site launch date, including demographic data and pre-operative outcome predictions from surgeons, anaesthetists, and allied healthcare professionals. Follow-up data will comprise 30-day (mortality, morbidity, MLLA revision, surgical site infection, and blood transfusion) and 1-year (mortality, MLLA revision and ambulation). The accuracy of surgeons’ predictions will be evaluated and compared to pre-existing risk prediction scoring tools. Results PERCEIVE launched on 01/10/2020 with 23 centres (16 UK, 7 international) registered to collect data. 50 other centres (27 UK, 23 international) have expressed interest/are pursuing local audit/ethical approval. We aim to collect data on clinicians estimate of outcomes for over 500 patients. Discussion This study will utilise a trainee research network to provide data on the accuracy of healthcare professionals’ predictions of outcomes following MLLA and compare this to the utility of existing prediction tools in this patient cohort.

Psychosocial predictors of long-term adjustment to lower-limb amputation and phantom limb pain

2004 ◽  
Vol 26 (14-15) ◽  
pp. 882-893 ◽  
Author(s):  
Marisol A Hanley ◽  
Mark P Jensen ◽  
Dawn M Ehde ◽  
Amy J Hoffman ◽  
David R Patterson ◽  
...  
Keyword(s):  
Lower Limb ◽  
Phantom Limb Pain ◽  
Lower Limb Amputation ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Psychosocial Predictors ◽  
Limb Pain

Surgical Treatment of Chronic Phantom Limb Sensation and Limb Pain after Lower Limb Amputation

2006 ◽  
Vol 118 (7) ◽  
pp. 1562-1572 ◽  
Author(s):  
Lukas Prantl ◽  
Stephan Schreml ◽  
Norbert Heine ◽  
Marita Eisenmann-Klein ◽  
Peter Angele
Keyword(s):  
Surgical Treatment ◽  
Lower Limb ◽  
Lower Limb Amputation ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Limb Pain

scholarly journals Development of a Multimodal Analgesia Protocol for Perioperative Acute Pain Management for Lower Limb Amputation

2018 ◽  
Vol 2018 ◽  
pp. 1-9 ◽  
Author(s):  
Roberta De Jong ◽  
Alexander J. Shysh
Keyword(s):  
Pain Management ◽  
Lower Limb ◽  
Phantom Limb Pain ◽  
Multimodal Analgesia ◽  
Lower Limb Amputation ◽  
Phantom Limb ◽  
Limb Amputation ◽  
Multiple Sources ◽  
Limb Pain ◽  
Pain Mechanisms

Multimodal analgesia may include pharmacological components such as regional anesthesia, opioid and nonopioid systemic analgesics, nonsteroidal anti-inflammatories, and a variety of adjuvant agents. Multimodal analgesia has been reported for a variety of surgical procedures but not yet for lower limb amputation in vasculopathic patients. Perioperative pain management in these patients presents a particular challenge considering the multiple sources and pathways for acute and chronic pain that are involved, such as chronic ischemic limb pain, postoperative residual limb pain, coexisting musculoskeletal pain, phantom limb sensations, and chronic phantom limb pain. These pain mechanisms are explored and a proposed protocol for multimodal analgesia is outlined taking into account the common patient comorbidities found in this patient population.

scholarly journals Research priorities in children requiring elective surgery for conditions affecting the lower limbs: a James Lind Alliance Priority Setting Partnership

BMJ Open ◽  
2019 ◽  
Vol 9 (12) ◽  
pp. e033233
Author(s):  
Martinique Vella-Baldacchino ◽  
Daniel C Perry ◽  
Andreas Roposch ◽  
Nicholas Nicolaou ◽  
Stephen Cooke ◽  
...  
Keyword(s):  
Priority Setting ◽  
Lower Limb ◽  
Healthcare Professionals ◽  
Research Priorities ◽  
Lower Limbs ◽  
Nominal Group ◽  
Face To Face ◽  
James Lind Alliance ◽  
Research Questions ◽  
Priority Setting Partnership

ObjectiveTo identify and prioritise research questions concerning the elective surgical management of children with conditions affecting the lower limb by engaging patients, carers and healthcare professionals.DesignA modified nominal group technique.SettingUK.Participants388 individuals (29 patients, 155 parents/carers, 204 healthcare professionals) were recruited through hospital clinics, patient charities and professional organisations and participated in the initial prioritisation survey; 234 individuals took part in the interim prioritisation survey. 33 individuals (3 patients, 9 parents/carers, 11 healthcare professionals, 7 individuals representing the project’s steering group and 3 James Lind Alliance (JLA) facilitators) attended the final face-to-face workshop to rank the top 10 research priorities.InterventionsSurveys were distributed using various media resources such as newsletters, internet messaging boards and the ‘Paediatric Lower Limb Surgery Priority Setting Partnership (PSP) website. Printed copies of the questionnaire were also made available to families in outpatient clinics.Outcome measuresSurvey results, top 10 and top 26 priority rankingsResultsThe process took 18 months to complete (July 2017–January 2019); 388 people generated 1023 questions; a total of 801 research questions were classified as true uncertainties. Following the JLA methodology, 75 uncertainties were developed from the initial 801 questions. Twenty six of those were selected through a second survey and were taken to the final face-to-face workshop where the top 10 research priorities were selected. The top10 priorities included questions on cerebral palsy, common hip conditions (ie, Perthes’ disease and developmental dysplasia of the hip) as well as rehabilitation techniques and methods to improve shared decision-making between clinicians and patients/families.ConclusionsThis is the first JLA PSP in children’s orthopaedic surgery, a particularly under-researched and underfunded area. We have identified important research topics which will guide researchers and funders and direct their efforts in future research.

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