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Abstract
SUMMARY As value-based care gains traction in response to towering health care expenditures and issues of health care inequity, hospital capacity, and labor shortages, it is important to consider how a value-based approach can be achieved in plastic surgery. Value is defined as outcomes divided by costs across entire cycles of care. Drawing on previous studies and policies, this article identifies key opportunities in plastic surgery to move the levers of costs and outcomes to deliver higher value care. Specifically, outcomes in plastic surgery should include conventional measures of complication rates and patient-reported outcome measures to drive quality improvement and benchmark payments. Meanwhile, cost reduction in plastic surgery can be achieved through value-based payment reform, efficient workflows, evidence-based and cost-conscious selection of medical devices, and greater use of outpatient surgical facilities. Lastly, the authors discuss how the diminished presence of third-party payers in aesthetic surgery exemplifies the cost-conscious and patient-centered nature of value-based plastic surgery. To lead in future health policy and care delivery reform, plastic surgeons should strive for high-value care, remain open to new ways of care delivery, and understand how plastic surgery fits into overall health care delivery.
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Affiliation(s)
| | | | - Thomas C Tsai
- Boston, MA
- From the Harvard Medical School
- Divisions of General and Gastrointestinal Surgery
- Plastic Surgery, Brigham and Women's Hospital
- Harvard T.H. Chan School of Public Health
| | - Justin M Broyles
- From the Harvard Medical School
- Plastic Surgery, Brigham and Women's Hospital
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2
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Lakshmi A, Vijayan R. Form and function no more? PROMs and the inexorable creep of funding criteria. J Plast Reconstr Aesthet Surg 2024; 88:281-282. [PMID: 38029472 DOI: 10.1016/j.bjps.2023.11.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2023] [Accepted: 11/15/2023] [Indexed: 12/01/2023]
Affiliation(s)
| | - Roshan Vijayan
- East & North Hertfordshire NHS Trust, Lister Hospital, Coreys Mill Lane, Stevenage SG1 4AB, UK
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Choi E, Leonard KW, Jassal JS, Levin AM, Ramachandra V, Jones LR. Artificial Intelligence in Facial Plastic Surgery: A Review of Current Applications, Future Applications, and Ethical Considerations. Facial Plast Surg 2023; 39:454-459. [PMID: 37353051 DOI: 10.1055/s-0043-1770160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/25/2023] Open
Abstract
From virtual chat assistants to self-driving cars, artificial intelligence (AI) is often heralded as the technology that has and will continue to transform this generation. Among widely adopted applications in other industries, its potential use in medicine is being increasingly explored, where the vast amounts of data present in electronic health records and need for continuous improvements in patient care and workflow efficiency present many opportunities for AI implementation. Indeed, AI has already demonstrated capabilities for assisting in tasks such as documentation, image classification, and surgical outcome prediction. More specifically, this technology can be harnessed in facial plastic surgery, where the unique characteristics of the field lends itself well to specific applications. AI is not without its limitations, however, and the further adoption of AI in medicine and facial plastic surgery must necessarily be accompanied by discussion on the ethical implications and proper usage of AI in healthcare. In this article, we review current and potential uses of AI in facial plastic surgery, as well as its ethical ramifications.
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Affiliation(s)
- Elizabeth Choi
- Wayne State University School of Medicine, Detroit, Michigan
| | - Kyle W Leonard
- Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan
| | - Japnam S Jassal
- Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan
| | - Albert M Levin
- Department of Public Health Science, Henry Ford Health, Detroit, Michigan
- Center for Bioinformatics, Henry Ford Health, Detroit, Michigan
| | - Vikas Ramachandra
- Department of Public Health Science, Henry Ford Health, Detroit, Michigan
- Center for Bioinformatics, Henry Ford Health, Detroit, Michigan
| | - Lamont R Jones
- Department of Otolaryngology, Henry Ford Hospital, Detroit, Michigan
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Besmens IS, Zoller FE, Guidi M, Giovanoli P, Calcagni M. How to measure success in lower extremity reconstruction, which outcome measurements do we use a systematic review and metanalysis. J Plast Surg Hand Surg 2023; 57:505-532. [PMID: 36779747 DOI: 10.1080/2000656x.2023.2168274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/14/2023]
Abstract
Different factors have to be considered and weighted in the treatment algorithm of lower extremity reconstruction. A combination of both clinicians' and patients' perspectives is necessary to provide a conclusive picture. Currently, there aren't any standardized and validated measurement data sets for lower extremity reconstructions. This makes it necessary to identify the relevant domains. We, therefore, performed a systematic review and metanalysis of outcome measurements and evaluated their ability to measure outcomes after lower extremity reconstruction. A systematic review and metanalysis according to the 'Preferred Reporting Items for Systematic Reviews and Meta-Analyses' protocol were performed for studies reporting at least one structured outcome measurement of lower extremity reconstruction. Both Patient (PROMs)- and Clinician reported outcome measurements (CROMs)were analyzed. Of the 2827 identified articles, 102 were included in the final analysis. In total 86 outcome measurements were identified, 34 CROMs, 44 PROMs and 8 (9.3%) outcome measurements that have elements of both. Twenty-four measure functional outcome, 3 pain, 10 sensations and proprioception, 9 quality of life, 8 satisfaction with the result, 5 measure the aesthetic outcome, 6 contours and flap stability and 21 contain multidomain elements. A multitude of different outcome measurements is currently used in lower extremity reconstruction So far, no consensus has been reached on what to measure and how. Validation and standardization of both PROMs and CROMs in plastic surgery is needed to improve the outcome of our patients, better meet their needs and expectations and eventually optimize extremity reconstruction by enabling a direct comparison of studies' results.
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Affiliation(s)
- Inga S Besmens
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Florence E Zoller
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Marco Guidi
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Pietro Giovanoli
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Maurizio Calcagni
- Department of Plastic Surgery and Hand Surgery, University Hospital Zurich, University of Zurich, Zurich, Switzerland
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Mallina R, Bamford E, Shelton I, Selby A, Russell P, Johnson N. A Review of Outcome Reporting Practices after Flexor Tendon Repair in Zones 1 and 2. J Hand Surg Asian Pac Vol 2022; 27:226-232. [PMID: 35404198 DOI: 10.1142/s2424835522500357] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Background: Outcome reporting following flexor tendon repair has historically concentrated on range of movement. Recently, there has been an increase in the use of patient-reported outcome measures (PROMs). At present, there is no agreed set of outcomes to report following flexor tendon repair. The aim of this study is to review outcome reporting practices after flexor tendon repair in zones 1 and 2. Methods: A search of Ovid MEDLINE, Ovid EMBASE and Cumulative Index to Nursing and Allied Health Literature (CINAHL) between 1 January 1980 and 31 December 2019 was performed to identify the studies that reported outcomes following the repair of flexor tendons in zones 1 and 2. Study characteristics and data with regard to the reporting of eight outcome domains was extracted: functional outcome (quantitative), functional outcome (subjective), activities of daily living (ADL), satisfaction/quality of life, post-treatment recovery, resources, aesthetics and safety. Results: A total of 94 out of 4,118 articles identified were included in the review. All studies reported range of motion using 17 different methods of measurement. Eleven studies defined measurement methods incorrectly or unclearly. Only 16 studies reported PROMs, with only one reporting data on assessment of quality of life. Eighteen studies reported time away from employment. Minimal data on resource utilisation and aesthetics were included. Conclusion: This review highlights wide heterogeneity and paucity of data reporting clinical outcomes of flexor tendon surgery. The development of a core outcome set that would ensure essential outcomes are correctly defined, measured and reported is required. Level of Evidence: Level IV (Prognostic).
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Affiliation(s)
- Ravi Mallina
- Pulvertaft Hand Centre, University hospitals of Derby and Burton, Derby, United Kingdom
| | - Emma Bamford
- Pulvertaft Hand Centre, University hospitals of Derby and Burton, Derby, United Kingdom
| | - Ian Shelton
- Pulvertaft Hand Centre, University hospitals of Derby and Burton, Derby, United Kingdom
| | - Anna Selby
- Pulvertaft Hand Centre, University hospitals of Derby and Burton, Derby, United Kingdom
| | - Peter Russell
- Pulvertaft Hand Centre, University hospitals of Derby and Burton, Derby, United Kingdom
| | - Nick Johnson
- Pulvertaft Hand Centre, University hospitals of Derby and Burton, Derby, United Kingdom
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Hopkins A, Barry NP, Bowman SRA, Sathasivam S, Kumar RJ, Preketes AP, Dowd MB. Traction splinting (EAVAST protocol) versus operative fixation of proximal phalanx fractures: a comparative study of patient outcomes. AUSTRALASIAN JOURNAL OF PLASTIC SURGERY 2022. [DOI: 10.34239/ajops.v5n1.265] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
Introduction: Phalangeal fractures are common, frequently deformed and unstable, and are regularly managed operatively. However, closed methods of reduction are increasing. This study aimed to compare functional outcomes for a non-operative cohort using a skin traction method developed by the Nepean Hospital, Sydney, Australia, termed ‘early active vector adjustable skin traction’ or EAVAST, compared to operatively managed patients as a potential alternative for the management proximal phalanx fractures.
Methods: A prospective cohort study of patients who underwent operative fixation or traction using the EAVAST protocol between January 2018 and January 2020. Patients were managed on a case-by-case basis by fracture type and mechanism of injury. Functional outcomes were assessed at three months post intervention using total active motion, mean strength and QuickDASH scores. Measurements were conducted by independent clinicians with patients wearing gloves to blind the assessor to signs of intervention.
Results: Of 38 patients identified for inclusion in the study, 15 underwent operative fixation and 23 underwent traction. There were no significant differences found between the two groups for all outcome measures. The mean total active motion, mean strength and QuickDASH scores for the traction and operative groups were 90.8 per cent versus 90.7 per cent (P = 0.97), 84 per cent versus 79 per cent (P = 0.58) and 1.48 versus 2.5 (P = 0.54), respectively.
Conclusions: We found no clinically or statistically significant difference between EAVAST protocol and operative management of proximal phalanx fractures. Future study is now warranted, ideally a multi-centre prospective randomised controlled trial with blinded assessment of outcomes in-cluding a cost–benefit analysis comparing standardised operative and traction techniques.
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Shaw AV, Holmes DG, Rodrigues JN, Lane JC, Gardiner MD, Wormald JC. Outcome measurement in adult flexor tendon injury: A systematic review. J Plast Reconstr Aesthet Surg 2022; 75:1455-1466. [PMID: 35219612 DOI: 10.1016/j.bjps.2021.08.033] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2021] [Revised: 06/27/2021] [Accepted: 08/26/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Defining the optimal, evidence-based management of flexor tendon injury remains challenging. Lack of consensus on which measures to use to assess the outcome of interventions is a key issue, especially with regard to patient-reported outcome measures (PROMs). This systematic review defines the landscape of outcome measurement in studies on interventions for flexor tendon injuries to guide future research. METHODS A PRISMA-compliant systematic review was conducted using bespoke search strategies applied to MEDLINE, EMBASE, PsycINFO, CENTRAL, CINAHL and AMED. A protocol was developed and registered prospectively (CRD42020186780). We identified all studies describing adult patients undergoing interventions for acute hand flexor tendon injuries. RESULTS Of the 4844 studies, 114 studies met the final inclusion criteria for evaluating the outcomes of 8127 participants with 9071 injured digits. Studies included 24 randomised controlled trials, 19 cohort studies and 61 case series. Nine different PROMs were used in 24 studies (22%): three site-specific PROMs, one generic quality-of-life measure and four visual analogue scales. Clinician-reported outcome measures were used in 103 studies (96%), such as the range of motion reported in 102 studies (94%). Adverse outcomes were reported in 96 studies (89%), with the most frequently reported adverse outcomes being tendon rupture and infection. Re-operation was reported in 21 studies (19%). The most frequently reported health economic outcome measure was the length of work absence, reported in ten studies (9%). CONCLUSIONS There is variability in the use of outcome measures used to study interventions for flexor tendon injuries. An independent systematic review of the psychometric properties of the identified outcome measures and a specific multi-stakeholder consensus process may support optimal choice and standardisation for future studies.
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Affiliation(s)
- Abigail V Shaw
- Department of Plastic & Reconstructive Surgery, Oxford University Hospitals NHS Foundation Trust, Oxford, United Kingdom
| | - David Gw Holmes
- Department of Trauma & Orthopaedic Surgery, Leighton Hospital, Crewe, United Kingdom
| | - Jeremy N Rodrigues
- Department of Plastic & Reconstructive Surgery, Stoke Mandeville Hospital, Aylesbury, United Kingdom; Warwick Clinical Trials Unit, University of Warwick, Coventry, CV4 7AL, England.
| | - Jennifer Ce Lane
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Matthew D Gardiner
- Department of Plastic & Reconstructive Surgery, Wexham Park Hospital, Slough, United Kingdom; Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, United Kingdom
| | - Justin Cr Wormald
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Science (NDORMS), University of Oxford, Oxford, United Kingdom
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A Primer for Success as an Early Career Academic Plastic Surgeon. Plast Reconstr Surg Glob Open 2022; 10:e4066. [PMID: 35186625 PMCID: PMC8849379 DOI: 10.1097/gox.0000000000004066] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Accepted: 11/24/2021] [Indexed: 11/26/2022]
Abstract
The early career academic plastic surgeon strives to be an expert surgeon, an innovative researcher, and an impactful educator. Navigating these challenges is difficult in a healthcare landscape with diminishing public research funding, increasing demand from institutions for clinical productivity, and decreased value of surgical education. To help the junior academic plastic surgeon, this article discusses the fundamental aspects of developing an early academic plastic surgery practice, rooted in clinical care, research, and education.
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QuickDASH questionnaire items behave as 2 distinct subscales rather than one scale in Dupuytren's disease. J Hand Ther 2021; 36:228-233. [PMID: 34972605 DOI: 10.1016/j.jht.2021.11.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/17/2021] [Revised: 11/05/2021] [Accepted: 11/13/2021] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN Retrospective cohort BACKGROUND: Exploratory Factor Analysis (EFA) and structural equation modelling (SEM) assess relationships between questionnaire items and the constructs ("factors") measured by a questionnaire. The QuickDASH has not been subjected to these analyses in Dupuytren's disease. PURPOSE To undertake EFA and SEM to identify the factors measured by the QuickDASH in patients with Dupuytren's disease. METHODS We identified 750 cases of surgery for Dupuytren's disease at a single center with preoperative QuickDASH scores. We performed EFA on QuickDASH responses in R, using established methodology. Based on the EFA results, we conducted SEM in a training sample of 200 participants. A test SEM analysis was performed in a second, independent sample of 200 participants. RESULTS EFA suggested a 2-factor model. Items 1-6 measured one factor (we interpreted this as "hand function"), whereas items 9-11 measured a different factor ("hand symptoms"). Items 7 and 8 (social and work activities) did not reflect either of these factors well, and may be influenced by other variables. A structural equation model based on the EFA results, with 2 first-order factors, demonstrated excellent fit in our first SEM sample. This was confirmed with a second independent sample in a test analysis. CONCLUSIONS The QuickDASH PROM may measure 2 distinct factors in patients with Dupuytren's disease. This aligns with previous analyses of the full-length DASH PROM. Separation of the QuickDASH PROM into 2 sub-scales with distinct scores to measure "hand function" and "hand symptoms" may improve its structural validity in patients with Dupuytren's disease.
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Har-Shai L, Ofek SE, Brandstetter A, Cohen KH, Shay T, Amir A, Ad-El DD. Quality of Patient-Reported Outcome Studies Utilizing the BREAST-Q: A Systematic Review. Aesthet Surg J 2021; 41:NP1448-NP1458. [PMID: 33556165 DOI: 10.1093/asj/sjab057] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Patient-reported outcome (PRO) studies are essential in the assessment of surgical procedures in plastic surgery. One accepted and validated questionnaire is the BREAST-Q. OBJECTIVES The aim of this study was to assess the quality of PRO studies in plastic surgery utilizing the BREAST-Q questionnaire. METHODS This study involved 2 steps: (1) a systematic review of 23 key criteria assessing the quality of survey research in studies utilizing the BREAST-Q that were published between 2015 and 2018; (2) a review of current guidance for survey research in journals related to plastic surgery and breast surgery which were included in the systematic review. RESULTS Seventy-nine studies were included in the systematic review. Many key criteria were poorly reported: 51.9% of the studies did not provide a defined response rate and almost 90% did not provide a method for analysis of nonresponse error; 67.1% lacked a description of the sample's representativeness of the population of interest, and 82.3% did not present a sample size calculation. The methods used to analyze data were not described in 11.4% of the papers; in 27.8% the data analysis presented could not allow replication of the results. Of the 16 journals in the fields of plastic surgery and breast surgery for which the "instructions to authors" were reviewed, 15 (93.7%) did not provide any guidance for survey reporting. CONCLUSIONS The majority of key criteria are underreported by authors publishing their survey research in peer-reviewed journals in the fields of plastic and breast surgery. There is an urgent need to construct well-developed reporting guidelines for survey research in plastic surgery, and particularly in breast surgery. LEVEL OF EVIDENCE: 4
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Affiliation(s)
- Lior Har-Shai
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Sar-El Ofek
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | | | - Keren H Cohen
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Tamir Shay
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Avraham Amir
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
| | - Dean D Ad-El
- Department of Reconstructive Plastic Surgery and Burns Unit, Rabin Medical Center—Beilinson Hospital, Petach Tikva, Israel
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Madsen CB, Poulsen L, Jørgensen MG, Lorenzen MM, Tsangaris E, Klassen A, Sørensen JA. Advanced translation and cultural adaption of the LYMPH-Q Upper Extremity Module from English to Danish. EUROPEAN JOURNAL OF PLASTIC SURGERY 2021. [DOI: 10.1007/s00238-021-01890-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Abstract
Background
To better quantify the impact that breast cancer-related arm lymphedema (BCRL) has on health-related quality of life (HR-QOL), a disease-specific patient-reported outcome measure (PROM) is needed. The LYMPH-Q Upper Extremity Module was recently developed for patients with BCRL. The aim of this study was to perform an advanced translation and culturally adapt the LYMPH-Q Upper Extremity Module for use in Denmark.
Methods
The LYMPH-Q Upper Extremity Module was translated into Danish according to the guidelines of the International Society for Pharmacoeconomics and Outcomes Research (ISPOR) and the World Health Organization (WHO). The process included two forward and one back translation, an expert panel meeting, and cognitive debriefing interviews with patients. The focus of the translation was to develop a Danish version that used appropriate patient-friendly language while maintaining the meaning of the items, instructions and response options.
Results
The two forward translations resulted in minor differences in terminology. These discrepancies were discussed among the translators and a harmonized Danish version 1 was achieved. Comparison of the back translation to the original English version identified 14 items/instructions/response options that required re-translation. Subsequently, experts helped to identify and resolve the language for 10 items/instructions/response options that did not maintain the same meaning as the English version. Participants in the cognitive debriefing interviews did not report any difficulties with understanding the items/instructions/response options.
Conclusions
The translation and cultural adaption process led to the development of a conceptually equivalent Danish version of the LYMPH-Q Upper Extremity Module.
Level of Evidence: Not gradable
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Lanfranchi E, Fairplay T, Arcuri P, Lando M, Marinelli F, Pillastrini P, Vanti C. The Italian version of the Unité Rhumatologique des Affections de la Main (URAM) for Dupuytren's disease: The URAM-I(10). HAND THERAPY 2021; 26:91-101. [PMID: 37904881 PMCID: PMC10584047 DOI: 10.1177/17589983211034532] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 07/05/2021] [Indexed: 11/01/2023]
Abstract
Introduction Several general hand functional assessment tools for Dupuytren's disease have been reported, but none of the patient-reported-outcome measures specific to Dupuytren's disease-associated disabilities are available in the Italian language. The purpose of this study was to culturally adapt the Unité Rhumatologique des Affections de la Main (URAM) into Italian (URAM-I) and determine its measurement properties. Methods Cross-cultural adaptation was performed according to the current guidelines. Construct validity (convergent and divergent validity) was measured by comparing the URAM-I with the Pain-Rated Wrist/Hand Evaluation (PRWHE-I), Short-Form 36 (SF-36-I) scale and finger range of motion, respectively. Factor analysis was used to investigate the URAM-I's internal structure. Reliability was assessed by internal consistency (Cronbach's alpha) and test-retest reliability by Intra-Class Correlation Coefficient (ICC). Results This study included 96 patients (males = 85%, age = 66.8 ± 9.3). Due to the cultural adaptation, we divided the original item #1 into two separate items, thus generating the URAM-I(10). Convergent validity analysis showed a strong positive (r = 0.67), significant (p < 0.01) Pearson's correlation with the PRWHE-I. Divergent validity analysis showed a weak, negative (r < 0.3) and not significant correlation with the SF-36-I subscales, except for the physical pain subscale (r = -0.21, p < 0.05). Factor analysis revealed a 2-factor, 4-item solution that explained 76% of the total variance. The URAM-I(10) demonstrated high internal consistency (α = 0.94) and high test-retest reliability (ICC = 0.97). Conclusion The URAM-I(10) demonstrates moderate construct validity, high internal consistency and test-retest reliability, and showed a 2-factor internal structure. Its evaluative use can be suggested for the Italian Dupuytren's population.
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Affiliation(s)
- E Lanfranchi
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - T Fairplay
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Hand Surgery and Hand Rehabilitation, Modena Polyclinic Hospital, Modena, Italy
| | - P Arcuri
- Studio Fairplay - Arcuri - Functional Rehabilitation of the Upper Extremity, Private Practice, Bologna, Italy
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - M Lando
- Department of Hand Surgery and Hand Rehabilitation, Modena Polyclinic Hospital, Modena, Italy
| | - F Marinelli
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - P Pillastrini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
| | - C Vanti
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
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Stiernman M, Klintö K, Persson M, Becker M. Comparison of Corresponding Scores From the Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q in Swedish Patients With Cleft Lip and/or Palate. Cleft Palate Craniofac J 2021; 58:736-745. [PMID: 33047614 PMCID: PMC8165751 DOI: 10.1177/1055665620964124] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
OBJECTIVE The primary aim of this study was to compare corresponding scores between 2 existing cleft-specific patient-reported outcome measures (PROMs)-Cleft Hearing Appearance and Speech Questionnaire (CHASQ) and CLEFT-Q. The second aim of the study was to investigate patient opinion on the 2 PROMs. DESIGN Cross-sectional questionnaire study. SETTING Participants were recruited from a University Hospital. They answered CHASQ and CLEFT-Q either in the hospital or at home. PARTICIPANTS Thirty-three participants with cleft lip and/or palate, aged 10 to 19 years. MAIN OUTCOME MEASURE CHASQ and CLEFT-Q. RESULTS The CHASQ scores and the corresponding CLEFT-Q scores on appearance correlated significantly. Corresponding scores regarding speech did not correlate significantly. A majority, 15 (58%) participants, answered that they liked CLEFT-Q more than CHASQ, 18 participants (69%) thought CHASQ was easier to complete, and 19 (76%) thought CLEFT-Q would better inform health care professionals. CONCLUSION Both instruments showed strengths and limitations. Clinicians will have to consider each instrument's respective qualities when choosing to implement either PROM.
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Affiliation(s)
- Mia Stiernman
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden
| | - Kristina Klintö
- Department of Clinical Sciences in Malmö, Lund University, Sweden
- Department of Otorhinolaryngology, Skåne University Hospital, Malmö, Sweden
| | - Martin Persson
- Department of Health and Society, Kristianstad University, Sweden
| | - Magnus Becker
- Department of Plastic and Reconstructive Surgery, Skåne University Hospital, Malmö, Sweden
- Department of Clinical Sciences in Malmö, Lund University, Sweden
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Atiyeh BS, Abou Ghanem O, Chahine F. Microneedling: Percutaneous Collagen Induction (PCI) Therapy for Management of Scars and Photoaged Skin-Scientific Evidence and Review of the Literature. Aesthetic Plast Surg 2021; 45:296-308. [PMID: 32875437 DOI: 10.1007/s00266-020-01927-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2020] [Accepted: 08/16/2020] [Indexed: 02/06/2023]
Abstract
Demand for safe, less aggressive and cost-efficient treatment modality to improve skin quality and appearance following scarring or photoaging is increasing steadily. A treatment modality that preserves the epidermis while promoting regeneration rather than cicatrization would be ideal. Percutaneous collagen induction (PCI) therapy or microneedling is claimed to approach this ideal objective. The current comprehensive literature review is intended to analyze the scientific basis supporting this therapeutic modality and to evaluate the efficacy of PCI microneedling therapy versus no treatment of patients with photoaged skin and scars of various etiologies on aesthetic skin rejuvenation, skin tightening and scar quality in prospective, retrospective and experimental studies. Twenty-five published studies were identified and included in this review. Four publications are experimental animal studies; most clinical reports are case series or small cohort non-randomized studies or trials lacking methodological unity with a heterogenous mix of scars, wrinkles and skin laxity being treated. The majority are studies about management of scars of various etiologies while only 4 specifically investigated the effect of PCI on wrinkles and aging skin. One study compared burn scar erythema in the treated area to the untreated area, and 5 studies included histologic evaluation of biopsies. Despite PCI promising therapeutic benefits and its increasing cosmetic applications, the current literature review unfortunately revealed a limited number of high-quality studies mostly experimental. Data and conclusions of clinical studies must be carefully interpreted before translating the evidence presented into clinical recommendations. LEVEL OF EVIDENCE IV: This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .
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Affiliation(s)
- Bishara S Atiyeh
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Odette Abou Ghanem
- Division of Plastic and Reconstructive Surgery, American University of Beirut Medical Center, Beirut, Lebanon
| | - Fadl Chahine
- Plastic and Reconstructive Surgery, Trad Hospital and Medical Center, Beirut, Lebanon.
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15
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Dobbs TD, Ottenhof M, Gibson JAG, Whitaker IS, Hutchings HA. The Patient-Reported Outcome Measures In Skin Cancer Reconstruction (PROMISCR) study: Anglicisation and initial validation of the FACE-Q Skin Cancer Module in a UK cohort. J Plast Reconstr Aesthet Surg 2020; 74:615-624. [PMID: 33127351 DOI: 10.1016/j.bjps.2020.09.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Revised: 01/09/2020] [Accepted: 09/30/2020] [Indexed: 11/25/2022]
Abstract
Facial skin cancer is common, and its treatment affects patient's health-related quality of life (HRQoL), as demonstrated by patient-reported outcome measures (PROMs). In this study, we anglicise and validate the novel FACE-Q Skin Cancer Module for the UK population. Anglicisation of the FACE-Q Skin Cancer Module followed international guidance for cross-cultural adaptation. Cognitive interviews were performed, producing a reconciled and harmonised version for validation. Patients undergoing facial skin cancer excision were prospectively recruited and asked to complete the anglicised FACE-Q Skin Cancer Module, along with the Skin Cancer Index (SCI) and European Quality of Life-Five Dimensions (ED-5D) questionnaire, pre-operatively and 6-8 weeks post-operatively. Data were analysed using classical test theory. Ethical approval was obtained (REC: 16/WM/0445). One hundred and ten patients were recruited between August 2017 and July 2018. Internal consistency was high (Cronbach's alpha 0.867-0.967). All subscales had a single-factor solution using principal component analysis. Construct validity, as measured between the FACE-Q subscales and SCI subscales, was good, with >75% of a priori predictions confirmed. Pearson's r for item-total correlation was >0.80 for several items, and significant ceiling effects are shown in 7 of the 10 subscales, suggesting some item redundancy. The UK version of this well-designed PROM demonstrates good face and construct validity. There is however a degree of redundancy within the scales, and further work using Rasch analysis on a larger sample will help address this.
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Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK.
| | - Maarten Ottenhof
- Department of Plastic, Reconstructive and Hand Surgery, Catharina Hospital, Eindhoven, the Netherlands; Patient-Reported Outcomes, Value and Experience (PROVE) Centre, Department of Surgery, Brigham and Women's Hospital, Boston, MA, USA; Department of Surgery, Harvard Medical School, Boston, MA, USA
| | - John A G Gibson
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute Of Life Sciences, Swansea University Medical School, Swansea, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Swansea, UK
| | - Hayley A Hutchings
- Health Services Research, Patient & Population Health & Informatics Research Group, Institute of Life Sciences 2, Swansea University Medical School, Swansea, UK
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16
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Fledderus A, Franke C, Eggen C, van Etten-Jamaludin F, van der Horst C, Brinkmann S, Spuls P. Outcomes and measurement instruments used in congenital melanocytic naevi research: A systematic review. J Plast Reconstr Aesthet Surg 2020; 73:703-715. [DOI: 10.1016/j.bjps.2019.11.023] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2019] [Revised: 08/21/2019] [Accepted: 11/22/2019] [Indexed: 11/28/2022]
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17
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Ishak A, Rajangam A, Khajuria A. The evidence-base for the management of flexor tendon injuries of the hand: Review. Ann Med Surg (Lond) 2019; 48:1-6. [PMID: 31660149 PMCID: PMC6806617 DOI: 10.1016/j.amsu.2019.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2019] [Revised: 09/30/2019] [Accepted: 10/06/2019] [Indexed: 11/27/2022] Open
Abstract
There is no consensus on the optimal flexor tendon repair technique at each anatomical flexor zone. There is paucity of high quality evidence. Heterogenous study designs limit inter-study comparisons. Patient reported outcome measures are crucial but there is a perennial need for robust disease-specific tools to be utilised.
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Affiliation(s)
- Athanasius Ishak
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS), King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Akshaya Rajangam
- Faculty of Life Sciences and Medicine, Centre for Human and Applied Physiological Science (CHAPS), King's College London, Strand, London, WC2R 2LS, United Kingdom
| | - Ankur Khajuria
- Department of Plastic Surgery, St Thomas' Hospital, London, UK.,Kellogg College, University of Oxford, Oxford, UK
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18
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Randall RM, Balch Samora J, Shannon C, Humbyrd CJ. Ethical Considerations in Limb Lengthening and Deformity Correction: Do Aesthetics Matter? J Bone Joint Surg Am 2019; 101:1428-1431. [PMID: 31393437 DOI: 10.2106/jbjs.19.00068] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Affiliation(s)
- Rachel M Randall
- Department of Orthopaedics, Nationwide Children's Hospital, Columbus, Ohio
| | - Julie Balch Samora
- Department of Orthopaedics, Nationwide Children's Hospital, Columbus, Ohio.,Department of Orthopaedics, The Ohio State University, Columbus, Ohio
| | - Claire Shannon
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland
| | - Casey Jo Humbyrd
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland.,Berman Institute of Bioethics, The Johns Hopkins University, Baltimore, Maryland
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19
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Site-specific Patient-reported Outcome Measures for Hand Conditions: Systematic Review of Development and Psychometric Properties. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 7:e2256. [PMID: 31333975 PMCID: PMC6571349 DOI: 10.1097/gox.0000000000002256] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 03/18/2019] [Indexed: 12/26/2022]
Abstract
Background There are a number of site-specific patient-reported outcome measures (PROMs) for hand conditions used in clinical practice and research for assessing the efficacy of surgical and nonsurgical interventions. The most commonly used hand-relevant PROMs are as follows: Disabilities of the Arm, Shoulder and Hand (DASH), QuickDASH (qDASH), Michigan Hand Questionnaire (MHQ), Patient Evaluation Measure (PEM), Upper Extremity Functional Index (UEFI), and Duruoz Hand Index (DHI). There has been no systematic evaluation of the published psychometric properties of these PROMs. Methods A PRISMA-compliant systematic review of the development and validation studies of these hand PROMs was prospectively registered in PROSPERO and conducted to assess their psychometric properties. A search strategy was applied to Medline, Embase, PsycINFO, and CINAHL. Abstract screening was performed in duplicate. Assessment of psychometric properties was performed. Results The search retrieved 943 articles, of which 54 articles met predefined inclusion criteria. There were 19 studies evaluating DASH, 8 studies evaluating qDASH, 13 studies evaluating MHQ, 5 studies evaluating UEFI, 4 studies evaluating PEM, and 5 studies evaluating DHI. Assessment of content validity, internal consistency, construct validity, reproducibility, responsiveness, floor/ceiling effect, and interpretability for each PROM is described. Conclusions The psychometric properties of the most commonly used PROMs in hand research are not adequately described in the published literature. DASH, qDASH, and MHQ have the best-published psychometric properties, though they have either some poor psychometric performance or incompletely studied psychometric properties. There are more limited published data describing the psychometric properties of the UEFI, PEM, and DHI.
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20
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Objective and Patient-reported Assessments of Skin Grafts and Keystone Flaps-A Pilot Retrospective Cohort Study. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2019; 6:e2024. [PMID: 30881809 PMCID: PMC6414100 DOI: 10.1097/gox.0000000000002024] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2018] [Accepted: 09/21/2018] [Indexed: 11/29/2022]
Abstract
Background: The keystone perforator island flap provides a versatile form of reconstruction. Perceived benefits include better donor-recipient color match, less contour defect, and fewer complications. To date, there has been no high-quality evidence comparing keystone flaps to split-thickness skin grafts (SSG) from both a qualitative and quantitative point of view. Methods: The Objective and Patient Reported Assessments of Skin grafts versus Keystone flap cohort study compares keystone flaps with SSGs for the reconstruction of skin cancer defects. Patient-reported outcome measures were collected using the EuroQol 5 dimension scale and Patient and Observer Scar Assessment Scale (POSAS) questionnaires. Objective assessments of skin quality were assessed with the Courage and Khazaka system. Cost analysis was also performed. Results: Thirty-eight patients were studied: 20 keystone flaps and 18 SSGs. The keystone group had higher EuroQol 5 dimension scale scores (keystone median = 1.0; SSG median = 0.832; P = 0.641) indicating better general quality of life and lower POSAS scores indicating better disease/condition specific quality of life (keystone mean = 27.7; SSG mean = 35.7; P = 0.323). Observer POSAS scores were significantly lower in the keystone group compared with the SSG group (keystone mean = 10.889; SSG mean = 17.313; P < 0.001). Preservation of sensation was significantly better in keystone flaps (P = 0.006). There was an average £158/$207 (15%) saving when performing a keystone flap. Conclusion: This pilot study demonstrates a number of possible benefits of keystone flaps over SSGs. The results demonstrate the need for further research comparing these reconstructive options. We propose a prospective, controlled study using the methods developed in this pilot study.
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21
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Abstract
Dupuytren's disease (DD) is a common fibrotic disorder of the hand and can significantly impair hand function. Although the exact pathogenesis of this disorder remains to be elucidated, immunological, genetic and cellular factors likely interact. In this review, we summarise recent advances in the understanding of DD pathogenesis and look to the future for potential novel therapeutic targets. In addition, we discuss the therapeutic options in DD with a focus on the need for more rigorous evidence to allow a meaningful comparison of different treatment modalities.
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Affiliation(s)
- Thomas Layton
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
| | - Jagdeep Nanchahal
- The Kennedy Institute of Rheumatology, Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Oxford, UK
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22
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Geoghegan L, Dobbs TD, Rodrigues JN. PART 2: Can improvement in outcome measurement in plastic surgery be achieved in today's health systems? J Plast Reconstr Aesthet Surg 2019; 72:366-368. [PMID: 30660465 DOI: 10.1016/j.bjps.2018.07.042] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Accepted: 07/29/2018] [Indexed: 11/16/2022]
Affiliation(s)
- Luke Geoghegan
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK
| | - Thomas D Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Jeremy N Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK.
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23
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Dobbs TD, Rodrigues J, Hart AM, Whitaker IS. Improving measurement 1: Harnessing the PROMise of outcome measures. J Plast Reconstr Aesthet Surg 2019; 72:363-365. [PMID: 30655241 DOI: 10.1016/j.bjps.2018.12.040] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2018] [Revised: 11/18/2018] [Accepted: 12/21/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
| | - Jeremy Rodrigues
- Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences, University of Oxford, Botnar Research Centre, Nuffield Orthopaedic Centre, Windmill Road, Oxford, UK.
| | - Andrew M Hart
- Canniesburn Plastic Surgery Unit, Glasgow Royal Infirmary, North Glasgow University Hospitals NHS Trust, Glasgow, UK
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Swansea, UK
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25
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Dobbs TD, Hughes S, Mowbray N, Hutchings HA, Whitaker IS. How to decide which patient-reported outcome measure to use? A practical guide for plastic surgeons. J Plast Reconstr Aesthet Surg 2018; 71:957-966. [PMID: 29656898 DOI: 10.1016/j.bjps.2018.03.007] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Revised: 02/27/2018] [Accepted: 03/10/2018] [Indexed: 01/23/2023]
Abstract
The use of patient-reported outcome measures (PROMs) is increasing across all medical specialties, as their importance to patient care is validated. They are likely to play a particularly important role in plastic and reconstructive surgery where outcomes are often subjective, and the recent guidance from the Royal College of Surgeons of England advising their use in cosmetic surgery highlights this. To drive their routine use across our specialty, it is important that clinicians are capable of understanding the often complex and confusing language that surrounds their design and validation. In this article, we describe the process of PROM design and validation, and we attempt to 'demystify' the language used in the health outcome literature. We present the important steps that a well-designed PROM must go through and suggest a straightforward guide for selecting the most appropriate PROMs for use in clinical practice. We hope that this will encourage greater use of PROM data across plastic and reconstructive surgery and ultimately help improve outcomes for our patients.
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Affiliation(s)
- Thomas D Dobbs
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Singleton Campus, Swansea, SA2 8PP, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, UK.
| | - Sarah Hughes
- Health Services Research, Institute of Life Sciences, Swansea University Medical School, Singleton Campus, Swansea, SA2 8PP, UK; Princess of Wales Hospital, Abertawe Bro Morgannwg University Health Board, Coity Road, Bridgend, CF31 1RQ, UK
| | - Nicholas Mowbray
- Health Services Research, Institute of Life Sciences, Swansea University Medical School, Singleton Campus, Swansea, SA2 8PP, UK
| | - Hayley A Hutchings
- Health Services Research, Institute of Life Sciences, Swansea University Medical School, Singleton Campus, Swansea, SA2 8PP, UK
| | - Iain S Whitaker
- Reconstructive Surgery & Regenerative Medicine Research Group, Institute of Life Sciences, Swansea University Medical School, Singleton Campus, Swansea, SA2 8PP, UK; Welsh Centre for Burns and Plastics, Morriston Hospital, Heol Maes Eglwys, Morriston, Swansea, SA6 6NL, UK
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